The Many Hats of the SLP

Elizabeth Ulreich-Moran
Aug 1, 2019
4 min read

The Speech-Language Pathologist's Scope of Practice:

From evaluation to treatment of pediatric through geriatric populations across a variety of settings, learn more about a field that helps people form all walks of life on this journey of life.

"Oh, I thought you only worked with kids who have lisps or with kids who stutter...[enter look of confusion]."

Contrary to popular belief, the role of the speech-language pathologist (SLP) is vast. Let me tell you a little story about how I came across the field of speech-language pathology and what attracted me to it. I hope it's as eye-opening to you as it was to me!

Intro to Communication Disorders

I remember being in college and trying to decide on my major. Which path was I going to take? (More on my journey in another post). I decided to take the Intro to Communication Disorders course as I needed 3 more credits that semester.

What did I know about the field? Very little. I knew my brother had received services through early intervention and vaguely remember those sessions - bubbles - lots of bubbles came to mind.

It was my hope that I'd find out if the field of professionals who work with children was going to be the right fit for me.

It had to have been in the first or second class where I learned that SLPs do more than just work with children. [Enter my mind being blown away]. I'm fairly certain this was the first time my attention was grabbed in a class. I knew from that moment that this was the path I was going to take.

"Did you know that I can work with adults?!? I can work with people who have had strokes! I can work with people who have had concussions or traumatic brain injuries! I can work with people who have lost their voice! I can work in a school, early intervention, outpatient clinic, hospitals, nursing homes, home health care....The possibilities are endless!"

I remember constantly disclosing all of the facts I learned in this class on the phone with my parents. I was excited! Who knew a field could offer so much opportunity?

Who also knew how long I'd continue to explain what it is that I do on a daily basis throughout my career?

The Scope of Practice for the SLP

Yes, it's true. We work on more than lisps and stuttering, and we work in facilities other than schools! The following lists were adapted from ASHA. Link in references below!

Domains SLPs May Screen, Evaluate and Treat

Speech

Articulation (speech sound production)
Phonological (speech patterns)
Motor planning and execution
Accent/dialect modification

Language

Phonology (individual sounds)
Morphology (words and how they're formed - nouns, verbs, adjectives; singular, plural, etc.)
Syntax (sentence structure)
Semantics (meaning of language)
Prelinguistic communication (joint attention, communicative intent)
Paralinguistic communication (nonverbal communication: gestures, body language, signs)
Literacy (reading, writing, spelling)
Expressive: how we use language
Receptive: how we understand language

Voice

Quality (hoarse, raspy, strained, breathy)
Pitch (too high/too low)
Loudness (too loud/too soft)
Alrayngeal Voice (esophageal speech, electrolarynx)
Preventative vocal hygiene (see my Healthy Vocal Habits post!)
Gender affirming voice and communication

Resonance

Hypernasality (too much resonance in the nasal cavity)
Hyponasality (too little resonance in the nasal cavity)
Cul-de-sac resonance (resonance is trapped on one cavity due to an obstruction)
Forward Focus (resonance in the front of the mouth/face)

Swallowing/Feeding

Oral phase (mouth)
Pharyngeal phase (throat)
Esophageal phase (esophagus)
Atypical eating (food aversion, negative response, hypersensitive gag reflex)

Fluency

Stuttering (flow of speech is interrupted by repetitions, prolongations or blocks)
Cluttering (excessive breaks due to disorganized speech pattern, difficulty communicating meaning)

Cognition

Attention
Memory
Problem Solving
Executive Functioning (organization, reasoning, judgement)

Pragmatics

Social Communication (eye contact, body awareness, etc.)

Auditory Habilitation/Rehabilitation

Auditory processing (difficulty processing what is heard)
Communication and listening skills impacted by hearing loss, deafness

Augmentative and Alternative Communication (AAC)

Using high-tech or low-tech devices for patients to access communication

Additional Services

Business communication
Professional voice use
Public speaking

Etiologies (not a comprehensive list)

Neonatal problems
Developmental disabilities
Oral anomalies
Disorders of the aerodigestive tract
Respiratory compromise
Pharyngeal anomalies
Laryngeal anomalies
Neurological disease/dysfunction
Psychiatric disorder
Genetic disorder
Orofacial myofunctional disorders

For more details, check out the list on ASHA!

Facilities of Employment

Schools

Preschool
Elementary school
Middle school
High school
Special Education School

Hospitals

Acute care - including ICU, PICU, NNICU, subacute rehabilitation unit
Long-term Acute Care Hospitals (LTACH)
These are the primary, but not the only, settings where SLPs perform Modified Barium Swallow Studies and Fiberoptic Endoscopic Evaluation of Swallow studies.

Skilled Nursing Facilities (SNF)

Short-term care unit
Long-term care unit

Home Health Care

For homebound patients

Outpatient Clinics

Community or hospital based
Specialized multi-disciplinary teams, such as craniofacial or ASD

Early Intervention

For the birth to three population

There's More? YES! We are also:

Advocates
Supervisors
Educators
Administrators
Researchers
Counselors
Collaborators
Mentors
Advisors

Did I miss anything? Comment below!

In Closing

I love sharing the role of the SLP with others. It's such a wonderful conversation starter! These conversations often end in, "Wow! I had no idea!"

Being in private practice, I've learned how valuable these conversations are. These conversations have also taught me a lesson - I may never fully know the scope of another professional's line of work. So I ask!

Engaging in these conversations serves a primary purpose: patient-centered care. I love learning about other professionals so that I can build a resource pile and refer out!

Do you have a specialty area? Share it with me! I'd love to add you to my referral list.