We present a guest article from Kerry Bray, a Speech and Language Therapist (SLT) colleague and friend from Hackney, East London. Last year Kerry moved to New York City, to marry a lucky American. When her visa allowed it, she started working as a Speech and Language Pathologist (SLP). Here are some of Kerry’s observations on the similarities and differences between working as a SLT in the UK versus a SLP in the USA. Thanks Kerry!

I have been working here in New York for the last three months, and finally feel like I am getting to grips with the major similarities and differences in the professional structures and roles. It is pretty different in practice here, because the organisation of health and education is structured and funded so differently. I wouldn’t say that children receive a better or worse service in either country—there are major pros and cons to both systems.

Twice-weekly therapy sessions

Here most SLPs have a full day of pure therapy, carrying out about 10 sessions a day, mainly seeing individuals and small groups in schools or pre-schools. On average, children receive therapy two or three times per week, for half an hour. Speech and language difficulties are almost exclusively addressed at the impairment level, and there is no expectation of carry-over into the classroom or the home. Although there is lots of literature encouraging work at the activity and participation level, many therapists are paid per session—since paperwork, liaison, and training cannot be billed, it seems like there is no incentive or time to work at this level.

Seeing children so frequently, on an ongoing basis, means they make lots of progress, and you have a chance to really get to grips with each child’s strengths and needs. There’s also a surprisingly small amount of paperwork here, compared to the UK. We write just one line of progress notes per session per child, plus statistics. Each child is then evaluated once per year, and a short report and targets are written.

I arrive at 8:30 am, leave at 3 pm, and I’m paid a liveable wage (I haven’t compared salaries, as I am paid per session here.) A lot of people also do extra work in the evenings, and even at weekends.

Buying your own resources

A major downside here is that in some settings you are expected to buy your own resources.  I work in a special school one day a week, and a pre-school for the other four days. At the special school, the SLP had to buy her own colour printer and laminator. At the pre-school, these things are supplied, but there are few shared toys, or other therapy materials. As you can imagine, it takes a lot of time and money to build up resources for a huge range of abilities—I need resources for children with Profound and Multiple Learning Difficulties (PMLD), Autistic Spectrum Disorders (ASD), Oro-motor needs, or five-year-olds with language delay.

Trying not to generalise

I need to be careful not to make too many generalisations—I’ve only done volunteer work for a private practice, and paid work in three different settings, through an agency. However, I have talked to a lot of therapists, and I am always trying to find out whether my experience is typical, or not.

Are any of my British friends interested in working here? I’d be happy to answer any questions about working in the USA, versus the UK.

We’d love to hear views from SLTs and SLPs in the USA, the UK, and around the world—what are the similarities and differences between your experiences and Kerry’s? Please add a comment!