Speech Pathology Profession

12 early career tips for Australian speech pathologists and students considering a career in private practice

1 June 2022 By David Kinnane Leave a Comment

About a quarter of current Australian speech language pathologists (SLPs) joined the profession after May 2019; and about half of all SLPs work in private practice.

If you are an early career SLP in private practice – or if you are an SLP student considering private practice as a graduate – here are some early career tips:

You’ve made a great decision: We have a clear purpose. Demand is rising. Our practice scope is widening. Our evidence-base is growing. Technological innovations are accelerating. We’re striving to become more diverse; and to reflect the communities we service. But we’re short on numbers, with mushrooming waitlists. We need you!

Big questions: Who do you want to serve and how? Who do you admire, and why? What’s your timeline? How are you learning and growing? What seeds do you need to plant now? What relationships do you need to build? (Hiatt, 2021)

Long-term relationships and meaningful work > money: You need to be paid properly. But, on our deathbeds, few will care about money or business influence as much as we think we do. Meaningful relationships and useful work matter more. (Coleman, 2022)

Constant change: SLP work is complex, the profession is evolving, and general economic and health system volatility and uncertainty continue to increase. Stay open to possibilities, and keep your options open – don’t deskill. Stay curious. Read widely across many disciplines. Keep learning. Be flexible so you can adapt to change.

What employers want to know: What will it be like to work with you? How will you affect existing team dynamics? Can you learn? Do you take initiative and contribute? Do you take feedback constructively and act on it? Do you ask good questions? (Gallo, 2022)

Criteria to evaluate job offers: Do the practice’s vision, purpose, and strategy intersect with your goals? Do salary and incentives support team and individual growth? What is the job content and caseload? Workload. Respect. Supervision. Training. Safety and compliance. Quality control. Systems and resources. Clear career path. Turnover and burnout rates. Flexibility.

Getting up to speed: Figure out the ‘informal org chart’. Find leaders (supervisors, mentors, colleagues) who help to get things done. Make people around you feel valued, with good listening and engagement. Look for gaps and help fill them. (Cross, 2021)

Professional learning curve: Aggressively expand your ‘Circle of Competence’. Invest and track new technical, communication/advocacy, and leadership skills. Get educated on business: strategies, people management, systems, cost structures, break even, and cashflows. Learn, then share new knowledge. Apply new skills as soon as you can. Contribute new ideas!

Hanging in there! “Patience is annoying…But the truth is, in almost all cases, our most meaningful goals require effort and perseverance – and time…You might have to keep making the effort, even when it seems pointless, boring or hard. There will be dark moments when it’s unclear whether you’re making any progress at all” (Clark, 2021). Don’t give up too early! Professional growth is not always linear and is often a result of conflicting variables.

Don’t job hop for the sake of it: Consider moves only if they’ll increase your skills and opportunities. Fast leaps may not lead to long-term success and contribute to burn out. Don’t be distracted by titles – focus on substance. Think about whether the move will help or hinder your ability to achieve your long-term goals. (Hamori, 2010)

Don’t ‘specialise’ too soon: In the long-term, specialists often prosper. But, if you are unsure, stay general and focus on learning transferable skills. If you decide to focus on one practice area, choose one that’s growing quickly. Retaining intellectual breadth is important. (Gulati, 2012)

You only get one reputation: Relationships matter more than jobs and transactions. Think long-term. Respect your colleagues. Don’t burn bridges. Stay ethical. When you run into conflict – and you will – take the high road and stay professional.

For more, free private practice tips, check out our ‘12 Days of Tips for SLPs in Private Practice‘ series.

For more information about proper supervision of speech pathologists in private practice, download our “How to Supervise Speech Pathologists Properly in Private Practice” book, templates and video course on our Banter Speech & Language clinic website. ⁠

Australian speech pathologists: 13 things you should know about health care complaints and the Health Care Complaints Commission

29 June 2019 By David Kinnane Leave a Comment

As healthcare workers, we share the responsibility to ensure we are delivering health services in a professional, safe, and ethical manner. This week, we attended a very practical workshop hosted by Tony Kofkin and his colleagues from the Health Care Complaints Commission NSW (the ‘Commission’) to better understand the role of the Commission and its complaints management process.

Here are our 13 key takeaways for speech pathologists:

Speech pathologists in Australia are “Unregistered Health Practitioners”, because we are not currently required to be registered under the Health Practitioner Regulation National Law. You can read more about this here.
Speech pathologists in Australia are self-regulated. For example, members of Speech Pathology Australia are bound contractually by the Code of Ethics, and Certified Practising Speech Pathologists are also bound by professional self-regulation professional development and other obligations.
Self-regulation doesn’t mean Australian speech pathologists are completely unregulated, however. Speech pathologists in New South Wales, Queensland, South Australia and Victoria, are subject to “negative licensing” under statutory Codes of Conduct. In NSW, for example, speech pathologists must display and are bound by the Code of Conduct for Unregistered Health Practitioners. This Code of Conduct is set out in Schedule 3 of the NSW Public Health Regulation 2012. A National Code – which is very similar to the NSW Code – has been implemented in South Australia, Queensland, and Victoria, and is being implemented across the other States.
Sometimes, clients, families or others may wish to make a compliant about a speech pathologist. Most of the time, this is best managed directly with the speech pathologist in question. Speech Pathology Australia has a complaints system, including an Ethics Board to investigate alleged breaches of the Code of Ethics. However, people can also make complaints about speech pathologists to the Health Care Complaints Commission (or its equivalents in other States). This is not very common, with the most serious complaints being lodged with Speech Pathology Australia and investigated by the Ethics Board.
The Commission is independent of Government (including the Minister for Health) and is obliged to investigate every written complaint it receives, although protecting public health and safety is its paramount consideration.
The Code of Conduct outlines minimum standards for safe and ethical practice, and includes clauses about:

the need to have a clinical basis for treatment;
competence;
informed consent;
infection control;
improper relationships;
not making claims to cure serious illnesses;
working when impaired (e.g. by mental or physical illness or when under the effects of drugs and alcohol);
professional indemnity and other insurance requirements;
record keeping/progress notes;
first aid;
privacy; and
displaying the Code.

The Code of Conduct for Unregistered Health Practitioners on display at our clinic.

7. Common complaint issues include:

professional conduct, including elder abuse and theft;
treatment, including treatment advice that causes significant harm; and
communication issues, including abruptness and refusal to answer questions.

8. If a complaint is received, the Commission generally seeks records from the speech pathologist. The Commission has coercive powers if you do not respond.

9. Investigations follow a two stage test: (1) Is there a breach of the Code of Conduct? and (2) is there a risk to public health and safety? The Commission can seek expert advice if needed.

10. The Commission has the power to make interim and final prohibition orders, preventing the speech pathologist from providing health services or imposing conditions (e.g. training, supervision) on the provision of health services. Reciprocal arrangements are in place with Queensland and South Australia (but not Victoria) to ensure that prohibition orders made in one of these states apply to the others. In practical terms, this means, as an example, a speech pathologist won’t be able to provide health services in Queensland if a prohibition order has been issued in NSW (and vice versa).

11. The Commission can also make public statements about health practitioners, and/or make comments to the speech pathologist to help the speech pathologist improve her or his practice.

12. If a speech pathologist in NSW is unhappy with the outcome, she or he can seek a review by the NSW Civil and Administrative Tribunal.

13. The Health Care Complaints Commission publishes a Register of Orders on its website. You can access it here.

To access an A3 poster of the Code of Conduct to display at your clinic or business, see the Health Care Complaints Commission’s website here.

Image: httpss://tinyurl.com/y59p35ph

Speech pathologists in private practice: do you know about these free resources?

9 June 2019 By David Kinnane Leave a Comment

As a profession, speech pathologists are generous to a fault. I’ve discovered that most speech pathologists (including very senior academics and over-worked clinicians) are delighted to share their knowledge with those of us in private practice. The key challenge is connecting the dots: carving out the time to find and filter the research, and to then apply it to our practices to improve client care.

Some organisations and professionals are doing terrific work to make it easier for busy speech pathologists to find and translate research into practice. For example, The Informed SLP and many universities are now using social media and new technologies to help practitioners find out about their work. But we could all do more to help bridge the gap between research and day-to-day practice.

To do our bit for knowledge sharing – and to help manage our fear of missing out on the joint Speech Pathology Australia-New Zealand Speech-Language Therapists’ Association (NZSPA) Conference in Brisbane last week – we spent each night of the conference going through the #NZSPAConf tweets to find resources, tools and tips that could help our practice and other private practices to improve client care.

So here is our list, including:

29 useful free resources we discovered (or rediscovered) from the NZSPA Conference tweets last week, with links to the actual tools and resources; and
11 other ideas, including mental models, pending research, and other useful information to help clinicians in private practice.

In most cases, the authors of the resources are clear from the links, although we’ve tried to add in twitter handles (or at least lead author names) where we could find them. Any errors of interpretation are ours alone.

Note that our selection bias was extreme: we chose things that were of immediate, practical, clinical interest to us in a busy private practice; and our interests are wide and eclectic! There were (literally) hundreds of other resources and tips on other topics that we could have shared from what was by any measure an amazing conference.

If you know of (or created!) other free evidence-based resources that would help private practitioners, please feel free to let us know, and we will add them to the list!

Other clinically relevant things I found out about from the NZSPA Conference tweets:

Image: httpss://tinyurl.com/y6953792

Happy New Year!

11 January 2019 By David Kinnane Leave a Comment

Happy New Year to all our friends, followers and fellow speech pathologists! We wish you all the best with your practices in 2019.

We’ll be uploading lots of new products this year, so feel free to check back in on a regular basis.

Hope you like our new video and feel free to contact us at hello@speechiesinbusiness.com.au if you’d like to get in touch.

Speechies in Business

Speechies in Business is owned and operated by David Kinnane, a Certified Practising Speech Pathologist, lawyer, writer and speaker in private practice in Sydney, Australia. You can read more about David’s professional background, qualifications and experience here. David also co-owns and co-manages Banter Speech & Language, an independent private speech pathology clinic, and Bodkin Wood Legal & Advisory, a law firm specialising in allied health issues. David sits on Speech Pathology Australia’s Ethics Board and Professional Standards Advisory Committee and is a part-time Associate Lecturer at the University of Technology Sydney’s Graduate School of Health.

How can we make speech pathology private practice more ‘hospitable’ for our staff and ourselves?

4 November 2018 By David Kinnane Leave a Comment

Workplace stress!

1. Most private practice owners feel it

In a typical month, we might experience cash flow issues caused by late payments and unexpected bills, fake and anonymous online reviews, unexplained spikes in ‘failures to attend’, data privacy challenges, client complaints, social media ‘run-ins’, the odd family law-related subpoena, glitches in clinic and business management systems; and of course staff issues, like motivation and performance challenges, staff turnover and handover problems, and puzzles like how to coordinate staff leave and client coverage. I felt my blood pressure rise just typing that list!

2. Staff feel it too

When I speak with grads and others who are in their first couple of years of practice, I hear lots of anxieties about speech pathology graduate numbers (particularly in cities), cost-cutting initiatives due to increased competition and privatisation (e.g. reduced hours, cuts in training budgets), limited supervision and mentoring, insufficient “admin time” to call back clients and write reports (and expectations on staff to regularly work outside contracted hours), and struggles to get reimbursed for resources, equipment, petrol, parking and other work-related costs. And I still hear too many stories about straight out ‘shonkiness’ like underpayment of award and other entitlements, sham contracting arrangements, unpaid “internship” offers, and overly restrictive employment contracts.

3. Clients pick up on our workplace stress

One thing I’ve observed in my practice is that clients are very good at picking up on when things aren’t going well behind the scenes. Regardless of how well we try to insulate clients and client care from “back of house issues”, even very young clients can pick on on workplace stress – even when everyone is smiling and pretending everything is fine. And no one wants a grumpy, distracted speech pathologist, even if they are doing a good technical job.

4. Is this just how it is?

Is the stress just reality? Should we all just get used to being stressed out? If so, I can understand why so many of us leave the profession so early.

So what can we do to right the ship? Even if we can’t remove the stressors, how can we make work-life better – for owners and our staff?

5. If you can’t take the heat…air-condition the kitchen?

I’ve been looking recently at what others do in other high stress, people-focused occupations. One of the most stressful industries out there is hospitality.

I’ve written before about the importance of learning from other industries, e.g. in how we handle negative online reviews. I think we can learn a lot from how leading restaurant owners – people with skin in the game – have tried to improve their workplace culture despite the headwinds of stress.

One of the most successful restaurant owners in the USA is Danny Meyer, owner of the Union Square Cafe and Shake Shack. And he has some provocative – and useful – tips on how to succeed. Below, I’ve tried to translate some of his key ideas for speech pathologists in private practice.

6. Change your focus, change your reward system, change your culture, change your outcomes

(a) The Big 5

All businesses, including private practices, have 5 key stakeholders:

customers/clients;
staff;
communities in which we operate;
suppliers; and
owners/investors.

(b) Going beyond just providing a service

Obviously, speech pathologists provide a service. “Service”, here, is just the word for the technical delivery of what we do. Offering a good service means that you are offering something of value to people that works.

Providing a quality service is of course necessary if you want to stay in business for long. But many clients want more than just a contractual exchange of services for money.

Many clients want what Danny Meyers calls “hospitality”: speech pathologists not just providing services to clients, but going above and beyond the call of duty for their clients.

(c) Staff come first

Now here’s the counter-intuitive part of Meyer’s philosophy. He says that, if you want to offer true hospitality to clients, you need to start by treating your staff well and rewarding them, first, for helping each other:

I’m going to give you guys the best recipe you’ve ever had in your life. And it only has two ingredients. So it’s really simple. It’s 49 parts performance and 51 parts hospitality. And that’s what you are going to be judged on. That’s how you’re going to get paid. That’s how you’re going to get your bonus. And guess what guys? In this business, the customer is going to come second.

(d) But isn’t the client always right?

Radically, Meyer says no: “No one is right all the time”.

In Meyer’s businesses, staff come first. Each staff member is responsible for doing extraordinary, expected things for each other. For showing off to each other: to model what it’s like to be great at what you do. And to show what it’s like to make other staff feel good.

Meyers says this to his staff:

You’re responsible for doing extraordinary, unexpected things for each other and showing off for each other what it’s like to be great at what you do and even greater, 51%, at how you make people feel and I believe that if you do that for each other, our [clients] are going to be in for a treat when they come in and they’re second.

(e) Virtuous cycle

Focus on your team, your customers, on hospitality, on your culture.

By doing so, you create a long term “virtuous cycle”, a compounding loop that will ultimately lead to greater long-term success.

The key point, here, is as follows:

If you do not invest in your team – if the are not rewarded for going above and beyond the call of duty to make clients feel welcome, pleasantly surprised and delighted – then the virtuous cycle will break. As Meyer says:

I think it gets back to servant leadership, which is: how do you find opportunities on a daily basis to take care of the people who are ultimately going to take care of you? And I inculcate it by talking about it till people roll their eyes because they’re so sick of hearing me talk about it. And I just feel like culture is driven by language. I don’t know any culture in the world that is not glued together by language. Whether it’s your family, your religion, there’s language. And I think that the CEO of a company is the shaman of that culture. And they either have to be more fluent at that language than anybody else or the language is going to go sideways and lose its very special meaning.

And what better message could you give a speech pathologist! We need to communicate better with staff – and to speak to each other in the language of hospitality. If we want to work with people we respect, in workplaces we enjoy, and in businesses that we’re proud of, and in achieving long term success for our clients and practices, hospitality begins with learning to treat each other better – even if it costs practice owners more in the short-term.

Principal source: Reid Hoffman’s interview with Danny Meyer on Masters of Scale.

Image: httpss://tinyurl.com/y732qnxu

Tool/resource	Links	Credit/contact
The Squirrel Story (narrative Ax with Australian norms)	httpss://www.languageandliteracyinyoungpeople.com/apps-resources httpss://www.blacksheeppress.co.uk/product/squirrel-story-narrative-comprehension-assessment-nca/ httpss://www.blacksheeppress.co.uk/wp-content/uploads/2018/02/SquirrelNCA_IntActForm19feb.pdf	Suze Leitao @Suze_Freogirl, Emily Dawes @emilydawesSLP and team at Black Sheep Press (UK)
Oral inferential comprehension intervention for children with #devlangdis (full free Rx resource)	httpss://www.dropbox.com/sh/sh93neh6ql658xq/AADrIdNSms49Pr9el9D_51eda?dl=0 httpss://journals.sagepub.com/doi/abs/10.1177/0265659018815736?journalCode=clta	Emily Dawes @emilydawesSLP, Suze Leitao @Suze_Freogirl and team
Health literacy and SLP Report Writing presentation (the slides themselves are a master class in Plain English, and clear expression)	httpss://www.harmonyturnbull.org/2019/06/03/conference-presentation/	Harmony Turnbull @SP_Harmony
PEERS for Young Adults program for social skills (free social communication videos)	httpss://www.routledgetextbooks.com/textbooks/9781138238718/videos.php	Elizabeth Laugeson
Marleen Westerveld’s free resources, including discourse level narrative, retell tasks and a free photo bank you can use for a variety of receptive and expressive oral and written language tasks	httpss://www.marleenwesterveld.com/resources/	Marleen Westerveld @MWslp
A treasure trove of Phonological Awareness Resources (University of Canterbury)	httpss://www.canterbury.ac.nz/education/research/phonological-awareness-resources/	Gail Gillon @gailtgillon
Accessible information about speech, language and communication	httpss://www.speakupsalford.nhs.uk/	Via @speechiemsm
ERLI (comprising 120 typical first words and gestures, developed for young children in remote Northern Territory, but of potential use for many other populations, too)	httpss://www.facebook.com/pg/EarlyRemoteLanguageInventory/photos/?ref=page_internal	Caroline Jones and colleagues
PFASE (free e-course on paediatric feeding!)	httpss://central.csds.qld.edu.au/central/courses/219	Clinical Skills Development Service (Queensland)
OZI-SF (Australian MacArthur Bates vocabulary Ax) – watch this space!	httpss://journals.sagepub.com/doi/abs/10.1177/0142723716648846?journalCode=flaa	Marina Kalashnikova and colleagues
ReST (evidence-based CAS treatment)	https://sydney.edu.au/health-sciences/rest/	Tricia McCabe @tricmc and colleagues at the University of Sydney
TIDieR – Better Reporting of Interventions descriptions to allow better replication (checklist/guide)	https://www.equator-network.org/reporting-guidelines/tidier/	Tammy Hoffmann and colleagues
Free – Sampling Utterances and Grammatical Analysis Revised (SUGAR)	httpss://www.sugarlanguage.org/	Bob Owens and Stacey Pavelko
Decoding Dragon to chase away the guessing monster (literacy)		Lyn Stone @lifelonglit
Michigan 10 key skills for early literacy instruction	httpss://memspa.org/wp-content/uploads/2017/10/Booklet-FINAL-9.14.17.pdf	Via @tricmc
Liberator AAC resources and information	httpss://liberator.net.au/support/education	httpss://liberator.net.au/
MOSAIC Online Ax for observations of people withintellectual disabilities	httpss://www.mosaiccommunication.com.au/	@AndySmidt
Intelligibility in Context Scale	httpss://www.csu.edu.au/research/multilingual-speech/ics	@SharynneMcLeod
SoundLog Noise Dosimeter	httpss://itunes.apple.com/au/app/soundlog-noise-dosimeter/id1063941394?mt=8	Australian Hearing Services
Ottawa Patient Decision Aid to support families	httpss://decisionaid.ohri.ca/
Drooling Quotient	httpss://www.aacpdm.org/UserFiles/file/drooling-quotient-instructions.pdf	van Hulst and colleagues
Drooling Impact Scale	httpss://www.aacpdm.org/UserFiles/file/The-Drooling-Impact-Scale.pdf	Susan Reid and colleagues
CSDRNetwork Transcription Guidelines (Guidelines Relating to Clinical Management of Child Speech Disorder \| North Bristol NHS Trust)	Guidelines Relating to Clinical Management of Child Speech Disorder	Via @speechieellie
Promoting use of home languages:YouTube Resources from NSW Health SESLHD	How Childcare Educators can support bilingual children?:httpss://www.youtube.com/watch?v=z-7-KN4gFCc Helping your child learn two languages: httpss://www.youtube.com/watch?v=PIrD7PkeDdg
Youth Voices in Youth Justice	https://talkingtroublenz.org/presentations-publications/youth-voices-about-youth-justice/	Talking Trouble NZ
Multilingual Language Ax	The Alberta Language Development Questionnaire ALDeQ (Paradis) – questionnaires, intended to be administered in interview Non-word Repetition Task	Johanna Paradis Dollaghan & Campbell
Multilingual Speech Ax	httpss://www.csu.edu.au/research/multilingual-speech/speech-assessments	@SharynneMcLeod
Office Lens (App) totake photos of whiteboards and presentations (free)	httpss://itunes.apple.com/au/app/microsoft-office-lens-pdf-scan/id975925059?mt=8	Via @robertPwells
Boys and literacy acquisition	httpss://digitalmediaprojectforchildren.wordpress.com/2019/04/19/boys-and-literacy-acquisition-introduction/	@ProfRvach

Topic/issue/model	More about it	Research to watch/follow
New tongue tie research		Holly Salt, Sharon Smart @sharonsmart79, and Mary Claessen @SpeechMary
More about the duty of Care vs Dignity of Risk, including in the context of dysphagia	httpss://www.dailymotion.com/video/x6btzqu	Via @emilywaites
New drooling research on its way		Michelle McInerney
Linda Worrall’s 7 Habits of Highly Effective Aphasia Therapists Goal Setting model for aphasia (SMARTER): Shared, Monitored, Accessible, Relevant, Transparent, Evolving and Relationship-centred (Hersh et al., 2012)		@aphasiologist1
Watch out for soon to be published systematic study about Childhood Apraxia of Speech + evidence-based tips to help us to differentially diagnose Childhood Apraxia of Speech		@LizMurraySpeakand colleagues via @speechiellie
Launch of the Centre of Research Excellence in Aphasia Recovery and Rehabilitation	httpss://www.latrobe.edu.au/research/centres/health/aphasia
More on the effects of classroom noise on language comprehension		@SamHarkus Australian Hearing
Why classroom acoustics are an issue for SLPs		Rebecca Armstrong @bec_armstrong18
4 dimensions Maori health model (NZ)	httpss://www.health.govt.nz/our-work/populations/maori-health/maori-health-models/maori-health-models-te-whare-tapa-wha
Better Scientific Posters design templates	httpss://osf.io/ef53g/
Excellent review/discussion of the Simple View of Reading	httpss://www.tandfonline.com/doi/full/10.1080/19404158.2019.1609272	Kate Nation @ReadOxford