Speech & Language Pathologists (SLPs) have the advantage of choosing from a variety of different work settings. Whether you’re just starting or have been in the field for a while, one of the most common decisions SLPs face is choosing between working in a school setting or a medical setting, including outpatient clinics.
Each environment offers a unique daily experience. Life as a school-based SLP looks very different from working in an outpatient clinic. Same job, very different experience!
If you’re looking to expand your professional skills, outpatient therapy offers perks that are hard to match in a school setting. In this article, we’ll explore the key differences between in-clinic and school-based speech therapy and highlight the unique advantages of clinic-based therapy for professional growth.
Differences in Caseloads
Your caseload will look very different if you work in a school as opposed to an outpatient clinic. Clinics typically offer a wider variety of cases and smaller overall caseloads, making them great for professional growth. Both new and experienced SLPs can expand their knowledge and techniques due to the diverse range of cases encountered in an outpatient clinic.
Variety of Caseload
One of the biggest perks of working in an outpatient clinic is the variety of speech and language disorders you’ll encounter. In schools, students must qualify for speech services through an Individualized Education Plan (IEP), meaning their speech disorder must impact their academic performance. This means a child with pronunciation issues might not qualify for an IEP but could still benefit from therapy, making outpatient clinics ideal for these cases.
In an outpatient clinic, you may go from seeing a 2-year-old with a speech delay to a 13-year-old with social communication challenges, and many different speech and language disorders in between. Families in these settings are often highly motivated to resolve speech issues, leading to quicker results and better outcomes.
Caseload size
Another key difference is caseload size. School-based SLPs manage larger caseloads, with the maximum in Illinois currently being 60. In contrast, outpatient clinic SLPs have smaller caseloads, allowing for more individualized attention. Westside’s target caseload for SLPs is 31.
Differences in Treatment Setting
School-based SLPs typically see children in small group settings within the classroom or pulled out into a different space. Students can be grouped by age or specific speech challenges they face. School-based speech therapists are often involved in social skills groups, where multiple children participate in specialized sessions focused on social interactions. Sometimes, speech therapy is combined with these social skills groups, which can be challenging if the students have varying speech issues.
On the other hand, clinic-based SLPs work with children one-on-one. This personalized approach allows for tailored treatment plans and maximizes the time spent addressing each child’s individual needs. It enables the therapist to meet the child where they are on any given day and quickly pivot if the child masters a skill or if a new strategy is needed.
This one-on-one approach is one of the biggest advantages of the outpatient clinic setting. It fosters strong relationships with the child and their family and provides the flexibility to adjust the treatment plan as needed.
Differences in Workload
One of the biggest challenges for school-based SLPs is the significant amount of time dedicated to tasks that are not direct therapy. These include IEP meetings, administrative meetings, billing, teacher consultations, and testing. Many SLPs are responsible for scheduling their own speech-only IEPs, conducting the entire IEP meeting, and handling the detailed paperwork.
If you’ve never worked in a school, the IEP meeting might be new to you. These meetings, which typically involve the principal, school social worker, teachers, aides, various therapists, and the child’s parents, are held annually to discuss each student’s IEP. They usually last about an hour and are a forum for presenting recommendations or progress updates.
IEP meetings can be taxing, as parents may not agree with the school’s recommendations for therapy and ongoing goals. These meetings require extensive preparation and documentation. They can be anxiety-inducing, particularly for those who are nervous about presenting in front of a group. Even if you’re doing everything correctly, it can feel like you’re at fault if a child hasn’t met their goals.
In contrast, clinic-based SLPs typically meet with parents one-on-one to discuss a child’s progress, which is generally less stressful and more straightforward. The Clinic Director can help support these meetings with parents as well.
School-based SLPs also handle other administrative tasks, such as billing, scheduling, and managing caseloads, which can add to their workload and reduce the time available for direct therapy. At Westside, our dedicated billing team handles financial tasks and our customer service team supports scheduling needs, allowing our SLPs to focus more on providing direct therapy to their clients.
Family/Caregiver Involvement and Support
Therapists who have experience in both school and outpatient clinic settings often find that family support and involvement are more robust in the outpatient setting. In a clinic, you typically have a few minutes at the end of each session to discuss progress with parents and provide “homework” for them to work on with their child before the next visit. This direct interaction fosters better carryover of therapy techniques into the home environment.
Depending on insurance, private therapy clients may pay a copay or all of their visit fee. These families are highly motivated to work with their child at home and complete therapy as quickly as possible. This increased involvement often leads to better outcomes for both the child and the therapist.
School-based SLPs have larger caseloads, which limits their time for in-depth communication with families. This makes engaging parents a challenge, and many therapists find it a juggling act. Too little communication means there’s not enough carryover at home, but too much communication adds to their already overwhelming list of emails and phone calls.
Resources and Equipment
Outpatient clinics are often equipped with resources and equipment that you might not find in a school environment. From specialized diagnostic tools to the latest in therapeutic technology, these resources enable you to provide the highest quality of care to your clients.
Access to these resources means you can stay at the forefront of the latest treatment techniques and research. Whether it’s using advanced software for speech analysis or incorporating innovative devices into your therapy sessions, these resources can make a substantial difference in the outcomes for your clients and your growth as a therapist.
Unfortunately, schools are often limited in their funding and resources, which can restrict access to the latest technologies and tools. In some cases, this includes access to basic toys and materials.
Collaborative Work Environment
At a pediatric clinic like Westside Children’s Therapy, you’ll experience a truly collaborative work environment. Here, you’ll work closely with other therapists, such as physical therapists, occupational therapists, feeding therapists, counselors, and those specializing in Applied Behavior Analysis (ABA). This cross-disciplinary approach helps you grow as a therapist and hone skills and techniques from other disciplines.
In an outpatient clinic, you’ll also have other SLPs to collaborate and share ideas with. School-based SLPs may feel isolated, especially if they are the only SLP on staff. This can result in fewer opportunities for sharing strategies and less support from colleagues in similar roles.
School or Clinic: Which is Right for You?
Choosing between a school-based and clinic-based setting depends on your career goals and preferences. Each environment offers unique advantages and challenges, from caseload diversity and individualized attention in clinics to the structured, group-focused approach in schools.
Outpatient clinics provide opportunities for in-depth, one-on-one therapy, advanced resources, and strong family involvement, enhancing professional growth and client outcomes.
Westside Children’s Therapy offers job opportunities across Speech Therapy (ST), Applied Behavior Analysis (ABA), Physical Therapy (PT), Occupational Therapy (OT), Feeding Therapy, and Counseling, and we provide on-the-job training to those who are new to the field.
Please contact us with any questions! We look forward to hearing from you!
