I book my appointments in Cliniko, and it synchronises with my personal and family calendars on iCal. For privacy you can adjust the level of information displayed in iCal, choosing first name, full name or initials. It’s straightforward to book clients in for blocks of sessions and Cliniko emails the parent a reminder before each session. I’ve set it to go out 2 days before the appointment, at 10am. The email simply reminds families of the date and time of the upcoming therapy session, which parents tell me they find useful.

I write my clinical case notes using a form that I’ve customised. It’s a mix of check boxes (e.g. where the appointment was and who the child attended with) and free form text boxes for things like the session’s aims and information about how the child responded. It’s easy to look back over past sessions and see how the child is progressing.

The other features I use are invoicing and file attachments. You can upload your company logo to Cliniko and make a professional looking template for invoices. It’s quick to produce them and the system can either email the invoice to the client directly or you can save it and email it yourself. It also lets you track who has and hasn’t paid. I use the file attachment feature to upload documents to each patient’s record. I scan in the case history form and any assessment record sheets – once you’ve made a pdf, it’s a drag and drop interface to add them to a patient’s record. I also upload all the reports and letters I write so they’re in one place, secure and available whenever I need them.

There are some fun touches, like it reminds you when it’s a client’s birthday, as well as lots of features that I don’t yet use. For example it supports clients booking their own appointments directly online, via your website. You can also use it to track your business expenses.

Cliniko has allowed me to run an (almost!) paperless business. I can write and review case notes wherever I am. And the automated appointment reminders increase attendance rates. I recommend it. (I pay for my Cliniko subscription, and they don’t know I’ve written this review!)

I kept two principles in mind when deciding what I needed to buy or borrow to start my therapy business:

• Wait and see what I need and then buy it – with internet shopping lots of things are available on next day delivery.
• Buy things that can be stored easily and used for multiple purposes – as I’d need to store everything at home and then carry it to therapy sessions.

Assessment materials

I bought two standardised assessments, my most expensive purchase. I’m happy with the two I chose and how many times I’ve used them. The publishers have displays at industry conferences or events and offer discounts, so if you’re planning on going to an event and need to buy assessments check and see if the timing works out.

I also use informal measures like Language For Thinking and sequencing pictures from Black Sheep Press. Some observation schedules are available for free online, like the Modified Checklist for Autism in Toddlers – so I use these.

Toys and books

My colleagues in the NHS asked what I’d like as a leaving gift, so my toy collection started with a tea set, a train set and Mr Potato Head! I bought toy animals, food and a fishing game. My parents still have toys from when my sisters and I were little so I “borrowed” soft toys and books from them. (Check the content of books, I love There’s a Hippopotamus on Our Roof Eating Cake but in my original copy, the character gets a smack: I skip this page.)

I’ve found some great bargains at charity shops and bought things to motivate particular clients. Homemade toys often go down well too, I still have the sparkly tube I made back in 2008 and still get strange looks carrying it to work on the bus!

Technology

I use my iPad in therapy. I record and watch back videos in Parent Child Interaction therapy, with a small set of speakers to boost the audio. I also use it to play games such as my favourites from Toca Boca. When I made a snakes and ladders style game to work on speech sounds, I realised I didn’t have dice, so I downloaded a free app (I think it’s for poker!)

We already had a colour printer and scanner at home, and I use both regularly. I bought a laminator and I use it for making visual timetables and other resources. I’ve written before about Lessonpix – the online product I use to make my visuals (and bingo games!) Finally, I use Cliniko to manage my appointments, write my case notes and send invoices. I’ll write more about how I use it in the next post.

Other bits and pieces

I bought two folding child sized tables and four chairs which I used for every session in my original therapy rooms and currently don’t use at all.

And my secret weapon? A box of tissues. I’ve finally realised that if I bring the tissues, I’m much less likely to get sneezed on!

This blog post is part of a series, read the previous posts here.

I feel uneasy talking about money here on the blog and in real life with clients. Kathleen Shannon has some useful advice in her Money Mojo post. Kathleen works with creative entrepreneurs and while that’s not how I’d describe myself, the Braid Creative blog is a wonderful resource. Kathleen encourages readers to “sell your goods with confidence” and talk about money, so here goes.

Prices

People starting their own therapy business ask me how I decided what to charge. I searched online for therapists in London, to see how much other people were charging. Then I calculated each therapist’s hourly rate. There was quite a range! I looked at how experienced each therapist was, and what they specialised in. I estimated my monthly costs, considered how many days I wanted to work and how much money I needed to make.

I want to be transparent about money; I decided on an hourly rate, and I charge the same for everything that I offer: assessments, therapy sessions, report writing, school visits and travel time. I publish this information on my website. I think parents want to know what therapy costs when considering therapy for their child. And it saves me time; if my prices are more than a parent wants to pay, they can see this on my website before they call me – much easier.

Payments

I started out accepting cash, cheques and bank transfers, on a session by session basis or for a half term’s worth of sessions. I’ve gradually changed this, now:

• I require a deposit to confirm the initial booking.
• Parents pay in advance for a block (a half term) of sessions.
• I accept payments by bank transfer, online via Paypal, or in person by credit or debit card.
• I don’t accept cash or cheques.

This is working well for me. It means I deal with “billing” just once every half term, and I’m not going to the bank every week, or chasing late payments. As parents are paying in advance they think about whether they can make all the sessions; the number of cancellations due to clashes with other appointments has decreased. I was apprehensive explaining this new policy to parents who were used to paying in cash after each session. No new clients have questioned it.

PayPal Here Chip and PIN card reader

I bought this card reader (on a special offer of £49.95). PayPal charge a 2.75% fee, I’m happy to pay for the convenience. It’s a great little gizmo, that works via a bluetooth connection to my phone. As long as I remember to charge the device, it’s quick and easy to take payments. It can send a receipt by email or text message.

Accounts

I’m self employed, I got advice from an accountant before I started seeing clients and I pay for support with my taxes each year. I keep a simple spreadsheet to record the money coming in, and going out and have a separate bank account, although it’s not required.

Is there something else you want to know about the money side of setting up my therapy business? Get in touch. Next up: resources, what do you need and what can you manage without?

This blog is part of a series about Becoming Independent.

I don’t have space to see clients at my flat. I needed to decide if I’d go and visit people, or rent a therapy room and have clients come to me. When I calculated how much time I’d spend travelling from family to family, I realised I’d only be able to see 4 or 5 clients in a day. It made more sense for me to rent a room, I’m able to book in between 6 and 8 clients a day.

There are of course advantages to seeing clients in their own home or educational setting. There are also advantages to seeing people in a distraction free, neutral space where both children and their parents can focus on the therapy session.

I work part time, so I looked for rooms I could rent by the hour or day. I’ve used 5 different therapy rooms and learnt what’s important to me, here are some things to consider.

Where is the room?

I look for somewhere close to public transport. One of my current rooms has a car park which is a bonus. Families have also commented that they enjoying coming somewhere close to cafes and shops. I decided not to work from one practice that looked gorgeous during the day, but felt isolated at night, I didn’t think I’d feel safe.

Is it accessible?

Think about the access. If you work with pre-schoolers like I do, they may arrive in pushchairs. My first therapy room was up 3 flights of stairs. They may also be in the process of toilet training, how far away is the toilet?!

Is there space for your clients to wait if they arrive early? Are there any resources you can borrow, such as child sized furniture or musical instruments? Is the room suitably furnished, or will you need to remove fragile things before getting started each day? How often is it cleaned? Is there any storage you can use?

What are the rental terms?

The places I’ve worked from have varied hugely in terms of the admin, and payment terms. Two places required me to sign a contract, provide my insurance information, and give notice if I wanted to stop using the room. Others have been more flexible. When I was gradually returning to work after maternity leave, I chose a room I could book on an ad hoc basis to minimise the risk of paying for a room I wasn’t using. Then when it wasn’t available on the days I needed, I found a room where I book 6 sessions at a time, but don’t need to sign a contract. I was surprised that when I asked for a discount, one place was happy to give me one.

What’s not essential but nice to have?

I like the idea of having access to a kitchen, but in 18 months I’ve only made myself 1 cup of tea! I do use the sink to fill and empty buckets for water play though. I thought wireless internet access would be useful, but on the rare occasions I’ve needed my iPad online, I’ve tethered it to my phone.

Referrals and other benefits

It might be worth thinking about what other businesses or services work at any location you’re considering, as they may be able to refer people to you. Some venues offer other incentives: when I rented a room in a wellness centre, I was considered a “teacher” and could go to yoga classes for £1!

Each time I need to look for a new therapy room I feel overwhelmed, something always comes up though! If you have questions about finding a therapy room leave a comment or email me.

This post is part of a series, I wrote about how I advertise my service and how clients contact me in previous posts. Coming next pricing, billing and all things money.

People have asked me how I advertise my practice. When I ask clients how they found me about half say someone they know recommended me. Some tell me they found me via the ASLTIP directory, and the rest searched google and found my website.

Encourage Personal Recommendations

Happy clients tell their friends! I’ve worked with a former client’s next door neighbour, been contacted by a woman who said her sister’s friend suggested me, and had parents recommended me to their child’s classmates.

I told people in the NHS and education department where I used to work, that I was leaving to work independently, and I’ve had enquiries and recommendations from them. I also tell people I meet that I’m a paediatric SLT – I once worked with my yoga teacher’s son! So carrying business cards is useful, I have these mini ones from moo.

I receive personal recommendations from other independent SLTs in the local area. Several friends work on a part-time basis, or specialise in particular areas of therapy. When these therapists receive an enquiry from a family they don’t want to take on (for various reasons) they recommend the family contact me. And I signpost families to particular colleagues if I think they’ll be a better fit for the child.

Use the Directory of Independent Speech and Language Therapists

I am a member of the Association of Speech and Language Therapists in Independent Practice so have an entry in their directory. Parents who find me here often haven’t seen my website, so they aren’t always aware of how I work and my prices.

Finding My Site by Searching on Google

I haven’t tried paying for google ads. I attempted to make my site findable by thinking about what parents might search for and including relevant content. I write blog posts about things I hope parents will be interested in, and I added myself to google maps. You can use a free or low cost service, like Squarespace, to make a website without having to hire a designer.

What didn’t work?

I haven’t had much success with adverts. In 18 months I’ve had two enquires from a (free) advert on netmums. I spent £20 on an advert on a local parenting website (I think they also included me in their newsletter) which didn’t generate any interest. I’ve written articles about communication development that were included in local parenting magazines, but again these didn’t lead to any enquiries.

I emailed around 25 local nurseries to introduce myself and explain what I could offer, attaching a pdf of a flyer I’d made. This led to me meeting one nursery manager, and then assessing one child and running a staff training session. So, it wasn’t a complete waste of time, but didn’t keep me very busy.

This post is part of a series about Becoming Independent. Next up, choosing where to work.

Several therapists working in the NHS have emailed me to ask my advice about starting their own therapy business. I thought I’d share what I tell them here, in a series of posts. I started working independently about 18 months ago, I’m not claiming to have all the answers! I’ll write about what works (and doesn’t) for me, here in London; you can decide if it’s relevant to you and your situation.

How do potential clients contact you?

I already had an email address I used for work, so I kept using it. My work phone number was more complicated. I see my clients in a rented therapy room (more on that coming soon) and do my admin at home. We don’t have a landline phone, and I didn’t feel happy putting my mobile number on the internet. So I bought a Skype phone number. I selected a London area code, and for £3.35 a month I have a work phone. When someone calls the number, Skype rings on my desktop computer. If I’m out and about and expecting a call, I can open the Skype app on my mobile, and that’ll ring too. The number has an answer phone, and Skype emails me when someone leaves a message.

When a family books a therapy session I give them my mobile number, so I know they can reach me if they’re running late. This set up is working well at the moment.

I only use this number for work so I’ve made my answer phone message specific. I ask callers to tell me where they live and how old their child is. This helps me filter my enquiries. I’m able to call parents of older children straight back and explain I only work with under 7s. As well as check my availability in a particular location (I work in 2 different places) before returning a call.

Short form on the website

I also have a form on my website that parents can fill out to get in touch with me. It’s a free service by Wufoo. One of the questions on the form is: What are you concerned about in terms of your child’s speech, language and communication skills? The way a parent answers this question sometimes gives me an indication of how involved they’d like to be in the therapy process. 

This post is the first in a series about Becoming Independent. I’ll write about how potential clients find my details in the next post.

Photo by Álvaro Ibáñez

Since setting up in independent practice I’ve had almost weekly emails from people who want to train as speech and language therapists. They explain they need to gain relevant work experience and ask if they can come and shadow me during therapy sessions with my clients. 

At the moment I can’t see how having someone observe me carry out therapy benefits my clients, who are my customers. So I’ve been politely explaining that I don’t offer shadowing opportunities for this reason. Am I missing something? Do you deal with these types of enquires differently?

I tend to suggest that people contact their local NHS service; when I worked in the NHS we offered half day observation sessions. Back when I was looking for relevant experience before applying to train as a therapist I had lots of luck with my local volunteer centre. They matched me to a weekly Stroke club and a summer day camp for children with Down’s Syndrome. I received training and worked alongside therapists, during both of these placements.

The guidance for applying for a place on a speech and language therapy degree course says applicants need to demonstrate awareness of client needs and the skills required to work as a therapist. I wondered if I could put together a short workshop that would support the people who ask to shadow me with their applications. I could cover things like:

• an introduction to the range of clients I work with, and their needs, with video examples,
• an introduction to different types of therapy, and ways of working,
• workshop exercises to demonstrate and practise the core skills therapists require,
• a reading or resource list, particularly those written by people with speech, language and communication needs or their families,
• suggestions for how to approach therapists, to ask for observation experience,
• an opportunity for questions and answers.

What do you think? Does this sound useful? If you’re in the process of applying for a therapy degree course would you attend?

Photo by crabchick

I came across LessonPix, it’s an online product, there’s no software to install or CD to lose, and I can use it on any computer that has an internet connection. The cost is $36 (USD) per year for an individual subscription, which converted to £22.62 when I paid online with my credit card. It’s less than £2 a month, and as there’s no CD to receive by post you can get started straight away.

I’ve used this resource every week since I bought it, and I recently renewed my subscription for a second year. I’ve made all the usual things, such as symbols for visual timetables using the picture cards template. I’ve also tried out new materials, my clients have enjoyed the games like dominos and board games. I even made a bingo game with s cluster words for a client’s birthday!

To make a resource you simply search for the pictures you want to use and drag each one into your “tray.” You then choose what materials (picture cards, now and next board etc) you want to make, and the site produces a PDF. You can save your trays to easily make different resources with the same pictures later on. As the finished resource is a PDF you can print it from any computer, you don’t need to be signed into the site. I store all my resources in Dropbox, so if I forget to print them, I can always pull them up during sessions on my iPad.

It is so quick to use that it’s easy to personalise the resources for each child, simply putting their name in the title is a detail they appreciate. You can upload your own pictures and photos to the site and then use them to make resources in the same way. If you’re using words with the pictures, you can replace any of the existing labels with your own words – which means the USA / UK English differences aren’t a problem; just search for ‘faucet,’ choose which picture of a ‘tap’ you want, and change the label!

The only thing I’d advise you to watch out for is getting signed out of the site. If I sign in and start filling my tray to build a resource, then get distracted and come back later, the site sometimes automatically signs me out. If I don’t notice I’ve been signed out and finish making the resource, and produce the PDF (when I’m not signed in) the PDF has large watermarks on it and I have to re-do it.

The service was designed and built by Lori and Bill Binko, a husband and wife team in Florida. Bill is an active Twitter user, where he responds to therapists’ queries and lets people know about special offers. It appeals to me that they promote their service by providing useful information and responding to feedback. The gorgeous pictures of Florida sunshine (on Twitter) can be hard to take during winter here in London though! The site has a friendly feel, for example, if you can’t find the picture you need, simply click ‘request an image’ and let them know what you think is missing.

I wasn’t asked to write about LessonPix, (I paid for both of my annual subscriptions) I’m choosing to spread the word about a product I find useful. My subscription to LessonPix has met my needs; I can produce engaging, personalised, visual materials quickly and easily. It’s so affordable and easy to use that I feel happy recommending it to parents. Check it out!

When I caught up with my former NHS colleagues recently, they asked me how my independent practice was going. I commented that I’d never seen children make as much progress. We started unpicking possible reasons for this rapid progress, was it that:

• I see the children once a week on an ongoing basis? Or
• The parents are particularly engaged because they’re paying for the service? Or
• I’m able to tailor therapy to a child’s particular needs? Or
• A combination of all three factors? Something else entirely?

I had a think.

The role of parents

The parents I work with take an active role in the therapy process, however, when I worked in the NHS this was also the case – so it can’t be that simple. I think timing may be a factor: parents contact me when they’re ready for therapy. In the NHS they might have to wait 6 months for a block of therapy, which comes at a time that doesn’t suit them (moving house, one parent away on an extended business trip, death in the family etc.) Parents then look like they’re struggling to engage with the therapy process, when the sessions have just come at an inconvenient time.

A friend suggested that parents who access NHS therapy are often engaged at the beginning of the process but become increasingly frustrated with the lack of flexibility they’re offered. I’ve seen the opposite happen in independent practice: parents engage with the service, they then see progress, and this reinforces their work and commitment. They feel ownership of the therapy process and continue to work hard at home, which means more progress and more reinforcement, and they continue to stay engaged with the process.

The flexibility to be client centred

Seeing the children on a weekly basis must have an impact on progress, however, I think my flexibility to provide them with exactly the type of therapy they need is more important. I’m not restricted to offering blocks of 6 sessions and then a long “consolidation” period, I can get to know the children and their families and they can get to know me. I’m not limited to seeing the children in groups containing a wide range of abilities and I’m not restricted in the type of therapy I can offer depending on the child’s diagnosis or the care pathway they end up on. I’ve spent a whole therapy session negotiating with a child and his mother how and when they’ll practise at home. I’d have struggled to justify this type of session in the NHS, but without it we weren’t going to get anywhere.

What motivates a therapist?

My motivation has changed since I began working independently; I still want to support children to develop their communication skills for the best start in life, I now also need to maintain my business to make a living. As most of my clients find me by personal recommendation from existing clients, I need to provide a quality service that meets their needs. In contrast, in the NHS I was judged on my ability to meet targets, such as waiting times for initial assessments. This can lead to situations that don’t make sense to families or support progress, such as being invited to an appointment two days before Christmas, so a therapist meets her target.

How stressed is your therapist?

Finally, I wonder about the contribution of therapists’ stress levels on progress. Being my own boss has significantly reduced my stress levels, I’m excited about therapy again. I’m now able to bring my whole brain to work, I feel confident to try new therapy approaches and I notice subtle details that perhaps I missed when my workload was out of control. Could these little details account for some of the progress I’ve been seeing?

Have I missed out a key factor? Therapists, what have you found supports progress? Parents, what did you notice about a time your child made speedy progress?

On Wednesday evening I attended the National Autistic Society’s Ageing and Autism launch event. Francesca Happé talked about the huge gaps in the research, and outlined the things we don’t know about what happens when people with autism age. As autism was first used as a diagnostic label in 1943, the children diagnosed then are now approaching their 60s and 70s.

Saskia Baron’s brother Timothy, was one of these children. In 1961 he was diagnosed with “Childhood Psychosis” which later became known as Autism Spectrum Disorder. He is now 57 years old. Saskia talked movingly about growing up with a sibling with autism, and her worries about Timothy’s future. She described how difficult it is for Timothy to let people know when he is unhappy or in pain. More positively, she talked about how she’s observed that Timothy is still able to learn new skills. Saskia agrees that early intervention is important, however, she feels it’s not justified to remove therapeutic resources in late childhood or early adulthood, as the door to learning is still open.

My clients with autism are between 3 and 6 years old, they’ll be approaching old age in 60 years! Saskia’s presentation made me think about two things, how can I support the siblings of my clients? And how can I teach my clients ways to express their pain?

This week I also had a wonderful conversation with Keena Cummins. I’m using her VERVE technique with several families and was thinking about how to manage parents’ expectations. All the children have been making great progress due to the efforts of their skilled and perceptive parents, yet these parents often express frustration that their children aren’t using more words. Keena suggested I’m clear about what I want parents to focus on:

 “During these therapy sessions I want you to focus on his playing, I’ll worry about his talking. I want you to think about how you’re supporting him to play, explore the toys, and try out his ideas. We’ll be thinking about his words later.”

This makes sense to me, I’ll try it out this week.