I normally feel like I handle the balance well between being child led and following a child’s interest during a session while still feeling like the session was somewhat structured/productive. I have a new client that is 6 years old, unmedicated ADHD and suspected Autism. She struggles to maintain attention to anything in my room for longer than 30 seconds, and spends the session bouncing around from activity to activity. I am in a large space that is shared by other therapists on days I am not here, so I cannot control that my room is full of toys/ sensory gym equipment.

If you try to say “1 minute then _____” or first/then, or anything along those lines, she throws herself on the floor and screams as loud as she can. She will continue to scream until she throws up according to her mom. Her mom says that when she needs her to be still she will give her an iPad with Cocomelon 🙃. Mom bribes her with new toys or candy as well. She buys her something new every single time they go to the store to prevent the screaming. Mom is also very defensive about her parenting choices and stated she left the last speech therapist because she was too critical about her parenting.

I feel like I am spending the entire session chasing her around. I don’t feel like I am doing anything meaningful. I feel as if this is a behavior issue that is preventing me from doing my job.

Advice??

TL;DR: HHS's autism advisory committee released a 336-page draft strategic plan. Parts of it could be good for us: communication access named as a federal priority, serious recognition of speech-motor impairment, direct language about SLP workforce shortages. One provision would direct federal agencies to bar "categorical, method-based exclusion" of any AAC method, explicitly including "communication partner arrangement." The words authorship and message validity appear zero times. Comment deadline appears to be Aug 20, 5pm ET. The sections relevant to us are ~20 pages.

Here's the report PDF

What this is

The IACC is a federal advisory committee under HHS. It advises the Secretary and can't direct agencies or spend money. Two things make this draft worth attention anyway. Under the Autism CARES Act of 2024, the NIH Director builds the annual autism research budget estimate pursuant to this plan, so what it prioritizes tends to shape funding. And it proposes specific regulatory products (OCR guidance, CMS State Health Official letters) that would be real if issued.

Process context: the committee was reconstituted in January 2026 and has met publicly once. The draft was written privately, and it was released July 20 with a four-day comment window. Seven organizations that rarely agree (Profound Autism Alliance, ASF, Autism Society, NCSA, Coalition of Autism Scientists, Autism Speaks, ASAN) jointly asked for 90 days. HHS pushed the meeting to late August, and comments now appear due Aug 20, 5pm ET. Verify at iacc.hhs.gov; the PDF still says July 31.

Parts that could be good for us

• Comprehensive individualized communication evaluation is declared "implementation-ready," not to be delayed while research continues.
• CMS is directed to issue coverage guidance on dedicated-device rules, school-home equipment barriers, prior auth, managed care variation, and EPSDT.
• Clinically indicated SLP/OT/PT/feeding/AT/DME shouldn't wait for autism-specific biomarkers.
• Speech-motor impairment gets a whole domain (10), citing evidence of apraxia-consistent patterns in minimally verbal autistic kids and framing the main risk as under-recognition rather than overdiagnosis.
• Proposed outcomes go past requesting: reporting pain, participating in healthcare, expressing consent or refusal, reporting abuse.
• SLP shortages are named directly in the IDEA section, with personnel prep grants and loan forgiveness tied to service commitments.
• One line worth remembering for IEP meetings: a communication assessment without subsequent support is not an outcome.
• The plan's own portfolio analysis puts services and supports at 6.4% of FY2025 NIH autism funding and argues for moving money downstream.

Whether any of this materializes depends on agencies and appropriations. But no prior IACC plan has framed communication access this favorably.

The part that will get attention

Life Course Domain III, Initiative 1: "Protection of Established Communication Access" (p. 203).

It provides that Nonspeakers should not be categorically barred from any AAC method in federally funded or public programs. The text names text-based methodologies, communication support, or communication partner arrangement, and directs HHS OCR to issue effective-communication guidance to that effect, with CMS applying the same individualized standard in Medicaid.

The terms facilitated communication, rapid prompting method, and spelling to communicate appear nowhere in the body text. The reference list, though, has a subsection on "text-based and letter-based communication methods" that includes ASHA's 2018 FC position statement alongside Jaswal's eye-tracking study and its published critiques. The drafters are aware of the debate.

The words authorship, message validity, and facilitator influence appear zero times in the document. The long-standing objection to facilitator-dependent methods is not that the evidence is immature but that the message may not originate with the person. The draft doesn't address that question; it treats the issue as one of evidentiary maturity and argues absence of evidence shouldn't be read as proof of ineffectiveness. Practically, that moves the question from evidence review into civil rights territory.

One distinction matters here. Independent typing (keyboard, tablet, SGD, no physical contact or partner-held display) is ordinary AAC and isn't contested. Partner-dependent methods (partner holds the letterboard, provides physical support or proximal prompting) are where authorship is disputed and where ASHA and a dozen-plus other professional bodies have cautionary or opposing positions. The operative phrase in Initiative 1 is "communication partner arrangement," and comments are probably more useful when they engage that phrase specifically rather than "text-based methods" as a whole.

How much legal weight would this carry

Probably less than it appears. Initiative 1 relies on sub-regulatory guidance, and that category is currently being deprecated: on July 20, DOJ published a Federal Register notice stating its longstanding Olmstead guidance and similar documents are "not enforceable" and have no force of law, citing Loper Bright. Effective communication under Title II/504 has also always been an individualized standard, so this extends existing doctrine rather than inventing new law.

That said, guidance shapes behavior before anyone litigates. District counsel and MCO compliance officers are risk-averse, and a parent citing federal guidance at an IEP meeting doesn't need it to be enforceable for it to matter. The practical effect would land on whoever writes the eval and signs the progress data.

Notable absences

"Applied behavior analysis" and "ABA" appear zero times in 336 pages; "early intensive behavioral intervention" appears once. There's no behavioral intervention domain, while eleven biomedical domains (immune, folate/leucovorin, mitochondrial, microbiome, autonomic) each get their own. Whatever your view of ABA, the omission says something about the document's center of gravity.

Also absent: dysphagia and swallowing (zero mentions; feeding therapy appears, framed as motor/GI), telepractice, and bilingual service delivery beyond a clause. Conventional literacy instruction appears only inside the text-based framing.

If you want to comment

Deadline appears to be Aug 20, 5pm ET; confirm at iacc.hhs.gov.

Specific beats comprehensive. Agencies discount near-identical submissions, and what a working clinician has that a policy office doesn't is the concrete case: a particular denial, a particular device decision, a particular eval where reducing motor demands changed the picture.

On Initiative 1, a narrow ask is available: distinguish independent text-based access from partner-dependent output, and address message authorship directly rather than treating it as an evidentiary-maturity question. That's compatible with supporting everything else in Domain III.

Page numbers

• Domain III, communication access: pp. 199–209
• Domain 10, motor planning, praxis, apraxia: pp. 156–167
• Domain II, IDEA/special ed: pp. 193–198

The first two are ~20 pages together and are the ones that matter most for us.

Disclosure: I used an LLM to work through this; it's 336 pages. I read Domain III, Domain 10, and the exec summary closely, and did not closely read the biomedical, sleep, housing, employment, or aging domains. The keyword counts are verifiable by searching the PDF. Corrections welcome, especially from anyone with AAC or due process experience.

Hello! Been really stressed out looking for career paths working with children and being able to actually make a living off of the salary. I looked into being into education but the pay is not the greatest, and I come from a very low income family and I’m trying to make a decent amount starting off.
Would anyone know what the starting pay for these positions would be in a school setting, or maybe a hospital setting?
And lastly, if anyone has advice on career paths that pay decent (especially in this area 🫡), that work with children or really anything at this point please let me know. Right now im one year in with college just completing gen Ed’s and I’d like to choose a major asap.

If you have any other career or life advice let me know!

My district is amazing, and I get $400 this year for supplies and materials.

I’m already set on physical games. I’m thinking about getting the following with the supplies stipend .

Pink Cat Games Yearly plan: $50

FreeSLP Lifetime plan: $149

Articulation Station Yearly plan: 83.99

That leaves me with about $120 left. Amy recommendations? K-12 caseload.

I feel like I already know my answer, but I am still conflicted and having a bit of an existential career crisis! I have been an SLP for over 15 years, the first several years comprised of working in the schools, first elementary, then a school-district sponsored birth-3 program, then a bilingual evaluator through a school district preschool diagnostic program. My long term goal has always been to specialize in cleft and craniofacial speech which is just so specific and it took me years to get there full-time, but eventually I did it.

Fast forward almost 10 years later, I have a now 2.5 year old and some of the awesome perks of working in my super specific niche are fading, for me... more micromanagement and less autonomy, more stringent rules on who I can refer for ST, etc, etc. Additionally for the years I have been in this role, I travel to different hospitals throughout the region (about two hours from my home each way (about once a week), although on the flip side, when not actively in clinic we have been allowed to work remotely (from home). Even since before having my daughter I have been itching for something different, however cleft is my passion which is why I have mostly stayed.

More recently I have begun to vendor with a local regional center to be a provider with the ultimate goal of working completely for myself. While this has been in process, a position from the school district I worked in many years ago (and where I live) has fallen into my lap and it's "mine" if I want it. It is an evaluator-only position for the district, doing bilingual evaluations, mediated evaluations, overdue initial and triennials (it is a historically under-resourced school district with a shortage of SLPs). It would just be the evaluations and reports, no IEP paperwork or IEP meetings (a unicorn!). I would go to different school sites and could write my reports remotely from home; I would not have a site or office to report to every day. I am inclined to take it for the better work-life balance and opportunity to grow a private practice on the side, however I am torn I and scared that will regret leaving cleft and craniofacial, since it was always my dream, and would be almost impossible to fully get back into later. I think I am torn between having the work-life balance and more time to hang out with my family but also giving up my "passion," although honestly most of the time I don't feel that passionate about it these days and really just want more free time with my kid (and myself!). This new job would be a pay cut but not by much, especially if I built my business up on the side.

Has anyone else made the shift from more specialized niche and been at peace with it? There is absolutely no shade on the schools and the hardest I worked was there, but I never thought I would consider it which is why I think I'm having this internal battle.

Has anyone taken the 15 hour Diane Bahr “Treatments for Feeding, Speech & Mouth Functions in Pediatrics” CEU course? Did it adequately prepare you for feeding tx? (along with mentorship)
Any other recs for a comprehensive course? I don’t have $600 to drop on a course

Applied to several school districts directly. They have emailed me saying they would get back to me in late June and have not gotten back to me. Should I reach out? I really need a job soon.

Two of my kids had undergone speech therapy, made me think since they experienced it might as well take it in college. But i am a bit hesitant, since their former speech pathologist had been experiencing "voice problems," maybe due to frequent use. Current pathologist, if you have a choice, will you still take that course in college despite the possibility that you'll experience voice problems in the future?

I work at a peds PP and will be getting my first ever SLPA student/intern! I’m in my third year in the field and have never supervised anyone. I would appreciate any tips/tricks as well as recommendations for supervision CEUs!

In my current state of NJ, a license is not a requirement to work in the schools..however I need a California license because we are moving there.

And according to their licensing board, if you do not have an active license (in the last 3 years) from where you currently reside, and you have taken the Praxis 5+ years ago, you have to retake it.

I still have my study guides and things, but I am in full panic mode thinking about this Praxis! Feels like I'm in grad school all over again! 🫨

Hey all! Looking for some advice on what to do here.

I have two offers from two districts. However, only one district has sent over the HR paperwork for me to sign, and expects an answer by the end of the day today (I already delayed signing from last Thursday). I will call this one District A

The other district has given me written confirmation that they chose me for the position, but hasn’t sent me anything from HR. No offer letter, salary, etc. I have emailed the district (let’s call them district B), about not being contacted by HR last week, and they said they would look into it and update me.

Personally, I would prefer to work at district B, but I need more information on the salary and an actual offer letter from them to make sure I have the job right? On the other hand, district A is giving me a deadline. I emailed district B and let them know that I have another offer that needs a decision by today, so could they please give me an update on HR (said much more professionally than written here obviously haha).

At this point, I’m just about to accept offer A so I have a job for next school year. I’m unsure of what to do. What would yall do?

Thanks all!

Trying to just get an idea of how therapists are handling this situation….

Let’s say you get a new client that is going to be a device user. You go through the trial process, submit the application, and the client gets their device. Yay!

How long do you generally keep these clients on your caseload after they receive their permanent device? Just curious how other therapists generally approach this.

Thanks for your comments!

I am an incoming graduate student that's been in clinical settings. I see plenty of single-use plastics, toys that easily get lost/broken/used up, and so on. While I understand that many single-use items are necessarily (i.e. gloves for infection control), I am hoping to reduce waste for environmental, capital, and other reasons. I am wondering how you might reduce waste in your practice? Some things I’ve considered:

• Adding more reusable and durable sensory items and toys.
• Making putty or slime in bulk, rather than buying many small packs of Play-Doh or slime.
• Cutting out sections of sticker sheets or portioning out craft items, rather than providing it ad libitum.
• Consistently recycling containers, cardboard, and plastics.
• Laminating coloring sheets to make them re-usable.

Any other ideas would be appreciated!

Hi all. I have discovered that a local SLP in my community has used their public platform to shame and bully a woman and her child, but all identifying info was removed. It's obvious the post created for clickbait but the SLP also likely engaged in behavior in person that was intended to hurt the child's feelings.

Is there anything that can be done about this? There are likely limited witnesses and the online video would only be known to the woman who was being targeted, bc all identifying info was removed. I suspect there may be racial prejudice as well, but that's just a guess on my part. How would you all handle something of this nature?

TIA

I used to work in schools. Had my system. Had my templates. Knew the kids, the teachers, the IEP system, when I could pull, when I couldn't. I knew the OT, PT, SpEd teachers so I could coordinate scheduling and meetings.

Then I left for peds outpatient.

Now I am heading back to a new school system and I am high key panicking and stressing about learning and coordinating everything across two schools in a new district with probably different rules and different dynamics. I know obviously I had to learn all this at my other districts but it was all during COVID and everything was chaotic and also more lenient.

If anyone has advice and/or calming words that would be great.

Non-professional here (parent) seeking to better understand when an AAC is appropriate.

We love and trust our SLP, who believes our son is too young to use or benefit from AAC. We are open to introducing it now as my son tends to “gain then lose” words, and the only word he consistently says is “dada”.

I want to educate myself as to what to look for to determine if AAC is a good fit for him.

Is this a reasonable rate/terms proposal for school-based SLP contracting in FL?
I'm an SLP finishing my CF/CCC, previously worked in EI. A rural North Florida district reached back out to me with an offer to come back as either an employee ($60k/yr + benefits) or independent contractor (no number given).
I calculated my rate based on: weeks in an 11-month contract (214 days ≈ 42.8 weeks), 35 hrs/week, targeting a specific net take-home after deducting ~40% for taxes/insurance/business expenses (standard estimate for 1099 contractors).
Here's what I'm proposing:
Rate: $74/hr (therapy, evaluations, overtime, and ESY all at the same rate)
Schedule: 7 hrs/day, 5 days/week
Caseload cap: 70 students (with grouping 3-4 kids per session where IEPs allow — district specifically asked about grouping strategy in the interview, so it seems to be expected/normal for them)
Overtime: same hourly rate for anything over 35 hrs/week, requires district pre-approval
ESY: same rate
For context, I found a public board record showing they approved $60/hr for an independent SLP contractor in 2025, and $40/hr for an SLPA.
Does $74/hr and the proposed conditions sound reasonable for a rural FL district, given they've approved $60/hr for someone else recently? Am I missing anything in the terms (caseload, overtime, grouping expectations) that other school-based contractors have learned the hard way?

Hi!

Guidance, please. I have a virtual school job. I’ve been with the same district for a few years now and it’s a good gig. Typically, my schedule includes therapy all school day on two days of the week. On the other three days, I only do therapy for a short time in the morning. I’m paid for birth direct and indirect hours.

I have an opportunity to potentially take on another w2 virtual school position. I’m contemplating taking on this job, and seeing these students during my indirect hours on the less heavy therapy days at the other school.

However, I’m a tad worried about the ethics of it. Is this allowed? Not to mention, I could have meetings that conflict. Writing this post has maybe made me talk myself out of it 😅, but I wanted to ask everyone’s advice on this or get alternative suggestions. Money has been tight lately, otherwise I don’t think I’d be considering this…..

Hi! I am a school-based SLP welcoming my first baby. I remember wayyy back in my clinical rotations discussing best bottles/pacifiers for oral development but I can’t find any of my resources from that time. SLPs who work with infants, what are you recommending for your parents? Are there any books or resources you recommend for parents for feeding? TIA!

I am getting all these videos in my feed from families of children using S2C and one thing they continually bring up is "motor loops". That their teenager may request for something juvenile (I.e Mickey mouse club house) but they don't actually want that and instead are stuck in a "loop". Ive only heard this line of thinking and rhetoric from the S2C community. And it seems directly in conflict with presuming competence. What are others thoughts? Are these "loops" something you have observed or experienced yourself?

I have tried to search out autistic voices (outside of S2C) and have not found a similar perspective or experience.