Private Ties These communication sciences and disorders professionals may be in private practice, but their treatment success depends on close work with specialists in other disciplines. Features
Features  |   January 2014
Private Ties
Author Notes
  • Claudia Goswitz, MEd, MA, CCC-SLP
    is the clinical director of Stone Oak Therapy Services & Learning Institute in San Antonio, Texas. She is an afliate of ASHA Special Interest Groups 1, Language Learning and Education; 11, Administration and Supervision; 12, Augmentative and Alternative Communication; 17, Global Issues in Communication Sciences and Related Disorders; and 18, Telepractice. ·
  • Audrey Adams, AuD, CCC-A
    is an educational audiologist in private practice and at the River School in Washington, D.C. ·
  • Renee Matlock, MA, CCC-SLP
    is owner and executive director of Speech Plus ( in Frankfort, Ill., a private practice serving children from birth through high school. She is a member of the American Academy of Private Practice in Speech Pathology and Audiology. ·
  • © 2014 American Speech-Language-Hearing Association
Article Information
Speech, Voice & Prosodic Disorders / Hearing Disorders / School-Based Settings / Practice Management / Professional Issues & Training / Features
Features   |   January 2014
Private Ties
The ASHA Leader, January 2014, Vol. 19, 48-52. doi:10.1044/10.1044/leader.FTR2.19012014.48
The ASHA Leader, January 2014, Vol. 19, 48-52. doi:10.1044/10.1044/leader.FTR2.19012014.48
When a speech-language pathologist or audiologist heads into private practice, “private“ relates only to the business model. The actual work can involve treatment of clients across ages, cultures, geographics and demographics, and with greatly variable severity levels. And the “un-privateness“ doesn’t end there. Because hearing and speech concerns can involve such a wide swath of broader medical and cognitive issues, working with specialists in other areas can be key to a successful private practice.
Read on to find out how two SLPs and an audiologist have built their practices around collaboration with other professionals, with some even bringing those professionals in-house.
The Quad Squad
How do you help a 4-year-old with autism spectrum disorder who has almost no range of motion in his neck because of muscle knots caused by such severe agitation to everything in his environment and his inability to communicate?
At Stone Oak Therapy Services & Learning Institute in San Antonio, we approached this boy’s treatment with a combination of physical therapy and speech-language treatment. We created a visual schedule of activities to help him understand what would happen in the physical therapy session and attached a visual reinforcement schedule with choices of preferred items so he would understand his reward for tolerating the painful stretches that the physical therapist needed to perform. We distracted him from the pain and modeled language through songs, fingerplays and interactive books—the tools we used before today’s smartphone and tablet era.
At Stone Oak, the largest exclusively pediatric clinic in the city and the only private clinic with a day program for children with ASD, this type of collaboration has been part of our mission since we opened 13 years ago. My clinical background is in psycholinguistics, speech-language pathology and applied behavior analysis, and I have a child with ASD. Even with my strong clinical background in language development, I felt overwhelmed by the conflicting information we received from various professionals treating my son. Because of my own experience, we view communication among team members as a cornerstone in drafting plans of care before we present them to our families. Our nonprofit side is called “The Brainstorm Center” for this very reason.
What does this collaboration look like? In dysphagia treatment, for example, a physical or occupational therapist helps a child with posture, while the speech-language pathologist stabilizes the jaw and presents a controlled bolus. During a noncompliant child’s aquatics session, the PT uses the water for various range-of-motion and strengthening exercises, while the SLP captures every opportunity to elicit communication.
We also help the PTs understand that all behavior is communication, something particularly important in children with maladaptive behaviors. Other productive collaboration has come from group sessions with SLPs and OTs who foster play and pragmatic skills using sensorimotor development activities.
The greatest outcomes and collaboration we have seen, however, come from co-treatment with applied behavior analysis and speech-language pathology. Despite the controversy between these disciplines regarding scope of practice and how language emerges, we have learned to use different approaches for different skills and reached the premise that children with more severe deficits in cognition or language typically respond better to the structure of a behavioral language approach and the discrete units presented after a task analysis performed by the board-certified behavior analyst.
Our keys to success are respect for one another’s specialties and the knowledge that the first step to effective treatment is effectively managing a child’s behavior. Image Not Available
Hearing SLPs’ Calls for Audiologists’ Help in Schools
In a tight economy, school districts often rely on speech-language pathologists to manage the needs of students with hearing impairment. Sometimes, that strategy works—but sometimes, the situation requires a partnership with an audiologist.
Several years ago, an SLP in a small school district contacted me for help with two elementary school children who had bilateral mild-to-severe sensorineural hearing loss. Both used personal FM and classroom amplification distribution systems provided by the school district. The SLP managed these systems and worked diligently with their manufacturers to ensure that they were installed correctly and set on appropriate channels. But after the equipment malfunctioned several times, the SLP convinced the school district to contract with an educational audiologist—me. Each month I traveled to the school, where I led training sessions for the SLP and teachers about the effects of the children’s hearing loss on communication and learning. I also gave in-service presentations and provided handouts on optimal use of hearing aids and FM systems, along with troubleshooting tips.
I conducted an acoustical evaluation for each classroom, and made recommendations to improve the classroom acoustics. As the SLP continued providing weekly speech-language treatment and audiologic rehabilitation, she passed on information to teachers about each child’s speech development and auditory skills. We continued to work together to meet each child’s communication needs, manage audiological equipment, couple the FM systems to technology in the classrooms, provide parent and teacher support, manage noise in the classrooms, facilitate self-advocacy for each student, and develop appropriate goals and accommodations for their individualized education programs. Even though I was contracted to provide audiological services once a month, contact with the SLP and other members of the team occurred on a weekly basis via e-mail or telephone.
We now also work together to meet the needs of other students in the school and the district, including those diagnosed with chronic middle ear pathology and with auditory processing disorders. Such collaboration is vital, given that approximately 11 to 15 percent of school-age children have hearing loss— see ASHA’s guidelines for audiology services in schools (
ASHA recommends in those guidelines that school districts employ one full-time audiologist for every 10,000 students. However, in a 2010 report to Congress (, the U.S. Department of Education indicated that 1,376 audiologists work in a school setting, leaving a gap of 6,765 audiologists to meet the ASHA recommendations. Instead, school districts often rely on SLPs to implement programs for students with hearing loss and manage their audiological equipment.
By contracting with audiologists, these SLPs can ensure that students are hearing well and that audiological equipment functions properly. This way, the SLP keeps up treatment momentum, and the child continues benefiting from classroom instruction. We can combine our professional skills, knowledge and experience to provide the highest quality of care. Image Not Available
A Winning Combination Within and Outside Practice Walls
Many of the children we see at Speech Plus come to us from neuropsychologists. They send them to us after neuropsychological evaluation for further testing to rule in or out such issues as receptive-expressive language disorder, pragmatic language disorder, auditory processing problems, reading disorder or problems with written expression. In turn, Speech Plus speech-language pathologists may refer children to neuropsychologists for concerns related to cognition, behavior, attention or minimal progress in treatment.
Collaboration continues during the speech-language treatment process, as the child may need follow-up behavioral or other therapy or retesting.
Testing leads to a comprehensive treatment plan, involving combinations of speech-language treatment, social-cognitive work, reading and writing intervention, and family education. As Jacqueline Rea, a neuropsychologist we work with, says, “With identification of specific intervention targets and then appropriate treatment, the children improve their skills and develop more confidence in their abilities. This is very important from a mental health perspective.”
As parents and professionals learned of our successful collaboration, we began to receive more referrals for language-literacy evaluations. We added reading specialists—master’s-level educators with training in an intensive, sequential, phonics-based methodology that uses visual, auditory and kinesthetic modalties—to the team. The collaboration among the SLPs and reading specialists is internal. It is not unusual to find them both targeting goals of vocabulary, reading comprehension, spelling and writing.
So what does this three-way collaboration look like?
A.G. is a typical Speech Plus client. The 6-year, 9-month first-grader was referred by one of our partnering neuropsychologists for a comprehensive language-literacy evaluation. The testing indicated an articulation disorder and expressive language disorder with word-retrieval difficulties, and the risk of a reading disorder. The intervention plan included individual speech-language treatment once weekly and reading services twice weekly.
The reading specialist initiated a program and collaborated with the SLP on goals. Both provided support and reinforcement on all goals during individual sessions. For example, when A.G. worked on decoding consonant-vowel-consonant words in reading, the SLP reinforced those words in the speech-language session. Similarly, as A.G. worked on oral storytelling with the SLP, the reading specialist prompted a conversation about A.G’s day. Ten months later, A.G. was discharged from speech-language services, and is seen on a consult basis at her school. She continues to receive reading services at Speech Plus, working on her decoding and spelling skills. In second grade, her reading scores were commensurate with those of her classmates!
Successful collaboration, outside and within a private practice, is a win-win for the professionals and the clients involved. And, it is a win for Speech Plus, as effective collaboration is a professional strategy that results in building a successful practice.Image Not Available

Contracted educational audiologists work in:

  • School districts that do not staff an audiologist.

  • Charter schools.

  • Private schools.

  • Early intervention programs.

Educational audiologists’ responsibilities:

  • Troubleshoot and manage audiological equipment.

  • Facilitate listening and auditory skills.

  • Facilitate speech and language development.

  • Communicate with parents/guardians.

  • Collaborate with students’ private audiologists.

  • Communicate and collaborate with teachers and special education department.

  • Manage classroom acoustics.

  • Individualized education program involvement.

  • Be familiar with new technology.

  • Provide support to and advocate for the student.

  • Conduct hearing screenings and hearing conservation programs.

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January 2014
Volume 19, Issue 1