Speech Pathology Interviews: Real Career Stories from 5 Practicing SLPs

Written by Sarah Keller, Last Updated: November 20, 2025

Choosing a career in speech-language pathology means entering a field with remarkable diversity. You can work with toddlers or elderly patients, in schools or hospitals, focusing on feeding disorders or neurological rehabilitation. The career possibilities are vast, but what’s it really like day-to-day?

We sat down with five practicing speech-language pathologists who’ve built careers across different specializations and settings. Their experiences span pediatric feeding therapy in NICUs, school-based services for children with autism, clinical work in nursing homes and hospitals, telepractice, and international humanitarian missions. Each brings a unique perspective on the challenges, rewards, and realities of working in this field.

Alyssa Conger: Pediatric SLP & TAASLP President

Alyssa Conger is the president of the Tennessee Speech Hearing Association (TAASLP), the state’s premier professional association representing audiologists, speech-language pathologists, and their valued clients. Under Alyssa’s leadership, TAASLP promotes professionalism, advocacy, education, and networking and serves as a resource for both practitioners and the public.

Since graduating from Tennessee State University (TSU) with her master’s in Speech and Hearing Science in 2012, her passion for helping those afflicted with communication disorders has only grown through her professional practice, which has involved working everywhere from the public school system to the Cookeville Regional Medical Rehab Center to working with individual clients through telepractice.

She is exceptionally dedicated to her pediatric clientele, including children with autism spectrum disorder. In her free time, she actively campaigns for the SLP profession, raising awareness and driving change on local legislative issues.

Q: Before I start firing off questions, I’d like to learn more about you. Can you provide a brief background on your official title, job description, areas of specialization, place of employment, etc.?

Alyssa: My name is Alyssa Conger, and I am a speech-language pathologist (SLP) in Tennessee. I work at Cookeville Regional Medical Center Outpatient Rehabilitation, where I serve the pediatric population. I’ve worked in this facility for the past 2-plus years. I also have experience in public schools and in the exciting world of telepractice.

Q: Tell us more about telepractice and what makes it such an exciting medium for providing SLP services?

Alyssa: Telepractice uses video conferencing between the therapist and the patient so that patients who might not have access to speech-language therapy can receive those services no matter where they are.

Speech-language pathologists can work with patients in any state across the country from the comfort of home, as long as they are licensed in the state in which the client lives. I know speech-language pathologists who have licenses in multiple states, precisely for this reason.

Q: What initially sparked your interest in speech-language pathology?

Alyssa: In 20,03 I contracted viral encephalitis, and I was unable to speak for a short period of time. During that time, I was in horrible pain but had no way to communicate this to others. After I fully recovered, I decided to change my career.

I had a passion to help others from a very early age. A childhood friend of mine taught me the sign language alphabet when I was in 3rd grade, and I really wanted to teach deaf children. Later, when I found speech-language pathology, I knew this career was for me.

Q: What kind of formal education/training did you acquire before employment? Did the education/training you received adequately prepare you for the realities of working in telepractice?

Alyssa: I obtained my master’s degree from Tennessee State University (TSU). The graduate program I attended adequately prepared me for all areas of the field, and the clinical fellowship experience was extremely valuable. It’s nearly impossible to learn about everything I have encountered in practice through graduate school alone.

I have had many mentors along the way who have helped shape me into the clinician that I am today. I was fortunate to have access to multidisciplinary teams at the school, including occupational, behavioral, and physical therapists. The individuals from these professions provided some valuable input that I continue to use today. For example, the occupational therapists I worked with taught me about sensory integration and the need for some children to follow a sensory diet to be successful in the classroom and in therapy. They also taught me the importance of using visual supports, such as visual schedules, to help children follow the expected routine during treatment. Behavioral therapists helped me understand why children behave in specific ways and how to shape behavior in the moment based on the child’s needs.

Most importantly, I learn from my clients. I learn something new from them every day, which is why I love my job. The children I work with challenge me to learn more.

Q: Working with children must be challenging. Why did you decide to work in pediatrics?

Alyssa: I love the energy of children. Children are resilient in many ways, and I love seeing them grow and change. When children start therapy as “a hot mess ” about their language abilities or articulation errors, and I know the progress that they make, I feel like I’m changing their future. Without therapy, they could easily be overlooked as a child who just doesn’t get it or as a child who cannot be understood when they speak.

When they make progress and I see the excitement and the confidence radiating from them, it is an entirely overwhelming experience. On the flip side, working with children is challenging at times. I’ve seen some meltdowns that would make even the most patient person want to run out of the room. I’ve had days when I may not see the progress I wish I could see. In my experience, the good far outweighs the bad, and I could not imagine working with any other population.

Q: Describe a typical workday for us. We’d love to hear details!

Alyssa: I typically start my day between 8:00 and 8:45, and I see patients until approximately 5:00 p.m., Monday through Thursday. I see between 10 and 13 children individually during the day, working with children who need help pronouncing words correctly and who have receptive or expressive language disorders. This means that a child either does not understand language concepts or cannot express themselves appropriately. Some children have difficulty with both areas of language.

I also see children with cognitive impairments. Children with autism spectrum disorder make up much of my caseload. Their difficulties with language can include receptive, expressive, and/or social language use. Because play is a child’s first experience with language, it is a big part of what we do. Playing with children enables me to label vocabulary for them, such as pictures on puzzle pieces, shapes, colors, and numbers. This also encourages them to repeat the labels I provide.

Children with articulation issues (pronunciation) are a little different. Because drill and repetition are essential elements of this type of therapy, they usually work to earn playtime or a turn in a game. At the end of the day, or during breaks throughout the day, I interpret the data collected during the sessions and document the treatments.

Q: Do you think academic institutions are keeping up with the changing trends within the SLP community?

Alyssa: All academic institutions are accredited through our national organization (ASHA). ASHA has stringent guidelines for becoming accredited and maintaining accreditation. I can’t speak for every institution, but the students I have encountered are well prepared and knowledgeable about current practices in our field.

Q: How important is technology to your profession? In what ways does it help or hinder client outcomes?

Alyssa: I use technology every day. I have speech and language development apps on my iPad. However, because so many children spend way too much time on screens, the majority of our playtime is with toys and games. Many children don’t know how to play with toys appropriately, but they can swipe through the screen of a device to find a preferred app in a matter of seconds.

Q: What is the hardest part of your job? What can be done to make it easier?

Alyssa: The most challenging part of my job is documentation. I enjoy working with even the most difficult children, but at the end of the day, when I’ve given every ounce of energy to them, it’s difficult to muster the energy to complete the required paperwork.

Unfortunately, the state and federal governments require this documentation, but there is not much I can do to avoid it.

Q: What are the most significant rewards that come with the work you do? Do the rewards outweigh the challenges?

Alyssa: The biggest reward is seeing the look on a parent’s face when their child says “Mama” for the first time or says any first word. Hearing a child produce a speech sound they previously could not and seeing the pride on their face is priceless. Watching a child use a speech-output device to request a toy or treat, and seeing their eyes light up when they get the desired item for the first time, is also priceless.

The rewards far outweigh the challenges. My feelings at the end of the day are exhaustion mixed with pure joy. I love what I do.

Q: What has been your most memorable moment working as an SLP?

Alyssa: There are many to choose from, but I think my first most memorable moment is when I received a letter from a parent thanking me for giving her daughter a voice. Her child’s speech was hard to understand, and at times this created frustration within the family. She rarely defended herself to her sister during disagreements. After this, the little lady began speaking more freely; she was able to protect herself and communicate a variety of emotions she had previously been unable to express.

Q: That definitely sounds like a complex case. What has been your most challenging case to date? How did you approach it?

Alyssa: My most challenging cases typically involve behavioral issues, which can be attributed to some disorders. There was a child who would not follow directions during our sessions. He ran around the room, opening the closet door and dragging out toys, etc. I allowed him to bring out one or two toys, and then I shut the closet door and brought out my token board. I explained that he could play with either toy as long as he earned the five tokens first. This worked: he completed the tasks I needed and earned his reward.

The best part was the look on his mother’s face. She couldn’t believe how well a simple board with five pennies could wrangle her little angel. I call it “kryptonite.” Most children will cooperate for a chance to earn something, especially if they can see the progress they are making.

Q: How do you cope with the stresses of working in the SLP field? Do you find comfort in your coworkers?

Alyssa: I stay VERY BUSY and so do my coworkers. I don’t really find my job itself stressful; it’s the sheer magnitude of clients that I see in a day and the paperwork that can feel overwhelming at times. My coworkers are in the same boat, though, so we do find ourselves bouncing ideas off one another to streamline our workload. I’m blessed to work with amazing people and have my supervisor’s full support.

Q: It must be incredible to be the president of the Tennessee Association of Audiologists and Speech-Language Pathologists (TAASLP). Which of the TAASLP’s accomplishments are you the proudest of?

Alyssa: My position is voluntary, but I see my role as president as one of my highest accomplishments. I love the opportunity to represent our association and help new graduates navigate the licensing process. I have enjoyed meeting new people and networking with others in our field, especially at our annual convention. I enjoy getting involved with legislative issues as well.

Q: Whoa. That sounds exciting! What kind of legislation issues do you get involved in?

Alyssa: The biggest legislative issue we are fighting right now in our state involves the professional privilege tax that speech pathologists and audiologists are required to pay. Other professionals, such as doctors and lawyers, are required to pay the tax as well, but our income is not equivalent to theirs, and we have been fighting this issue for some time. Hopefully, we will be successful in the near future.

No other state in the union has a tax similar to ours or as expensive, and no other state requires SLPs to pay a professional privilege tax.

Q: How do you measure your own success? In what ways could you become more successful?

Alyssa: I measure my success one child at a time. When I can observe the hard work manifest in their communication, I feel successful. I usually think successfully many times a day, which is why my career is the best. I’m sure that there is always room for improvement, but I feel successful every day.

Q: How does your professional success affect your personal life?

Alyssa: On a personal level, I feel that becoming an SLP has made me a better parent, a more patient one for sure. I also think I have greater compassion for people in general, especially for moms who are in the midst of toddler tantrumhood. I have difficulty at times balancing work and life because I love my career so much, but I am trying to improve at managing both.

Q: What advice do you have for students interested in becoming future SLPs?

Alyssa: Do it… Graduate school is hard, but it’s worth it, so keep your eyes on the prize!!

This career is in high demand and will remain so for years to come. I doubt you will ever need to worry about finding a job.

Dr. Paul Fogle: Educator, Author & International Humanitarian

Dr. Paul T. Fogle has been a Speech-Language Pathologist since 1971. He earned his BA and master’s in Speech Pathology and Audiology at California State University and his Ph.D. at the University of Iowa. He has extensive experience with children and adults with neurological disorders, attention deficit disorders, auditory processing disorders, stuttering, voice disorders, and cleft palate. He also has experience working in acute, sub-acute, and convalescent hospitals.

He is a retired professor emeritus who has authored several textbooks, many of which current SLP students are likely to recognize: Foundations of Communication Sciences and Disorders, Counseling Skills for Speech-Language Pathologists and Audiologists (co-written with Lydia Flasher, PhD), and his newest textbook: Essentials of Communication Sciences and Disorders, 2nd Edition.

In addition to running a private practice, Dr. Fogle contributes new literature to the field and shares his findings and insights with the SLP community through seminars and workshops. Dr. Fogle’s career has taken him around the world with conferences, workshops, and Rotary International humanitarian missions, most recently to Romania. He has also served as an expert witness in forensic speech-language pathology in medical-legal cases since 1987.

Q: Dr. Fogle, can you start by talking about how you became interested in being a speech-language pathologist?

Dr. Fogle: Yes, certainly. Like many speech-language pathologists, I did not go into college thinking about becoming a therapist. I was actually a biology major and was going to follow in the footsteps of my high school biology teacher, Mr. Rex Fischer. I was taking courses in biology, enjoying courses in zoology and animal science, but I didn’t actually want to be studying biology as much.

Then I was taking a course in education on how to become a teacher, , and the professor mentioned something about speech therapy, which I’d never hearof beforere. It sounded interesting, so the next semester I took the introductory course, liked it a lot, did well, and changed my major at the end of my junior year.

I sometimes tell people that we never know what we may say to someone or what we may hear someone say that can actually change our lives. That teacher in the education class changed my life, and it actually changed a lot of other people’s lives after that.

Q: It was something about the people in the speech language pathology field that attracted you to the profession and to change your major?

Dr. Fogle: Yes, very much. I’ve always found speech-language pathologists to be very warm and caring people. As I used to tell my students: the women in speech pathology are the kinds of women who men can bring home to their mothers, and the kinds of men in speech pathology are the kinds of men that women can bring home to their fathers.

Interestingly enough, nationwide in the US and around the world, 95 percent of all speech-language pathologists are women, while 5 percent are men.

Q: Do you have any explanation for why that might be?

Dr. Fogle: My students used to ask me, “Why are there not more men?” I used to say that I think most men don’t have enough of two essential qualities to be a good speech-language pathologist. One characteristic is patience, and the other is sensitivity.

Sensitivity is significant in this kind of work because we need to be very aware of the nuances – the emotional and social effects of the disorders we work with.

Q: Can you talk about how you made the transition between your education and the professional field?

Dr. Fogle: I earned my bachelor’s degree in 1970 after taking the introductory course in speech language pathology, anatomy and physiology, phonetics, child development, and speech language development; all the regular classes that you will be taking in your undergraduate work. I began my master’s degree in 197,1one and that year completed all the courses for it: one dissertation, 197,1 treatment.

In my first two years after my master’s, I focused on the treatment and education of children – actually, adolescents – with neurological disorders. Brain damage, actually, from head traumas, gunshot wounds, beatings, sledding accidents, and others who had neurological disorders for which we didn’t know the causes, but they had speech, language, and cognitive disorders.

I did that for two years. But during that time, I was also doing a lot of extra work to learn as much as I could.

I was training at UCLA with adult stutterers, and I also worked on Wednesday afternoons at Los Amigos hospital in Los Angeles, doing human brain autopsies – that was very interesting work every Wednesday for three years, actually.

Q: As a speech language pathologist, it sounds like you can have a wide range of work settings. I’m sure you have some interesting anecdotes from those different places where you’ve worked. Can you talk about the range of work settings where a speech-language pathologist could work?

Dr. Fogle: Yes, happy to. I should mention that I began my doctoral work at the University of Iowa in 1973 and completed it in 1976. I specialized in neurological disorders in adults and children, as well as stuttering. I’ve always very much enjoyed working in those areas.

Our profession allows us to work in many different areas. There are some statistics on that:

• About 53 percent of therapists – speech language pathologists and speech therapists – work in public schools.
• About 16 percent work in hospitals of different types: acute care, sub-acute, and convalescent.
• About 13 percent work in non-residential care facilities, such as outpatient clinics and rehabilitation centers.
• About 10 percent work in residential care facilities.
• About five percent work in colleges and universities.

We do work in quite a variety of areas, and what is nice is that we can change. Many therapists start off working in the schools and decide they want to work in a hospital. Then they go back for more training, brush up on some things, take continuing education courses, and go into hospitals.

Or vice-versa. Some therapists start working in hospitals, then decide they’d like to work in schools, and they can do that as well. We do go back and forth a little bit.

Q: Compared with lots of professions, you can really make it so there’s never a dull moment. You have a wide range of courses and educational options to choose from when you’re first starting in school, and you also mentioned continuing education.

Dr. Fogle: Yes, we do learn a lot. One of the things that often surprises students who are first entering this education is how many areas we need to know about.

As I mentioned, we cover everyday speech and language development, child development, anatomy and physiology, neurology, phonetics, language disorders, articulation disorders, voice disorders, cleft lip and palate, neurological disorders, and we learn a lot about audiological and hearing disorders; we have quite an extensive background in education.

One of the nice things about this profession is that we learn not only about speech pathology but also a lot about education in general, which helps us later on as adults, especially as parents. And we also learn a lot about the medical field,, which allows usnavigateh the medical system if we need to for our own personal needs.

Q: That’s very interesting. I don’t want to get too far away from something you alluded to. You mentioned some interesting stories. For example, did you work with someone who had a sledding accident?

Dr. Fogle: Yes, I remember him very well. His name was Michael.

Michael was in my classroom for children who had neurological disorders – this was right after my master’s degree in 1971.

Michael was in a sledding accident with his scout troop, who were on a day-long snow trip. He was going down the hill on his sled and hit his head on a tree. He suffered some severe brain damage: he lost his ability to speak, his ability to understand, and he also had a lot of cognitive and learning problems. Before the accident, he did very well in school; he had no learning difficulties; he was an excellent communicator; he played Little League baseball; and he was a normal boy.

I worked with him during those years, and he made some gains. Interestingly enough, his mother asked me to speak to his Boy Scout troop one evening. He was having some difficulties with them because the boys didn’t understand what had happened to him, and neither did the scout troop.

So one evening I went to the Boy Scouts meeting and Michael was there dressed in his full Boy Scouts uniform – he knew I was going to be talking about him – and I explained a lot about the problems he was having.

I answered a lot of questions, and I could see the other scouts and the scout master were developing some extra empathy and sympathy – mainly empathy – for Michael, and they better understood his problems.

That was really important. One thing we need to realize is that, as therapists, we need to step out of our regular work setting and sometimes go to people’s homes or other places where we can make a real difference in a person’s life.

Q: That sounds like a significant anecdote for highlighting the personal impact you can have on each person’s life with whom you work.

Dr. Fogle: Thank you. I should mention that in all of our work, no matter what kind of disorder we’re working with – a child or an adult with an articulation disorder, a language disorder, a voice disorder, cleft lip/palate, stuttering, neurological disorders, hearing disorders – there’s always an emotional and social impact on the person and the family.

As therapists, we need to address those and work with people in those areas.

Q: Yes, you need to treat the individual, but there are also social aspects that you have to take into consideration.?

Dr. Fogle: Definitely. And with that in mind, I always like to encourage students to take as many psychology courses as they can. And, if at all possible, to take classes in marriage, family, and child counseling.

I went back to school, earned my doctoral degree, and trained in marriage and family counseling, counseling psychology, educational counseling, and clinical psychology, to better understand people’s psychological and emotional needs and how to work with them.

Q: That’s very interesting. So you would almost come from the standpoint that a speech-language pathologist needs a solid grounding in psychology as well?

Dr. Fogle: Absolutely.

Q: On a slightly different subject, I was wondering if you have anything to say about prospective speech-language pathologists who have accents or dialects. Do they have to worry about anything?

Dr. Fogle: That’s a good question for someone who has an accent or dialect because they were born or raised in some other country, if their home language is different from the basic educational language taught in school, wherever that may be in any place in the world.

According to the American Speech-Language-Hearing Association, an accent or dialect should not interfere with learning and communication as long as a student can learn the information and communicate with clients, patients, and family members. When working with a child or adult who has some articulation problems, the accent or dialect must not interfere with producing the correct sounds for the language being used or its structure.

If a student comes in with a dialect or accent, that usually should not be a problem.

Q: I’m sure many prospective students will be glad to hear that. Speaking of accents, what about you and how your career as a speech language pathologist has brought an opportunity for you to participate in a lot of international work?

Dr. Fogle: It’s interesting that when I was a student, I was a normal student. I was nervous, and sometimes scared. Can I do well in the courses? When I’m doing clinical work, will my clients like me? When I’m working in hospitals, will my patients like me?

I think most speech pathologists, like most other students, will wonder, “Can I do this?” Can I make it?

I did, and I was also surprised to find that there are so many more opportunities, even at the international level, than I had imagined. I’ve been invited to join different organizations – one was the Flying Doctors – and I was sent to Mexico as a speech pathologist with a team of medical professionals – surgeons, anesthesiologists, nurses, and so on – to work at a clinic for children with cleft lips and palates.

In 2008, I was asked by Rotary International to be on their rotoplast mission – that is, plastic surgery – to Venezuela, and that was a two-week mission. It was very intense, working 12 to 14 hours a day, with one day off: Sunday.

In 2010, I was sent to Egypt. It was the same kind of work environment – always very challenging. In 2011, I was sent to India to work with cleft lips and palates. I’d see maybe 150 children and adults with cleft lips and palates over two weeks.

Then, in 201,4, Rotary International sent me to Romania to work at a clinic for autistic children. In October of 2017, they sent me back to the Fort Worth clinic for two weeks, and on that occasion, I was asked to head a team.

There are many interesting international opportunities. Still, I must say that it takes some experience and knowledge before you get to the point where you can work that independently. You really need to be able to work independently and teach others what you’re doing and how they can improve.

Q: It’s at least something that people can aspire to, and maybe one day do, once they put in the years of practice and work. Dr. Fogle, can you talk a bit about the career outlook and job prospects for speech-language pathologists?

Dr. Fogle: Yes, the good news is the current outlooks are excellent. I’m reading right now from a new textbook titled Essentials of Communication Sciences and Disorders, 2nd Edition:

Discussing the employment outlook for speech language pathologists, “US News and World Report (2016) ranks speech language pathologists number 19 in its ‘Best health care jobs’ category, and number 28 in its ‘100 best jobs in the US’ category. They define ‘good jobs’ as ‘those that pay well, challenge us, are a good match for our talents and skills, are not too stressful, offer room for advancement, and provide a satisfying work-life balance.'”

I should mention that speech-language pathologists typically have very high job satisfaction. Those who get into it and stay in it love their field. When I go to conventions – national and international – speech pathologists always have a lot to talk about, and we love sharing our own therapy stories.

What’s fun is that after a student has been in the field a little while, training in it, and having their own clients, they will have their own therapy stories, and they’re fun to share.

Q: That’s good to hear. It sounds promising, and coworkers who are self-sustaining will keep you going and share their enjoyable experiences. Can you tie that into the field of study for these students?

Dr. Fogle: Certainly. I’ve often told students that I think speech pathology – and this is a personal opinion – is one of the best, if not the best, professions for training and preparation for adulthood. Let me mention a few things students learn as they become speech-language pathologists. Students will learn:

• About the normal and abnormal development of infants and children
• How to work with children on a one-on-one basis and in small groups of two or three
• How to motivate children to work hard and improve their communication and academic skills
• How to manage the sometimes delicate task of talking with parents about their concerns regarding their children
• How to work with adults and older adults with a variety of neurological problems
• How to deal with sensitive issues that accompany impairments and loss of communication capabilities
• Problems regarding hearing impairments at all ages and their effects on both the person with the loss and the family
• How to be a patient, active listener; a trained listener – perhaps the most important interpersonal skill that you can develop

Speech language pathologists are actually a different kind of person than any other professional that I’ve ever known. We have a caring, sensitive way about us, we’re very likable in most cases, and because of that, we tend to be advanced.

If you’re working in one setting, you may have the opportunity to advance to administration if that’s an interest, because you’ll have excellent communication skills.

As I mentioned, the most important characteristic we have, in terms of abilities, is the ability to listen.

Q: That’s certainly a life skill that’s important outside of the field as well as within. Do you have any last comments or advice that you would give to someone who is thinking about going into this field as a speech-language pathologist?

Dr. Fogle: I would definitely encourage you to go into it. Look at yourself first and ask, Do I really like people? Do I enjoy being with them? Do I like working with people who have problems or disabilities? Am I patient? Am I sensitive?

If you’re a man, I would really encourage you to consider this as a field for you. There are great opportunities for men just as well as for women. It’s an equal opportunity employment setting and profession.

You can work in so many different places in so many other ways. You can leave the field for a while and come back. It is the most enjoyable field I could ever imagine getting into, and I’m so glad that I did.

I’ve been a therapist for over 45 years, and I plan to continue.

Q: Dr. Paul Fogle, thanks very much for taking the time to sit down with us for an interview.

Dr. Fogle: And thanks for interviewing me.

Briana Ralph: Multi-Setting Clinical SLP

Briana Ralph does it all as a clinically focused speech-language pinpatient—inpatient, outpatient, nursing home, and home health care are all part of her professional portfolinpatientiana, the job never gets old because there’s a new experience every day: helping a patient regain the ability to swallow following a stroke, teaching a laryngeal cancer survivor how to use an augmentative communication device, or focusing on a speech delay with one of her youngest patients.

We sat down for a conversation with Briana about what it’s like working with patients that run the gamut from toddlers with swallowing disorders to elderly adults coping with the effects of a stroke or Parkinson’s Disease.

Briana opened up about what she loves about the job and wasn’t shy about voicing her frustrations either.

Q: How long have you been a speech-language pathologist?

Briana: Seven years. My first job was at a skilled nursing facility, where I worked for about 6 or 7 months.

Q: What is your educational background?

Briana: I have a masters from West Virginia University and my bachelor’s from West Liberty University.

Q: And are they both in speech-language pathology?

Briana: Yes.

Q: And were you able to specialize at all in your master’s degree, or is that not an option?

Briana: I don’t think you can specialize in your master’s, but you can specialize later on… I know there are things through ASHA, like augmentative communication, that you could focus on.

Q: What made you decide to go into the clinical area versus education?

Briana: Right out of school, I wanted to stay clinical and use as many of the skills I learned as I could. Plus, the money is better. And then I thought I would go into the schools later on because I don’t want to say it’s easier, but it’s less of a broad range there.

The hospital where I am has outpatient and inpatient clinics, and we have many contracts. I do both, and I go into people’s homes to care for elderly patients. We also have a home health agency. I have some personal agreements, so I already have experience with IEPy. A lot of what I do is coaching parents in the home for birth to age three. I got trained doing assessments with children with autism, diagnosing them, and I do inpatient and outpatient. I also do swallow studies at the hospital—pretty much everything I was trained in, I use.

Q: So, essentially, you could make the transition relatively easily into education if you decided?

Briana: Probably, yes, because it’s about half what I do now.

Q: So, clearly, you’re moving and going to different places. Do you like that?

Briana: I do because it doesn’t really get stale, and I can choose to do something if I want a break or something different. For example, this summer, the therapist who did most of the home health work was super busy, so I took two of the home health referrals we got, which meant I had two adults for a while.

Q: What are the typical services for adults? Are they mostly post-stroke?

Briana: Yeah, and usually people with Parkinson’s. Sometimes we get ALS, but that’s traditionally focused on getting them a device.

Q: Which explains why you’re interested in augmentative communication.

Briana: Yes, I like that. It’s primarily strokes with adults or traumatic brain injury, and we’ve had so many people with a brain injury of some sort.

Q: So, are these services very short-term?

Briana: It all depends on how much progress they make. Usually, the most progress is made in the six months after, but some continue to make progress after, so they receive [services] for a while. We’ve had people who have had another, so they come back if they’ve had more than one.

Q: Tell me what your day is like working with preschool-age children? And tell me again, birth to three?

Briana: Yes, right now I try to fit in two visits in the morning. I go to someone’s home, and we usually talk about how things have been going for the last couple of weeks since I haven’t been there, and then they tell me what’s good or bad or what is new, and then what they’re currently working on or what’s difficult in their day. I’m used to giving them strategies to use throughout the day because the parents are with the kids way more than I am as a therapist. So, we work on things they can do throughout their day, and ways they can work on their child’s speech. And then at the end, we review the plan and what’s going to happen in the next couple of weeks.

Typically, the parents are my barrier; whether they want to participate… You know, it’s hard to get people on board, and sometimes you have to make it seem like it’s their idea. I don’t want us just to come in there and tell them what to do. I want us to talk about it and come up with things together, like what’s going to make sense for them to do, and I’m always telling them that I want you to feel like I’m [giving you] things you can do any time of the day.

Q: Is the [program] based on an IEP? Do you do the same type of things with short-term and long-term goals?

Briana: We have a birth to three state program. We don’t go off an IEP but an IFSP—Individualized Family Service Plan. The program is free and voluntary, and parents can sign up for the development assessment of their child. So, the parents come up with the goals for that child; it’s not me setting the goals for their child. The parents identify an area they’re lacking, and that is what we need to work on.

So, typically, the most common goal is using more words, so we look at their routines and work on it that way. So, if it’s mainly that the parents want their child to tell them what they want to eat or drink, it’s about coming up with things to work on.

Q: Do you work a lot with developmental delays? What are your typical patients?

Briana: Technically, it’s a diagnosis of speech delay. We get some kids with Down Syndrome and cerebral palsy. I also get feeding issues at this age. Babies who were premature or had neonatal abstinence, prenatal drug use, or other types of problems. So, some are in foster care.

We also get a lot of rare disorders. I have a patient with Miller-Dieker syndrome, one with Smith-Lemli-Opitz syndrome. When I get these kids, I have to research them!

Q: Do you have to be licensed?

Briana: I need a state license, and I have my Certificate of Clinical Competence (CCC). I have to complete continuing education hours every two years for my license and for my ASHA certification.

Q: Let’s go back to your school for a second. Did you know by the time you hit your graduate program that you wanted to focus on the clinical area?

Briana: No, I thought I wanted to work in the schools. I think everybody had an idea of where they wanted to work, but they didn’t end up there. I didn’t know it would end up working in a nursing home, but I ended up loving it and liking it a lot more than I thought I would.

You think it’s going to be sad and depressing, but it’s gratifying. If you can upgrade someone’s diet and they are pleased because they don’t have to have food thinner at all their meals, and they get to look at real food again.

I also have very appreciative and really nice families.

Q: So, what was it like working in the nursing home environment?

Briana: At nursing homes, it’s usually a contract company providing the services… I was happy there. I don’t know if I would have wanted to do it forever; the medical,, billing,, and other things are complicated because of the productivity rate you have to meet. So much of your day is spent in one-on-one patient time, which makes you feel like you’re scrambling all day. Documentation time doesn’t count.

The legal and administrative stuff was a turn-off because productivity was worse in some places. I was only 75%, but in some areas it’s 90%, which is impossible when you have to document, go to the bathroom, and walk down the hall! Any time I would spend talking to nurses or family didn’t count. Even when I would go to the patient’s room to see what they wanted to eat, then go down to the kitchen to get it and take it back, it would take 20 minutes of my time.

Q: Do you feel that your job is very collaborative? For example, in the nursing home, everybody had to be on board with the patient’s plan. Is that a little different now that you do home home?

Briana: Collaboration now is PT and OT being involved…physical and occupational therapy working with me. At my other job, I felt like I had to fight for patients. Like a PT would have my patient, and then I would say, ‘Can I have them a minute?’ But in an outpatient setting, we work a lot with PT and OT. We have a lot of kids come in and have all three disciplines, so sometimes we co-treat. If there’s a feeding issue, PT works on positioning, OT works on hand-to-mouth, and I’m working on feeding.

Q: How do you collaborate and come together to have a plan for the patient?

Briana: We usually talk about it in the office, and it comes down to the child’s needs. Sometimes it ends up being the child’s participation level, because if you have three disciplines and the child is going to be there for an hour and a half, some kids just completely max out after an hour, and then the third person gets nothing. So, sometimes we talk about what’s appropriate to treat together. Likewise, if it’s a feeding situation, we all share the same goals and work together. Some of the kids with developmental delays who won’t sit up, PT can work on things while I work with them, too.

Q: So, you’re literally working with the patient at the same time?

Briana: Oh, yeah. It’s usually me and a PT vs. an OT. If I’m playing with toys, I can entice them to crawl or walk toward me while I work on language, and the PT is working on balance.

Q: So, you’ve worked with the oldest population, and now you’re working with the youngest population. What do you prefer? And why?

Briana: It’s hard because it depends on the patient. I do like both, but I probably prefer working with kids because I have more fun. And it depends on the kid; sometimes I might be having fun, but they might scream and run to the other room. Sometimes they’re done with me. (she laughs) I’ve also had adults who were really fulfilling and really sweet.

Q: So, you don’t see leaving this area anytime soon?

Briana: I think about when I have kids, I might want to work in the school. But I like the setting that I’m in because I get to do so many different things. I feel like I won’t lose what I’ve learned because I use it all the time.

Q: What’s the best part of your job?

Briana: Probably when I do something that we’ve been working… and working… and working out for a while, and then all of a sudden, they do it, and then I flip out and I’m all excited!

And the kids look at me like I’m a crazy lady. (she laughs) But most of the time, they get excited too because they’re like, ‘Yeah, I did it!’ And then I tell the parent about it, and they’re excited.

Q: What’s the most frustrating part of your job?

Briana: Paperwork and parenting, probably.

Q: So, you really feel like parents are one of your most significant barriers?

Briana: It depends on what their understanding is of what we’re trying to do. Sometimes, when it comes to behavior… if we come up with something to work on with behavior and their parents don’t do it at home, it’s not going to work; it’s not going to get better.

When I go to a house for a follow-up visit and I ask how it’s been going, and I ask, ‘Have you tried this?’ and it’s, ‘No, we didn’t get to it, or no, I didn’t try this.’ Or I ask, ‘Did you use the picture cards?’ And they say they lost Tver, and here we go again.

Q: What was your most rewarding patient that you can think of, and why?

Briana: I guess what I can talk about was a guy who had a stroke, and all he could say was ‘wow’ and ‘yeah.’ Sometimes, so he would have whole-sentence conversations using just ‘wow.’

I got him a device, and he could use it. And he would use it to tell me things. And it was exciting. And he could tell me what he wanted to eat, and he was pretty proud of himself when he realized he could use that. And he could tell his wife his clothes were uncomfortable.

And then the other thing I can think of is augmentative also. In grad school, I did assessments for augmentative communication. And in the State of West Virginia, we were the only ones who did that, so people would come from all around because it was free…

And we had a woman who had laryngeal cancer, and she had her larynx and her tongue removed. So, she couldn’t make sounds at all, and she couldn’t even use one of the artificial larynxes because she didn’t have a tongue to articulate. And she babysat for her little grandchildren and she had no way to make sounds, which was terrifying because if something happened she couldn’t call anybody. And we just gave her a keyboard to type and we had a device like that and she would type it and hit enter. And she was talking to us and typing something funny about her husband, who was behind her, and he laughed. And she cried because she said something, and he heard her. It was so sweet, it was the best thing.

Q: If someone came to you for advice and said I’m thinking about going into speech language pathology, what would you tell them? What words of advice would you give?

Briana: It [speech-language pathology] is rewarding, and I do love it. What I like about the field is that you can do so many different things. I mean, you can research if you don’t want to work with patients. You can do it at a school. Then there’s also a hospital or voice clinic, where you work with an ENT and work specifically on voice.

Q: What made you decide to go into the field?

Briana: Well, I was going for English and dreading the next four years, and I was in a linguistics class with some speech pathology majors, and I didn’t even know what it was, and they told me what they were doing. Then I went back to my dorm, researched it, and said, ‘That sounds more like me!’ I’ve always noticed how people talk when they do something weird with their mouths or when somebody has a lisp. And I didn’t want to teach a whole classroom full of people. With this, I take two kids at a time. I don’t want to be in a room full of people.

Q: What are the most important traits a speech pathologist should have?

Being flexible and personable. Be able to work with stubborn kids and cranky adults, and roll with it.

Lindsey Spilecki: School-Based SLP

Lindsey Spilecki, CCC-SLP, is a speech-language pathologist with the Hancock County Schools in West Virginia. She may still be in the early part of her career, but she’s already figured out the key to being happy: Do something you love.

When asked about her future career aspirations, Lindsey’s pretty straightforward: “I don’t think I’ll ever leave; I think I’ll retire here. If I could, I would. This is my dream job.”

She’s committed, passionate, and perfectly content to make her first job her last. In fact, her only complaint is that she wishes she had more time to make a difference. Her words of advice to aspiring speech-language pathologists? Work hard, find a great SLP graduate program, and then use your graduate clinical experiences to explore the directions you can take your career.

We sat down with Lindsey for a conversation and learned a lot about what it’s really like to work as an SLP in a public school system.

Q: How long have you been a speech-language pathologist?

Lindsey: This year will be my seventh year.

Q: How did you prepare educationally to become a speech-language pathologist?

Lindsey: I studied at West Liberty State (College) University with a bachelor’s degree in Speech Pathology and Audiology (so I can do either-or with that), and I have a graduate degree from California University of Pennsylvania in Speech Pathology or Communications Disorders.

Q: What are the educational requirements to become licensed in West Virginia, where you work?

Lindsey: You have to have a master’s degree in speech-language pathology.

Q: Is that [the same] across the board? Do all states require that?

Lindsey: I am sure that all states require it. In some instances, if you have a four-year degree, you are capable of working as a speech language pathologist, but in that time frame, you have to be working toward your master’s degree so that you can work as an SLP aide or assistant. So, you get to do all the things a speech language pathologist does, except for some of the paperwork, the writing of goals, and things like that for students.

Q: Did you do that before getting your graduate degree?

Lindsey: I did not.

Q: What made you want to become a speech pathologist?

Lindsey: I initially wanted to teach, but there was that part of me that I didn’t know if I could handle an entire classroom of people. So, there was that apprehension. I ended up in a class with other speech-language pathologist students, and I liked that idea because you can still teach and help people, but you’re doing so in a smaller setting. So, you can reach more, and I liked that idea.

Q: Is your license K-12?

Lindsey: My license is from 99 to 99.

Q: Did you know what area you wanted to focus on, or did you have to choose that in your graduate degree, or how does that work?

Lindsey: Well, when you start your graduate program, the program offers a variety of courses, so you’re fully prepared to work with birth to 99. When you go through your program, you are also allowed to do clinical work, so you’re also given patients who are older, younger, and in between—you get a variety so that you know going into the field more of what you’re comfortable with and what your niche is – what you’re good at, and when you’re doing your clinical work in graduate school, you have a time period where you’re just doing clinical, and most programs, you have to do an education based and then one that is clinical—hospital based, so you’ve got the experience across the board.

Q: What made you want to go towards the education side instead of the clinical side?

Lindsey: I started in education—my first clinical experience was in education. Whenever I was going through my—it’s not a fellowship year, but it’s like a student-teaching time—and I loved it. And then I tried the hospital setting, and I was terrified. It was just not for me! There’s a lot of medical terminology, there’s a lot of not scary—I don’t want to say scary things—but a lot more medical stuff that I was not accustomed to, and it was just not meant for me. And then you find that I’m not good at this, but I’m very good at that, and then somehow it all just clicks when you get to the graduate level.

Q: So, that’s really interesting, so at the graduate level, if you were sure you wanted to go into a clinical area, would you still need to explore the other areas?

Lindsey: Yes, I’m 99% positive they make you have at least some experience in it, because you really don’t know where you’re going to end up, so they want you to feel you have some support once you get out onto the field.

Q: Let’s go back to the undergrad degree; was that also a general degree that allows you to explore different age groups?

Lindsey: Yes.

Q: Did you do student teaching?

Lindsey: No, we didn’t do student teaching per se, but we did observation. As part of the class, we had to observe in different areas and, of course, they expected us to have some education and clinical experience as well. So, going into graduate school, you know from what you’ve seen what you may want to do, and then in graduate school, you can experience actually working with and treating in those areas, and then you can say, I think this is for me.

Q: Is there an opportunity to specialize in speech-language pathology? How does that work?

Lindsey: Yes, if you go to school for Audiology, you end up with a PhD in Audiology, so you start with a smattering of both of those areas, and then if you branch off into Audiology, you end up with a Doctorate of Audiology. In speech pathology, you don’t get a chance to specialize. There are times when you can focus more on certain things. I would use that word focus through our governing body: the American Speech & Hearing Association allows us to gain more information, more knowledge in one specific area, but my degree and my certification do not have a particular voice. We all do voice, we all do fluency, we all do swallowing, so we are capable of working with that whole gamut, the entire umbrella that falls under speech language pathology.

Q: So, tell me, what does your typical day look like?. Are you pulling children from the classroom? Are you working alongside other teachers? How does that work?

Lindsey: I can tell you I have two jobs. I work at two schools. So, it’s almost like I have two entirely different jobs. So, at one school (New Manchester Elementary in Hancock County), I work in preschool. My day starts by pushing into a special needs three-year-old classroom, and I work very closely with the teachers and the teachers’ assistants. I work with functional communication throughout the day, at mealtime, and then once I’m done there, I can pull students from other classrooms.

In my second job at Allison Elementary, I primarily have children with severe and profound needs, so I push in a lot in that room as well, doing the same things. I work on functional communication and work closely with special education teachers to adapt materials to their needs. We’re switching AAC boards. But at the same time, the rest of my day is dedicated to articulation and language, so I’m pulling out for those students. I don’t have a day that’s ever the same.

Q: When you say, ‘push in,’ you’re working in the classroom, alongside the teachers?

Lindsey: Yes, I go right in and we can sit down for an entire lesson maybe and I’ll sit side-by-side with the kids and work with them individually throughout or I will walk into the classroom—I have one student with an iPad that he uses as an AEC device—augmentative communication device, so I’ll pull him an I’ll grab something that I know he likes and I work side-by-side with him while he’s in the room.

It’s a little bit of both, but like I said, my day starts differently than it ends. I have children with a range of cognitive abilities and needs.

Q: So, tell me, you are involved in the process from the IEP on?

Lindsey: Yes.

Q: So, tell me about that. If a new student comes to your school, how does that work?

Lindsey: When we have new students, our schools especially PreK & K, we do a mass screening of all the students and the students who fail the screening in some way so let’s say they have some language areas or some articulation areas that need further developed we will ask permission from the parents to do further evaluation and then from there we go on to develop an IEP for the students. It seems pretty straightforward: we develop goals based on what they test, decide what is developmentally appropriate versus what they can do, and develop an entire plan for that school year for the students.

Q: So, I’m assuming as part of their IEP, you have short-term goals and long-term goals.

Lindsey: Yes, we can break those goals down for schools for the entire school year, and then objectives by the end of the first semester., I want the student to be able to do this, this, and this with 80% or greater accuracy, which further pushes them toward the main goal for the school year.

Q: Tell me a little bit about—and I know you have a smattering of students everywhere—but tell me what your students face every day, what are the type of challenges you face?

Lindsey: I’ll tell you about my special needs students. That way goes along with that. I have several students who have developmental delays or neurological disorders such as autism. I have a few who have genetic disorders. Hence, those (SLP) disorders are secondary to that, so we’re working a lot with anxiety, we’re working a lot with behaviors, we’re working a lot with varying things that all combine to develop the outline of what the child is really like.

So, we’re working to help them communicate, cope at school, and succeed in their curriculum, wherever it may be. So, those are things that we’re looking at.

Q: So, it’s never remotely one-dimensional.

Lindsey: Never.

Q: So, there are so many different facets.

Lindsey: Yes. We have such great teams of teachers and staff who I can go to the cooks in the school, I can go to the janitors in the school, I can go to the school psychologist and say, ‘So and so is having issues with this, so if you could please talk to him. And when you talk to him, if you could say, Hey, repeat that so that I can understand you.’ So, everybody works so well because everybody’s there for these students, and they understand that there’s more going on than just what they see.

Q: That’s so interesting.

Lindsey: I love it. I got emotional when I talked about it because I don’t know how many places you can go where you can say,’ I have an entire staff of people who are here just for these students’. If you communicate effectively with them and have the right relationship, you can do amazing things for these kids simply by letting everybody know what’s going on. And it’s nice because our school—actually, our entire county—has a system where each grade-level teacher—each art, gym, and music teacher — has to read our students’ IEPs, so they know what our students are like. So, everybody knows.

Q: You split your time between two schools. Was that originally part of your contract?

Was it budgetary? Do you think you could handle being at one school full-time?

Lindsey: It was part of the contract. They decided that’s part of my contract: I am considered a county employee, so they can put me wherever they need me. I’m not just at one school. I do have a homeschool, but I’m not contracted to one. I was initially supposed to be in a southern school in the county, but since I live up north, they bumped me, so at least it’s convenient for me to travel.

But I love it! It’s my favorite part of the job. I don’t think I could ever work in just one place. And I don’t split my day up at those schools. I work two days with one school and three days at the other, so I’m not running back and forth. Some days I do—IEP season, I do!—but the rest of the time, I’m just in one school all day, then I leave and go to the next.

Q: So, what I’ve gotten from this is that you need to be highly flexible, and you clearly need to be able to be in a collaborative environment. Please tell me what else you feel makes a good speech pathologist.

Lindsey: I think anyone who goes into this thinking that they want to do it, you have to honestly, genuinely care about other people. That’s a given. You need to be creative because I have 55 students, all with different needs.

You have to be able to go, ‘Ok, ay this one has this goal and this one has this goal, so let’s see if I can do one thing that can target everybody.’ You find yourself after you’ve done it for so many years, just going, ‘Oh! I can use this for this!’ And then you go. I think creativity is one of the bigger ones. And excitement. You have to be excited about it and excited for them. I am easily excitable, and I sometimes scare my students because they get a goal and I say, ‘Yes!’ And I remember, ‘Oh, he doesn’t like loud sounds, I forgot!’

Being creative and excited about the job and where you are really helps the most. I can speak on the educational side of it; that’s what I learned the most.

Q: And do you see yourself ever leaving the educational field?

Lindsey: I don’t think I’ll ever leave; I think I’ll retire here. If I could, I would. This is my dream job.

I started my student teaching, I did preschool, and I didn’t think I would end up in the same school that I did my student teaching, so when I found out, it was such a pleasant surprise, and you just kind of find your little niche, you find your tiny space, and that’s it. I don’t think I would ever leave.

Q: Wow, you don’t hear that often.

Lindsey: Yeah, I love it.

Q: If you talk to someone who has an interest in it (SLP), what would your advice be to them? I think I want to be an SLP What do I do? Where do I go?

Lindsey: If you are thinking about it, take a few courses in it. It’s going to be tough. The field is very competitive, and you’re going to be up against the best and the brightest, so you’re going to have to work hard in the program and do as much research as you can into graduate programs to get yourself in ahead of time and—have fun from there!

I think if somebody had told me that years ago to be prepared, that it’s challenging work, and it’s gratifying work, but start slowly, and those courses, and then if that’s for you, continue to work hard because our field is quite competitive.

Q: Do you feel like the graduate programs are small in size? Are they hard to get into?

Lindsey: Yes, they’re small. Some are in the 20-25 range, some are just 10-15.

Q: So, what did you feel that you had to have under your belt to get into a good graduate school?

Lindsey: Grades are significant. You’ll find that the students who are coming in from undergrad are also very highly motivated and all 4.0 students. You’ve got a lot of competition regarding that. I don’t know if it’s the grades or your willingness to show up and be visible to the director in that graduate program. Go and introduce yourself, stand out a little bit, make sure they’ve seen you, and make sure you’ve toured the place so they can connect a name with a face. I think that helps a lot, and showing how interested you are in these places will help a lot.

Q: Beyond a GPA—clearly a competitive GPA—GRE scores?

Lindsey: I had to take the GRE. I don’t know how much it is in each school; I know I had to take it. I see each place is different, and it might mean the difference between you and another student. But, yeah, do your best on that.

Q: Tell me about your most rewarding case.

Lindsey: There’s been so many! I’ll tell this story…I had a student who is now in third grade. He began preschool at the age of three. I think he had a few sounds. I think he said, ‘Ooh’ or ‘Eee’; that’s how he communicated. And now we can’t get him to stop! At all – ever! He is now just in a regular general ed program; no IEP, nothing. He went into a three-year-old preschool with a complete IEP, developmental delay, and the early intervention is key, so key anymore! The early intervention kind of just bumped them up to where he needed to be for preschool, and in preschool, he continued to have the IEP for support, and then went into kindergarten without one, and he hasn’t had one since.

Q: Tell me about how you handle the students you can’t reach.

Lindsey: I don’t give up. We have tried a few. I have one right now that the mother and I—thank goodness I live in a small community—went to school together, and we can go back and forth. We text each other and say, ‘The pictures aren’t working, what can we do now? Let’s try this. What can we do to make him successful?’ I also do that with the teachers a lot. We sit and think of things we can come up with that might motivate them if there’s a lack of motivation. We try to find a good reinforcer that might encourage him to work for this. We collaborate, and we never give up. There are endless ways, endless possibilities, so we have to find the one that works.

Q: What’s the most frustrating part of your job?

Lindsey: Not enough time. There’s not enough time, and there are many demands on us. There are a lot of demands on us in terms of paperwork, which nobody will ever tell you about how much paperwork you’ll do in a lifetime when you’re in school. Still, you do a lot of paperwork and there never seems to be enough time to, I feel, properly in my best, get everything done. Time is a significant constraint. I wish there were another four hours in the school day, some days, because it’s like, ‘Can’t we just have another hour to get this done?’ There never seems to be enough time. That’s my chief complaint.

Kyrsten Theodotou: Pediatric Specialist

Kyrsten Theodotou (MA, CCC-SLP) works as a pediatric Speech-Language Therapist at the University of Minnesota Pediatric Rehabilitation Clinic. Before this, she served on the Pediatric Brain Injury Team and the Growth and Nutrition Team at Hennepin County Medical Center in Minneapolis. Kyrsten talked to us about what inspired her to become an SLP and how she’s thrived in a variety of diverse roles in the field since.

Q: What first drew you to speech-language pathology? Is there anything special about it that might make current students see this as a career fit?

Kyrsten: My mom is a speech pathologist, so I’ve been exposed to speech [therapy] most of my life, and when I was little, I was going to school with her, so I always had an interest in it. I just decided to declare it as my major in college, and the more I got involved in my program, the more I realized there was so much more to speech pathology:…I could work with kids [or adults] in hospitals, schools, or a clinic setting.

So I was first drawn to it just because of my environment, but then fell in love with it as I learned about the different areas I could potentially work in.

Q: What surprised you about this field of study?

Kyrsten: The first thing that surprised me was the pediatric feeding…it is such a small niche and group of people that do it…I had no idea that speech pathologists did that.

Q: Are there any other areas that are of special interest to you?

Kyrsten: Birth-to-three and three-to-five year olds, so preschoolers….They’re so pliable and teachable at that age. Birth-to-three is when the brain grows the most, so to be able to promote that…and not just do it between me and the child, but to incorporate the family, I really like that teaming aspect of it.

Q: During your graduate fellowship and early work, you spent time in the NICU. Could you explain your experience there and the role of an SLP in the NICU?

Kyrsten: I first trained in the NICU at the Cincinnati Children’s Hospital so I could do outpatient feeding therapy. The philosophy behind that was that you need to know where and when to treat these complex feeding cases.

I moved to Minnesota, worked at Hennepin County Medical Center, and got more involved in the NICU…[where] the most crucial role of the speech pathologist is to make sure the child is protecting their airway and not aspirating…aspiration would make them sick.

So then our role is to assess that and help with different strategies to make them functional, so they can get all their nutrition and hydration through the mouth and don’t need a tube.

You also collaborate closely with other disciplines [in the NICU], such as occupational therapists and physical therapists, to develop different positioning strategies.

Q: Does collaboration involve working together at the same time with a baby?

Kyrsten: Collaboration varies from patient to patient.

In my previous setting…I would work on the bottling, and the occupational therapist would help with maximal positioning, because sometimes [the infant’s] success in bottling was based on their positioning. So we are both there at the same time.

Other times, it’s more just a discussion about capacity, so it depends on the infant’s needs.

Q: When you are inpatient with kids in the NICU, what types of issues are kids coming in with?

Kyrsten: I’m really impatient with the map. Previously, it was a lot of brain injuries that I’d see, so it was an event that brought them into the hospital, so then we’re doing more cognitive and language testing. With feeding kids, they may have been admitted to see if they could even gain weight.

Currently, when I’inpatientd inpatient as a casual staff membe,r it has been to check up on their oral motor feeding skills or thinpatienting skills because they have…a genetic syndrome or have had surgery (like cardiac surgery), or recent extubation from another surge,ry. They’re not able to progress to a regular diet, typically, like you would expect. So it’s variable.

Q: Can you share a bit about your role as a speech-language pathologist on the Pediatric Brain Injury Team?

Kyrsten: We worked with infants to eighteen years. It’s a powerful team… we work with the pediatric ICU attending physician, nurses, and the social worker serves as the team coordinator, making sure our patients are cared for and coordinating plans.s

And plan your occupational therapists, physical therapists, and speech pathologists inpatient services, and really our goal for speech was to assess them and see: What are the inpatients they need ongoing services while they’re in the hospital to get them to go to acute rehab, like a place like Gillette [Children’s Hospital]? … Or do we recommend follow-up as an outpatient? Or are they functioning at the same level that they were before coming in? So it’s a lot of teasing that out.

We’ve relied heavily on the neuropsychologists and the psychologists because they can help process trauma…The neuropsychologist can help differentiate what is baseline versus what is a new onset from a mild brain injury or a concussion…maybe there was some underlying depression and anxiety, but now those things are exacerbated. They’re such a massive part of what we do and how we guide them during an inpatient stay.

And then we saw children with mild brain injuries—also known as a concussion—all the way to severe brain injuries. Anywhere from a car accident to a fall to a pedestrian versus a vehicle… so it covered the range of injuries.

Q: It sounds like these were some challenging situations families were facing. How did you deal with that?

Kyrsten: That’s where we relied a lot on social work and Child Life and the chaplain to help bridge that gap between therapies and the family’s experience, because it’s such a sudden incident for those families. You’re then essentially going into rehab mode with kids, whereas when I see children with developmental delay issues, you’re just habilitating them and working them up to normal; so it’s a lot of empathy and discussion and conversation with the family.

Q: Share a little bit about your involvement with the growth and nutrition team.

Kyrsten: Nutrition is a big deal because you want to make sure the kids are meeting their nutritional needs. So, relying heavily on what the dietitian thinks the child needs and what the doctor feels is important…[these things help] guide my therapy.

So if I feel like a child is at an adequate weight and the rest of the team agrees, I think I can be a little more liberal in telling families, “It’s ok, you don’t need to feed them all of the time or let them snack all of the time.”

But if they were low weight, I would…rely a lot more on the dietitian to give me the go-ahead on what I want to do in therapy.

So the role of the speech pathologist is to assess oral motor skills and how they’re impacting nutrition. Speech pathologists will also look at the sensory and behavioral components, because eating is not just one thing; it involves many different factors.

Q: Over thecoursee of a wee,k what is a normal number of patients or individuals that you would interact with?

Kyrsten: That’s a tricky question, just because you have what’s expected of you, and then you have who actually comes. Weather makes it difficult for families to come; when you’re working with children who are really sick and there are frequent hospitalizations and complex medical histories, they are at a higher risk for not coming, just because you don’t want them to get sick.

I would say[i] a wee,k you probably see like 25 patients (scheduled heavier than that).

Q: How much of a child’s success do you think is dependent on the parent and how the parent is involved?

Kyrsten: I think it’s enormous. And there’s research and data to support that. Even in, like, little little kids who are hospitalized. As an outpatient, you need to have parent buy-in, because I can see a child every day of the week for therapy. Still, I’m not home with them and executing it in their home environment, so it’s essential to have parents buy into what you’re doing and work with them on what is achievable at that time.

Families are going through different things, whether it’s that they have other children to attend to, or maybe they’re just trying to find housing or figure out where their next meal is coming from.

You have to keep in mind where the family is, but it’s essential to have the parents buy into what you’re doing and then modify strategies so that they can be successful in whatever environment they’re in.

Q: How might you modify a strategy when working with a parent?

Kyrsten: Just something as simple as getting a child exposed to different foods who are g-tube dependent…[and those who have] multiple complex medical issues. So, just getting the family to put whatever they’re eating on the tray for exposure.

{Normall}] I’d say “yep, everybody sits at the table at the same time”. Well, if mom’s coming home from work, dad’s out the door to work, and siblings are coming home from school… It’s tough for families to have that sit-down time, so maybe start with something small: ok, on weekends when you’re all together, do this meal together; or anybody who’s in the house at the same time comes to the table for snacks. So it’s modifying what I would see as ideal to fit the family’s situation.

Q: Is it common for someone in your position to spend all of their time focusing on just feeding or just speech, or do you do a little bit of both?

Kyrsten: Yeah, it depends on the child’s needs…So, for a 12-13-month-old child, when I’m working on feeding therapy, I probably won’t do language therapy unless it’s glaring that they need it, or they’re deaf or need more language stimulation.

Also, to formally address both of those in therapy, you need to have two separate evaluations.

Typically, I would not evaluate a child for speech and language until they are 15 months old. I think working on both of them is very appropriate for some kids, and you can incorporate language into your feeding therapy session by talking about what you’re eating, using it as vocabulary expansion, having them request more or eat, or using different signs…So you kind of organically put language into it without having it as a goal.

Q: Tell me a little about how you’ve worked out the timeline of managing school, family, and work? What has made it possible for you to continue to be a therapist and have kids at home?

Kyrsten: My path to school and starting a family: I started dating my now-husband when I was a second-year grad student, and throughout that whole process, I always knew I wanted to be a speech pathologist…I highly value family, so I always knew it would come first. (And that’s me personally.)

I am currently working very hard to maintain a precise balance and separation between “this is my work life and this is my family life”.

My husband was supportive of that, but at the time, I had to do what I needed to do to advance my career and get to where I wanted to be. I did an internship at Cincinnati Children’s Hospital, then returned for another internship at Fairview. Still, the doors were not open anywhere in Minneapolis, and this is where my now-husband was established.

So the opportunity came for me to do my clinical fellowship year at Cincinnati Children’s Hospital, and I took advantage of it, knowing it would be hard to do long-distance. But, you know, you have the ultimate goal in mind: you want to be back home, close to your family. So it’s about taking that leap of faith and trusting that the right doors will open at the right time.

Sure enough, they did. After my fellowship year, I returned home and worked for Hennepin County Medical Center for 5 years.

During that time, we got married and had our first child (and we have a second one on the way), and then it was a matter of what would be most appropriate for me to maintain a better work-life balance. I was full-time at HCMC and had the opportunity to cut back more quickly.  Keep my connections at HCMC, and I will still work casually and on call.

I’ve always been one to get my documentation done at work and then go home so I can have time with my family, because that’s a value…I value faith, family, and friends over…over everything. And I think it’s really easy in speech—it’s very competitive— it’s really easy to lose sight of what you personally find meaningful.

Even at your first job: It’s hard to land [it] and let go of that [intense mindset]…I encourage students who want that family-and-work-life balance to set their boundaries.

I saw it firsthand with my parents… my mom worked at the school and then picked up some casual hours at the nursing home in the summer…I saw the flexibility my mom could offer our family…I see that with my husband and me now. He’s a teacher. I can work part-time now; he’s home in the summer so that we can balance work and life together.

Q: What are essential personality traits for someone who wants to work in some of these specialized areas you mentioned, like brain injury and the NICU?

Kyrsten: In general, the personality trait of speech pathologists or someone in healthcare should be empathy and listening to the family. And you need to realize that you may have goals for the kid, and the family may not be at those goals yet. So it’s really about being a team member with the family, letting them be part of their child’s planning, …and getting families to the point where you want them to be.

My supervisor in grad school, during one of my practicums, told me: “You can teach someone the skills for feeding, for brain injury, for language, but you can’t teach someone how to be caring and empathetic and compassionate”…especially in these really challenging situations.

Q: What would you say has been the most challenging part of your job?

Kyrsten: I think the most challenging part of the job is…[that] you can’t do it all. Because you’re in a profession where you want to help people, and when you don’t see that progress and that barrier to progress is outside of your control, that is probably the most challenging part of doing it.

Q: What is the most rewarding part?

Kyrsten: I think the most rewarding part is when you have a breakthrough with a family. Whether it finally clicks with them [and] they start following through, you have a child who is now saying more words…or they are beginning to look to their parents to get them to do something…it’s really rewarding when a kid starts finding enjoyment in eating. The parents see, “Oh, they can do this”… it’s those little moments that make it the most rewarding.

Q: Is there any last advice you would give to graduate students or new practitioners?

Kyrsten: Take advantage of the opportunities given to you. Especially early on. Because those are pathways to discovering what you really love and what you want to keep doing.

My generation, you know, you don’t find one job and stay there forever…I mean, it’s rare to see that, so really embrace the different opportunities; whether it’s going to a conference or a chance to learn more or hear a speaker… or a job that may be far away from home but would really be a stepping stone toward where you want to go.

I’d encourage students to take advantage of that, because they don’t always come along… we always say, short-term pain, long-term gain!

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Sarah Keller

Sarah M. Keller, MS, CCC-SLP, is a licensed speech-language pathologist with 15 years of experience in pediatric clinics and university training programs. She earned her master’s in speech-language pathology from a CAHPS-accredited program in the Midwest and supervised clinical practicums for online and hybrid SLP cohorts. Sarah now advises students on graduate school applications, clinical fellowships, and state licensure. She lives in Colorado with her family and golden retriever.

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