So you have just graduated as a Speech Language Pathologist (SLP), congratulations! The next steps in your career development are passing the Praxis exam and beginning your clinical fellowship(CF).

A clinical fellowship provides you with supervised clinical experience in a setting where you can learn and grow your SLP skills, under the supervision of a seasoned SLP.

A clinical fellowship is a post-graduate program designed for SLPs who have recently earned their Master’s degree but who have not yet met all the requirements to obtain a Certificate of Clinical Competence (CCC).

Completing a clinical fellowship is a requirement for obtaining a CCC.

Why Pursue a Clinical Fellowship?

First off it is a requirement to obtain your Certificate of Clinical Competence (CCC). Completing a clinical fellowship offers many benefits. There has been an increase in clinical fellowship jobs in RI along with a rise in salaries. The CF provides a new  SLP with the opportunity to apply the knowledge they have accrued during graduate school to the real world situation of providing therapy to a caseload of clients with the support of an experienced mentor providing guidance.

As well, completing a clinical fellowship can improve your chances of passing the Praxis exam. Studies show that SLPs with a clinical fellowship had a higher pass rate than those who did not complete one.

How to Complete a Clinical Fellowship

An SLP must complete supervised clinical hours in order to complete a clinical fellowship (at least 1,260). They must be supervised by an experienced SLP for a minimum of nine months and holds a CCC.

The CF supervisor helps guide the SLP and offers support as they build their clinical skills. This mentorship allows the SLP to effectively provide therapy in a professional setting.

Examining the Value of a Clinical Fellowship

Research studies show that completing a clinical fellowship has a significant impact on an SLP’s long-term career success. CF graduates have more job opportunities, earn more income, and often have a more diverse set of clinical skills.

Completing a clinical fellowship can also lead to job placement and advancement opportunities. Clinics and hospitals desire SLPs with practical experience in a work setting and practical skills.

Once completed, SLP clinical fellowship on the SLPs resume demonstrates that they have acquired extensive clinical experience and technical skills needed to hit the ground running in a new job.

Challenges and Potential Downsides

While completing a clinical fellowship offers many benefits, it may come with some challenges and potential downsides.

One of the most significant challenges experienced by SLPs pursuing clinical fellowships is time management. Balancing their caseloads, clinical fellowship requirements, and personal responsibilities can be challenging.


Completing a clinical fellowship is a crucial step for SLPs who are in the process of obtaining their Certificate of Clinical Competence (CCC) by building experience and knowledge in the workplace SLP-CCCs can competently provide speech therapy in a variety of professional settings. In addition, completing a clinical fellowship typically leads to an increase in salary.

Combining a clinical fellowship with other SLP educational programs, such as SLP school jobs in RI, CFY supervision in MA, and exploring online speech therapy options, can lead to greater career advancement.

Reach out to the experienced SLP professionals at to guide you through your clinical fellowship application process.

When it comes to providing quality healthcare, having adequate staffing is crucial. A case in point is speech therapy, which requires specialized training and expertise. 

Here, we’ll define speech therapy staffing, explain its importance, and examine its benefits.

Qualifications Required for Speech Therapists

Speech therapists sometimes referred to as speech-language pathologists (SLPs), are required to have a master’s degree in speech-language pathology. 

They must also hold certification from the American Speech-Language-Hearing Association (ASHA) and be licensed by the state in which they practice. 

Specialization and experience can also play a role in determining qualifications for speech therapists.

Importance of Adequate Speech Therapy Staffing

Having adequate speech therapy staffing can have a significant impact on patient outcomes. Speech therapy can help patients with various conditions, including speech and language disorders, cognitive impairments, and swallowing difficulties.

Without proper staffing, patients may not receive the care they need promptly and effectively. Adequate staffing can also improve healthcare facilities’ overall quality of care, ensuring that patients receive the attention they require.

Benefits of Hiring a Speech Therapy Staffing Agency

One way that healthcare facilities can address these challenges is by working with a speech therapy staffing agency. 

These agencies specialize in recruiting and placing speech therapists in various settings, including hospitals, rehabilitation centers, and schools. 

Both school speech therapy staffing agencies and outpatient speech therapy staffing agencies can provide access to a pool of qualified candidates and can help reduce recruitment and training costs. 

Working with a speech therapy staffing agency can also provide flexibility in staffing, allowing facilities to adjust their staffing levels as needed.

Speech Therapy Staffing Models

Healthcare facilities can use several different staffing models for speech therapy staffing. In-house staffing involves hiring speech therapists directly as employees. 

Contract staffing involves working with a staffing agency to provide temporary or permanent staff. 

Hybrid staffing involves a combination of in-house and contract staffing. As with any model, there are advantages and disadvantages, and facilities should choose the model that best suits their needs.

Impact of Speech Therapy Staffing on Healthcare Facilities

Adequate speech therapy staffing can have a positive impact on healthcare facilities. 

It can lead to improved patient satisfaction, higher productivity, and better financial performance. 

Providing high-quality speech therapy services can also help facilities stand out from their competitors, attracting more patients and increasing revenue.

Best Practices for Managing Speech Therapy Staffing

To ensure the success of speech therapy staffing, healthcare facilities should follow best practices for managing their staff. 

This includes regular communication with the staffing agency, a collaborative approach to staffing, and ongoing training and development for speech therapists.


Speech therapy staffing is an important aspect of healthcare that should not be overlooked. Working with a speech therapy staffing agency can provide access to a pool of qualified candidates and reduce recruitment and training costs. 

By following best practices for managing staff and choosing the right staffing model, healthcare facilities can provide high-quality speech therapy services to their patients. 

If you are looking for SLP-CF jobs in RI, reach out to a speech therapy clinic in Rhode Island to learn more.

Universal strategies support learning for all students regardless of their disability status. However, systems embedded in the classroom are especially beneficial to students at risk of falling behind or receiving special education or related services. Providing best practices to all of your students is a win-win for general and special education staff and, of course, students.


Flexible Seating

Many people picture elaborate chairs and spaces when the topic of flexible seating comes up. T-stools, rocking chairs, and swings built into classrooms are excellent but flexible seating doesn’t have to be complex! Allow your students to stand at their table, move to a different space, or lay on their bellies during read-aloud. Movement helps both children and adults focus (hence the popularity of the office sit-stand desk). 

Positive Reinforcement

Positive reinforcement helps create a nurturing classroom environment and is a tool that encourages children to engage in appropriate behaviors. Positive reinforcement also builds up a child’s self-esteem. Give your students a high-five, recognize their hard work, or allow them to earn a fun activity. Use positive reinforcement often and with all of your students.


Use a Routine

Routines provide structure for a day with academics, social participation, lunch, breaks, and more. A transition is much smoother when a student is expecting it. Let your students know when there will be a change in the routine and remind them throughout the day. Post a schedule of the day where everyone can see it. Use picture images for young children and write the plan out for students who are confident readers.



For student well-being to occur at school, an adult must connect with them. Touching base with them each day can foster a community of positive mental health. You can use the Zones of Regulation or other programs or even teach and provide language for them in the classroom. Make them feel comfortable sharing by using examples from your own life and validating that experiencing different emotions is okay. When appropriate, offer strategies such as deep breathing or movement to help your students feel their best, and feel supported.

Provide Extra Time

Some children can easily recognize and process sensory information in the world and then quickly recall information and figure out how to respond to a question, for example. For others, it takes longer. Giving extra time to all students offers everyone a chance to participate in the conversation. Especially after asking, “does anybody have questions?” try to pause for five to ten seconds. 

Heavy Work

Sensory supports encompass a wide variety of strategies to support student learning. One popular activity, heavy work, targets the proprioceptive system to help students feel calm and regulated. Classroom jobs like pushing in or stacking chairs, wiping down tables or chalkboards, or carrying heavy books to the library all target the proprioceptive system. If any of your students are seeking movement, offer structured activities at recess. Include activities and games like wheelbarrow walking, hopscotch, four-square, climbing monkey bars, or climbing a hill. Embedded strategies aren’t just for children who receive special education or related services. Try these ideas to help all of your students be their best.

Tracking student progress is one of the most crucial components of a child’s journey in special education. Data collection allows us to provide children with the best possible interventions and actively impact their education. Special educators, occupational, physical, speech-language, and behavior therapists all use SMART goals as an efficient way to support intervention planning and data collection.  SMART is an acronym that stands for specific, measurable, attainable, relevant, and time-bound. The SMART template provides a consistent structure for goal-writing. They are widely recognized in education and help professionals ensure that the goal includes all necessary components.  

S: Specific

Educators should write goals with definitive criteria. Break down anything that might be considered vague. ‘Play-group’ could be described more specifically as ‘a teacher-facilitated recess group with five same-age peers.’ If the child has to switch school districts without notice, the new educators should easily distinguish all the goal criteria. Don’t forget to include any adaptive equipment, modifications, or cues that the student will use to meet their target.  

M: Measurable

This part of the goal reveals the intended outcome and helps track progress. To improve a goal, add one specific behavior that an educator can measure. For example, “Hakim will initiate three social interactions with peers, as measured by teacher data collection” rather than “Hakim will participate in a play-group.” Be sure to include who will collect the data or if there will be an observation period, retesting, or portfolio collection.  

A: Attainable

When a child qualifies for special education or transitions into a program, they undergo a thorough evaluation. The evaluation should contain the child’s present levels of educational performance. Use this information to create goals that are attainable within the term of the IEP. If a child is currently speaking with one-word responses, it is unrealistic to expect them to use an average of six words per sentence within a year. Use their present levels along with your clinical reasoning to determine what is an attainable goal.  

R: Relevant

Does the goal fit into the context of the child accessing their education? Does it make sense given the child’s individual learning profile and needs? If it is unclear, try using vocabulary that ties the goal back to the student’s educational needs. If it still doesn’t fit, consider what the team wants to prioritize to ensure that the goal is relevant.  

T: Time-bound

The goal should be attainable within the timeframe of the IEP. An IEP is typically valid for one year. However, if a related service gets added to the plan mid-year, the specialist will create goals for a shorter time. To ensure that you are using the correct timeframe, look for the next annual IEP date and write it into the goals. Refer back to this part of the goal to check that the target is attainable.  

Do your goals pass the SMART test?  Try using this easy acronym to structure your goals and use the results to track progress more clearly. 

Attention deficit/hyperactivity disorder (ADHD) is one of the most prevalent disorders of childhood. The CDC estimates that between 3 and 7% of school-aged children have ADHD. Characterized by inattention, impulsivity and/or hyperactivity, ADHD impacts many areas of a child’s life. This includes social participation with peers and relationships with adults, academics, executive functioning skills like organization and time management, and more. Pediatricians may recommend medication and/or a variety of non-pharmaceutical interventions.  


Nonpharmacological Interventions


Behavior modification: This intervention involves using behavioral strategies in everyday routines to provide structure, reward positive behavior, and communicate expectations. Examples of behavior modification may include:

These methods effectively improve academic and social performance and are even more impactful when carried over in different environments such as school and home.  


Cognitive Behavioral Therapy: Also known as CBT, cognitive behavioral therapy involves self-management that results in behavior modification. The process involves identifying and challenging problematic thoughts and behaviors and replacing them with practical actions. A child may learn and practice problem-solving, role-playing, and the ability to redirect, instruct and guide themselves. Strategies take into account the child’s strengths and goals.   


Environmental Modifications: Children with ADHD are more likely than their peers to be overresponsive to sensory input; thus, the classroom can be more difficult for them to navigate. Modifying the environment to support the child’s nervous system functioning may include:


Sensory Integration: Sensory integration is a specific intervention approach used by occupational therapists. This sensory-rich therapy allows children to process and integrate different kinds of sensory input in a controlled environment. Therapists look for adaptive responses such as decreased impulsivity or the ability to tolerate increased volume without having a meltdown. The ultimate goal is that eventually, changed neurology results in more consistent appropriate responses to sensory stimulation.    


Activity Modifications: For the child with ADHD, a multi-step activity can become overwhelming and result in behaviors or withdrawal. Breaking down large tasks into manageable chunks can allow the child to experience success. Reduce the size of homework or the amount of written material on handouts. Focusing on quality rather than quantity can enable these children to showcase their best work.  


Social Skills Training: Social skills training provides children with ADHD the opportunity to learn and practice social skills. Several professionals use this intervention, and intervention may include education, use of social protocols, modeling, role-playing, practice in the community, and more.  


Team Collaboration: When a child’s disability impacts their participation at school, the child’s team may adopt an IEP or 504 plan. Children benefit from interdisciplinary collaboration, and the team may consist of the parents or caregivers, the child’s physician, special education teacher, regular education teacher, social worker, counselor, or occupational therapist. Since ADHD impacts multiple areas of functioning, each profession can contribute its specialty. For example, the physician can help team members understand side effects, and the occupational therapist can suggest sensory strategies.  The child, family, and team all benefit from collaboration. 




Centers for Disease Control and Prevention. (2007).  Attention-deficit/hyperactivity disorder (ADHD).

DuPaul, G. J. (2007) School-based intervention for students with attention deficit hyperactivity disorder: Current status and future directions.  School Psychology Review, 36, 183-194.

Toplak, M. E., Conners, L., Shuster, J., Knezevic, B., & Parks, S.  (2008). Review of cognitive, cognitive-behavioral, and neural-based interventions for attention-deficit/hyperactivity disorder (ADHD).  Clinical Psychology Review, 5, 801-803. 

Children with ASD often qualify for an Individualized Education Plan (IEP) or a Section 504 plan.  Each of these programs promotes support for students to access their learning environment.

Anyone on the IEP team can suggest accommodations: Teachers, behavior analysts, speech-language pathologists, occupational therapists, and even parents and administrators.  Each student should have accommodations in place to best support their unique needs.  Common adaptations fall into the cognitive, sensory, behavioral, emotional, and communication domains.
















Creating IEP accommodations is a collaborative process.  Different disciplines will bring a unique perspective on supporting the child with an autism spectrum disorder.  It is helpful to attend the meeting with suggestions and ideas but stay open-minded to hear views from the entire team.



The expectation for kids to start writing is getting earlier and earlier all of the time.  However, the youngest children don’t have the physical development needed to use the small muscles in their fingers and hands to hold and control a pencil.  Writing is a foundational learning skill that helps requires visual-motor integration, bilateral coordination, midline crossing, etc.  It is correct that it is an important skill to master.  But how do you get young children started before jumping in with a pencil and paper?  Read on for several ideas to help kiddos get ready to write without actually writing.  

Strengthen Big Muscles First

For a person to write successfully, they need to be able to stabilize their upper arm.  If the movement comes from their shoulder joint when they write, they will get tired out quickly.  Use play to strengthen the upper body.  Wheelbarrow walking, crawling, and animal walks all work well for this.  For an extra fun activity, tape a big piece of paper to the bottom of a child-sized table.  The child can lie underneath it and straighten their arm to paint. 

Get vertical!

Tape a piece of paper to a wall or find an easel with a chalkboard or blackboard.  Let the child color to their heart’s content.  Kids enjoy the novelty of this activity, and it allows for practice with grasp and getting the wrist into the correct position for writing.  If this feels tricky, tape a sheet of paper to the wall and let them place stickers on it for a similar effect. 


Creating simple drawings is a great way to work on visual-motor integrations skills.  Sometimes referred to as hand-eye coordination, visual-motor integration involves using coordinated movements to make marks with intention.  Start with easy drawings and work your way up. An excellent progression could be drawing a smiley face, then a person, then a teddy bear.  First, demonstrate how to make it so that your child can copy you.  For ideas and inspiration, check YouTube or your local library for drawing guides. 

Letter Recognition

Letter recognition is a part of learning to write.  Point out letters in books, on signs, blocks, and in their name.  Focus on capital letters, to begin with since those are the first letters they will most likely learn to write.  Alphabet magnets are a popular exploration item.  With adult support, kids can start learning the names of the letters and recognize them. 

Write… But Not On Paper

Practice creating letters in new and different ways!  Try rolling out play-doh letters, making letters with sticks, lines and curves cut out of paper, Legos, and anything else you have handy.  You can make a sensory tray with a box lid and fill it with rice or salt to trace letters.  As a bonus, many children are kinesthetic learners, and this activity can help reinforce the other work you do. 

Kid-Size Tools

When the concepts and skills are coming together, and your child is ready to start writing letters, use child-sized writing utensils.  This promotes the development of a mature grasp.  Start with bits of chalk and broken crayons.  For older kids, try golf pencils. 

Transitions are a part of everyday life at home and school.  However, they can be challenging for children and adults alike, and the demands can be complex!  During transitions, the sensory environment is more stimulating, and expectations are often higher than during lessons or structured activities.  Often there is more noise in the room, lots of movement, and visual distractions.  We expect students to follow multiple-step directions and navigate their bodies through the room while their peers do the same.  The following strategies offer ideas to support our students during this frequent occurrence in the school day.  

1.  Calendar

Younger classrooms often have a visual schedule, but older kiddos can benefit too!  Offer a written plan for students who can read.  When a child asks what is next, refer them to the schedule to teach them to use it.  As adults, we often use our planners or apps to keep track of our days.  Learning to check a calendar is a tool that kids can use in their childhood and beyond.  Be sure to keep your schedule updated to prevent unexpected changes.  

2.  Provide a Warning

Unexpected transitions are more challenging.  Think of the last time you experienced a surprise fire drill.  It feels alarming and dysregulating!  Many children feel this way during routine changes.  A simple way to prevent this is by giving the group advance notice of the upcoming transition.  You can direct this by announcing how much time they have left or making it more concrete.  For example, let them know they can color one more shape, and then they will wash their hands.  

3.  Keep It Structured

We have children with a variety of needs in our classrooms.  It can be challenging to develop a transition routine when you have students who need different supports.  Some children will complete the transition quickly and become impatient or unsure of what to do while waiting for the next direction.  Offer an activity to keep the structure going.  For example, when children complete an art project, they can grab a book and return to their seats.  When they finish lunch, they can pick a center.  

4.  Sing it! Move it!

An efficient strategy for younger ones, singing provides a constant familiar activity while students complete their transition.  You can use the same songs for daily changes to give an extra level of consistency.  Similarly, offering a movement activity can provide a motor break and support the flow of the transition.  Try marching to the bathroom, tip-toeing to cubbies, or walking heel-to-toe to another room.  

5.  Recognize a Job Well Done!

Transitions are a complex routine to learn for young children.  Provide plenty of praise for students who follow directions and stay regulated.  Providing positive reinforcement helps students understand what expected behavior looks like by observing what their peers are doing well.  

CBS Therapy is passionate about helping children with special needs and serving the schools, therapists, and families who support them. New England’s premier provider of school-based and special education staffing services in the Northeast, CBS Therapy also has therapy clinics that offer speech-language, occupational and physical therapy services.  

Anxiety disorders occur on a spectrum and can impact children in a variety of ways.  Some children may deal with low levels of apprehension, while other children develop severe and intense anxiety.  While students with anxiety will benefit from the following recommendations, consider implementing them in larger groups such as classrooms or group therapy.  This promotes an inclusive environment from which all learners can benefit.

Use structure:

Incorporate daily and weekly routines to help children learn what to expect.  Post schedules in a visible area.  This is especially important for older children who have rotating or complex schedules.  If there are any upcoming changes in routines (such as a substitute or a fire drill), give children advance notice whenever possible.


Provide a ‘just right’ challenge:

Allow students to learn and grow while building their self-confidence.  Grade your activities so that they are just challenging enough to stretch the child’s learning. 


Offer choice: 

By using a topic, subject, or medium that is exciting to students, they will naturally gravitate toward engagement.  Especially when an assignment or activity is new and daunting, a small piece of choice can motivate children toinitiate the task.  This could include anything from designing a math problem based on their favorite sports team to giving a book report on their favorite classic.


Use positive feedback:

Positive reinforcement signals to children that they are doing what is expected and can be a great way to boost the confidence of children who have anxiety.  Feedback can be in the form of a token system, a smile, nod, or words of affirmation. 


Teach challenging skills: 

Sometimes, learners need extra direction.  Direct instruction can be a great way to improve skills and, therefore, confidence for activities with a physical component, such as writing or playing a sport.  Break down tasks into smaller chunks, demonstrate skills to your students, and practice.


Use clear expectations:

Letting students know exactly what you expect is a great way to communicate mutual respect. Particularly when a project or activity is brand new, knowing the outcome will be helpful to children with anxiety.


Be flexible about participation: 

Try making group participation optional.  Let students know that they can contribute to the conversation when they are ready and that you will not call on them. 


Eliminate busywork:

A child working on fractions does not need to complete 100 problems to master the skill and demonstrate competence.  If a worksheet looks overwhelming or visually ‘busy ,’ it could likely benefit from being revised or broken up into smaller assignments. 


Identify strengths:  

Use one-on-one time to reflect on past successes, strengths, passions, and skills.  If you want to use an example in a group setting to provide an example of problem-solving skills, ask for student permission beforehand.


Teach self-management: 

Another strategy that students with and without anxiety disorders can benefit from is self-management skills.  Talk about self-regulation, brainstorm symptoms of being dysregulated, develop language, and teach strategies.  Use examples from your personal life to connect with students and demonstrate the importance of this life skill.

Documentation for therapy services can be a time-consuming yet essential component of service delivery. Many practitioners and clinicians attempt to streamline their daily note process. Some critical details should not be overlooked, though it is still possible to create a concise note while including everything that reimbursement experts need to see.


Many professions, including occupational therapists, physical therapists, speech-language pathologists, ABA therapists, and others, use SOAP notes for their daily sessions. SOAP is an acronym that stands for Subjective, Objective, Assessment, and Plan. SOAP notes are valuable because they provide information about different therapy components, and since therapists use them widely, the interdisciplinary team can use them as a means of timely communication. 

S: Subjective: What is the client saying about their experience?

Subjective information may include reports of pain, challenges since the last session, or what the client shares they can or cannot do. You may record behavior during the session for pediatric clients, including arousal level and engagement in therapy. You can also include reports from the client’s family or teachers. 

O: Objective: What are you observing? What data can you collect?

Include any compensatory strategies your client uses, physical or cognitive strategies for participation, and data you collect. The objective section could include the percentage of trials completed correctly and the client’s level of support needed to perform the activity. If your client needed any adaptive equipment, assistive technology, or modification of a task, include that information here as well. It is vital to make sure that you focus on the active experience of the client rather than the therapist. For example, note that the “Client needed moderate physical assistance for bathroom mobility” rather than “Provided moderate physical assistance to the client.”  

A: Assessment: What is your interpretation?  

Consider what you wrote in the subjective and objective categories. What does this mean? You’ll use your clinical expertise to interpret the information into an analysis of the client’s performance. Note any improvement, regression, or progress toward your client’s goals. Refer back to the subjective and objective categories to support your assessment. 

P: Plan: What is going to happen next?

Include the frequency, duration, and location of recommended services. If you are recommending discharge, include specific information about recommendations for follow-up. Otherwise, include detailed information about your intervention plan and how you will use it to address the problems noted in this session.   Daily documentation and SOAP notes are a tool that are essential to all parties involved in therapy:

CBS Therapy is the premier provider of school-based and pediatric special education staffing services in the Northeast.  

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