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 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.

A few weeks back I found myself listening to inspiring speakers at The House of Commons. These speakers weren’t politicians or the academics who’d invited me, they were children, young people and adults with language impairments. The event was celebrating 2 years of the RALLI campaign, which aims to raise public awareness of what language learning impairments are, how to identify them and how to support people who have them.

The team behind RALLI are trying to make this information accessible by publishing it on a YouTube channel. The short videos are accompanied by slide presentations with references to relevant research and the evidence base.

Looking into the future

I work with pre-school children, so I find it valuable to hear from older children, and adults who have the same conditions as my clients. It’s like being able to fast forward 5, 10, or 15 years and see what the future might hold. The people with language impairments talked about what helped them and what they found difficult. A teenager spoke about how his life at school changed when people started giving him one instruction at a time, as well as extra time to process what they’d said. A woman spoke about the frustration of having to explain what a language learning impairment is, when you have a language impairment!

Watch a video

Thanks for inviting me RALLI team, it was a wonderful evening! If you’re not familiar with the RALLI videos take a look at Dorothy Bishop explaining why they launched the campaign or here’s me and two colleagues talking about SLI and Bilingualism. 

Tuesday 12 August at 06:00 PM BST (view in your timezone), £45

Are you considering a career in speech and language therapy? Participate in this 90 minute webinar to learn about client needs, therapy techniques and skills. Find out if SLT suits you and complement any shadowing opportunities. This will help you to apply for SLT courses.

Through case studies you’ll learn:

• what needs clients have and several therapy approaches that work
• what core skills therapists need (and how to identify your existing skills that are relevant)
• how to approach therapists to arrange observation sessions (and other ways to get practical experience)
• how to find resources (books, blogs, videos) to learn more about speech and language therapy and prepare your application form.

You’ll also have a chance to ask questions and afterwards you’ll receive a video recording of the webinar.

Buy a ticket to the Introduction to Speech and Language Therapy webinar.

This is the first time I’ve blogged since I had a baby 8 weeks ago. I’m delighted to be sharing my life with this tiny person, although he sure does change the landscape of my days. Spare moments are scarce, when I find them, I hop into bed for a nap!

I’ve been told by parents I’ve worked with that I didn’t understand particular things because I didn’t have children. In my foggy mental state I’ve reflected on a few things I’ve learnt as a new parent.

I’ve realised how dedicated some parents are. I’ve known families come to therapy sessions with their older child when their new baby was just days old. In those first few weeks I called it a successful day if I could shower and comb my hair. These families had a legitimate reason for cancelling sessions but they didn’t: they came along, took part, and supported their older child. Wow. 

I also now understand how difficult it can be to get to appointments on time. I hate being late, but it’s hard getting me and the tiny person out of the house at a set time. I’ve sacrificed the shower and hair combing to make sure we made it. As a therapist, I can’t organise my day so that families can come to their appointments 20 minutes late although I can try and schedule the appointment for a convenient time. 

As a new mother, I’ve been the “patient” or “client” which takes some getting used to. I hadn’t spent a night in hospital since I was born! I’ve struggled with breastfeeding, when I tried to access support I realised: I didn’t know what normal was, and I needed to listen to my gut.

When I started telling the midwives and then the health visitors that feeding was incredibly painful they all said a variation of: “it is at the beginning,” and suggested I give it time. My gut told me something was up, but I’d never done it before and I didn’t know what to expect, I had no idea what “normal” was. It took lots of tears (mine – not the baby’s!) blood, an infection, and me doing my own research before I insisted on a referral to the tongue tie clinic. After 4 weeks I’d found the reason for all the pain and we could begin to move on. 

As a therapist I want to remember that parents may not know what type of communication to expect at their child’s age and although, of course, there is a huge range of “normal” I can provide them with this information. I also want to give parents time to explain to me what their gut is telling them, and really listen to them. I felt frustrated, overwhelmed, and angry when my need to be understood wasn’t met. I knew the professionals I saw didn’t have a magic wand, and couldn’t make the pain disappear, I needed to be understood.

Finally, although I knew no one I spoke to would have that magic wand, I really wanted them to. I know this is how some of the parents I work with feel. My partner gently reminded me we were looking for small improvements, aiming to move in the direction of painless feeding. He encouraged me to record the progress we were making in a notebook, suggested I review it often, and broke out the bubbly when we made it! I want to be this supporter in the therapy process, and bubbly on discharge is an idea I could get behind! 

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

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?

At a recent study day (Child Talk What Works consensus event) I heard Dawn Smith, Healthcare Professionals Advisor, talk about commissioning SLT services. She suggested we tell stories about the impact our services have, with compelling headlines and concise evidence. She talked about the importance of making “effective relationships … across increasingly complex systems” and said that the services thriving under the new commissioning arrangements have “transformational leaders.” It was an interesting talk.

We need to write headlines, and stories with evidence, but we’re not writers. We need to make “effective relationships” with finance people, and non-clinicians but we don’t know what makes them tick. And there wasn’t much on how to be a transformational leader on my SLT degree course.

Dawn’s talk made me reflect on something I’ve been mulling over for a while – to be successful SLTs, in today’s tricky climate, we need to be open to learning from other disciplines, and I don’t mean other allied health professionals. We have excellent clinical skills, we have trouble with the other part of our roles, such as getting sign off to try new models of service delivery, working collaboratively with professionals from other disciplines, and balancing conflicting priorities. I think we can learn from professions like software developers, project managers, writers, religious leaders, entrepreneurs and performers.

Let me give you an example. In September I attended an improvisation workshop. One of the activities involved pretending to pack a picnic with your partner, we did this 3 times. In the first round, whenever you partner suggested an item to add to the picnic basket you had to reject it outright and explain why it was a terrible idea. In the second round when your partner suggested an item you reluctantly agreed to pack it, but explained why it wasn’t such a great idea. And in the third round when you partner suggested an item, you responded “yes, and,” accepting the idea and adding to it with your next contribution. This was an “aha” moment for me. I’ve been in so many meetings that get derailed by the passive aggressive behaviour we experienced in the second round, the “yes, but….” response to a suggestion. The third round felt energising and collaborative, exactly what I want to channel into meetings. Here was a simple, practical tool, I could use immediately in my work. Bingo!

On 20 January 2014 I’m involved in an event called #dareconf mini, the tag line is: Learn to collaborate, communicate and reflect. It’s designed for digital professionals but I think the themes are also relevant for therapists. SLTs are pretty good at reflecting but we can definitely do with some help collaborating and communicating with all these new people in our ecosystems.

The presentations will cover:

• How to communicate with compassion
• Undermining the power of our organisations
• How parts of our jobs make us feel like a fish out of water
• How to balance vulnerability and courage, to make bold choices
• Using facilitation to help people work together in times of change
• How to be a coach and a mentor

As well as leadership and how to leave your comfort zone.

Have you found it difficult to explain what your team does to people who have no shared frame of reference? Have you struggled to negotiate shared objectives with an angry stakeholder? Have you wrestled with how to phrase a project proposal, or request for training in a way that gets you your desired outcome? This day on people skills can help. Each presentation combines a personal story with a practical “how-to” you can apply to your work and you’ll take home a personalised workbook with next steps from each talk.

This full day of practical learning, includes lunch and costs just £165 +VAT if you book before 18th November. Join us. And help spread the word: email this information to friends and colleagues, post about #dareconf Mini on Facebook and Twitter, and tell your boss!

I’m considering how to explore this theme of what SLTs can learn from other professionals. Do you know someone I should talk to? Let me know.

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.