Stepping Out of Your Zone So you want to switch from an ENT clinic to home health. From skilled nursing to schools. From a public hospital to a private clinic. Can you build the skills to do it? Absolutely. Here are a few suggestions. Features
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Features  |   February 01, 2015
Stepping Out of Your Zone
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School-Based Settings / Healthcare Settings / Features
Features   |   February 01, 2015
Stepping Out of Your Zone
The ASHA Leader, February 2015, Vol. 20, 42-46. doi:10.1044/leader.FTR1.20022015.42
The ASHA Leader, February 2015, Vol. 20, 42-46. doi:10.1044/leader.FTR1.20022015.42
I graduated from college with an economics degree and promptly started a job at a children’s book publisher in New York. A year or so later, rather disillusioned with the romance of starting out in a big city—making ends meet was hard—and the realization that my job involved no actual children, I started perusing career books. The career possibilities that most appealed to me were librarian, reading specialist, occupational therapist and speech-language pathologist.
I chose speech-language pathology because it encompassed a lot of my interests, involved fewer “messy” life skills than occupational therapy, and provided lots and lots of flexibility. Although I knew I wanted to work in pediatrics, I liked that there would be the option to move to different settings, different populations and even different ages if I chose. How many professions can offer that?!
The reality, though, is that as we start our careers in one area, we tend to become more entrenched with each passing year. It’s as if we pigeonhole ourselves with our own expertise.
It doesn’t need to be this way. The field we love continues to hold a wealth of opportunities that we can grab hold of again—even if it’s been years since we opened a text on voice disorders or worked with an adult struggling with fluency.
The big question is—where to begin? How do you go about honing your skills in a less-familiar area or delving into a completely different sub-specialty while maintaining high-quality and ethical services?
The good news is that not only can you learn new skills, but you’re better equipped to both learn and master them than you were in graduate school.

The field we love continues to hold a wealth of opportunities that we can grab hold of again—even if it’s been years since we opened a text on voice disorders or worked with an adult struggling with fluency.

Change up your learning
I recently asked seasoned SLPs and audiologists on social media how they develop their clinical skills. Nearly all list “reading books and articles” as a primary learning resource. SLP Pam Marshalla, a Mill Creek, Washington, private practitioner who focuses on articulation, phonology and oral motor techniques, advises that we look “beyond our own field and stretch—reading neurology, anatomy, psychology and child development sources.”
Audiologist Kathleen Peterson, clinical assistant professor at Arizona State University in Tempe, elaborates: “My method for learning new skills or honing old ones is to find a continuing education course in that area. If that is not possible, then I contact a professional who is considered an expert in that area and ask for a reading list. If that is not possible, I look to the journals and newly published textbooks.”
Looking back on your grad school habits and realizing long, uninterrupted study sessions are no longer possible? No worries. Learning doesn’t have to happen in traditional ways. In fact, research summarized in a recent book suggests that many effective learning techniques fit well into a busy adult’s lifestyle, whether that involves juggling a full-time job or staying at home with young ones. In “How We Learn: The Surprising Truth About When, Where and Why It Happens,” Benedict Carey makes the case that varying the environments in which you learn actually boosts retention. So, go ahead and read for 20 minutes while waiting to carpool, another 20 minutes over your sandwich, and another 45 minutes when the house is finally quiet. It’ll stick.
Distraction, it turns out, also has benefits. Research shows that our minds tend to remember more of an interrupted task than one we’ve completed, and the time spent “incubating” while we work to get back to the task can be invaluable—not just in terms of figuring out the answer or meaning, but in retaining the information even after the lesson is complete. Given how frequently work gets interrupted for most of us, this unexpected learning advantage is welcome news.
Tap CEUs
Another frequently cited learning resource from our colleagues is continuing education courses for ASHA CEUs. Many of us enjoy courses, because they allow in-depth study of a topic and because they provide an opportunity to ask questions and hear about the experiences of other clinicians. But unlike graduate school, when you would complete a course and be “checked off” as proficient, continuing education courses often raise as many questions as they answer.
Again, our brains are better equipped for this kind of learning. Regular testing—in this case, stepping into the treatment room—is one of the best ways to learn new material, even if our first performance doesn’t go well. And it’s more effective for retention than studying diligently for a cumulative exam.
In his book, Carey also cites research showing that studying one topic exclusively is not nearly as effective as studying a topic interspersed with others. The opportunity to compare and contrast as you work through the new material will give you a deeper understanding of it. Makes you appreciate your varied caseload, doesn’t it?

Regular testing—in this case, stepping into the treatment room—is one of the best ways to learn new material, even if our first performance doesn’t go well.

Get mentored
Finding a mentor for your professional development is another frequently used strategy—so much so that some settings have well-established “collaborative care” systems that allow clinicians to attend others’ diagnostic or treatment sessions for educational purposes. One impressive example is the Craniofacial Clinic at the Children’s Hospital of St. Louis. This clinic awards ASHA CEUs to school-based clinicians willing to expand their knowledge as they follow the treatment of their students.
Onsite mentoring services aren’t always easy to establish, however, so some clinicians use virtual mentoring to help fill the void. Experienced clinicians on Twitter, in specialty-specific Facebook groups, and in ASHA Special Interest Groups can point you to continuing education resources and provide feedback on your practices.
When boning up on a new skill area, when would you feel “competent” enough to actually provide services? That depends on the area. If you’re learning a new medical procedure such as fiberoptic endoscopic evaluation of swallowing, a swallow study or feeding treatment, you need to work under the supervision of a seasoned clinician who can help determine when you are ready for independent practice.
Set up under a specific set of guidelines, a situation like this could possibly qualify you for ASHA CEUs under ASHA’s Independent Study program. And, once you’ve established yourself, ASHA offers options to pursue clinical specialty certification in four areas (child language and language disorders, fluency and fluency disorders, swallowing and swallowing disorders, and intraoperative monitoring). More information is available through the Council for Clinical Certification in Audiology and Speech-Language Pathology. You can use specialty certification to distinguish yourself from others in the profession, gain referrals and clearly show your advanced training and expertise to clients.
Let’s take a look at several different routes professionals have taken to gain new skills. SLP Jennifer Lesher from Reading, Pennsylvania, wanted to switch from early intervention to providing services in schools, so she spent a year preparing before applying—reading books and articles, attending seminars and shadowing other professionals. Other areas of practice may be more “learn as you go,” making self-evaluation an important tool for skill-building: SLP Linda Silver in Plainview, New York, has switched populations frequently throughout her career, providing services in traditional elementary and middle schools, special schools for children with autism, and an institution for children with behavioral issues and learning disabilities.
Each time Silver changed populations, she used students’ assessments to gauge her success. “I tried to be very thorough in pre/post testing to make sure I was actually having an impact, (and) went back to the books if I wasn’t seeing steady progress.”
SLP Natalie Snyders of Oakwood, Illinois, recently posted on her blog about moving from an elementary school to a middle school. What changed most for her was presentation of her materials. “A big worry was making sure that (my) students didn’t think (my) materials and ideas were too juvenile,” Snyders says. She also adapted to changes in scheduling students in this new environment, focusing more on fostering their independence by having them take charge of their own attendance.
For SLP Deb Kerner of McKinney, Texas, a mentor made all the difference when she moved to home health from the schools, where she’d spent 16 years. She read up and attended workshops on pediatric feeding, but her coup was landing a mentor with exemplary feeding therapy skills. During her two-year review, her mentor declared that she was a “feeding therapist,” validation that she had indeed mastered her new niche.
Our certification permits us to work with a wide range of issues—too many for any one clinician to master. But layers of overlap allow us to shift our focus based on client needs, changing markets and our own clinical interests. Never be afraid to branch out—but make sure you’re well-prepared.
1 Comment
February 10, 2015
Valentina Nesterovskaya
Thank you!
Thank you for that article! I have thought about switching settings for a while and this was very helpful.
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February 2015
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