Medical versus Educational Language

We challenge the medical-style language that keeps school-based SLPs stuck in isolation and overload, and we replace it with an educational, MTSS-aligned way of thinking. We lay out concrete language swaps and service design choices that help us build teacher capacity, reduce overwhelm, and create clear, doable work. 
• medical terms that shape unrealistic expectations, including client, wait list, referral, therapy, discharged 
• why medical-style prioritisation happens in isolation and misses school context 
• MTSS framing where the school is the client and teacher support is the goal 
• using a family-centred mindset to clarify teacher goals and classroom needs 
• shifting from referral to request for service as an active, shared process 
• defining a piece of work with a clear aim and conclusion across Tier 1 to Tier 3 
• examples of Tier 1 and Tier 2 support, including UDL, inclusion, neurodiversity, professional development 
• documentation options for collaboration and how responsibility stays with the school team 
• planning a gradual change versus a total service revamp with administrators and colleagues 
If this episode resonated with you, I’d love to hear about it. Share your experiments, your questions, your aha moments, because your experience matters and may be exactly what another SLP needs to hear. 

https://sarahdowlingschoolslpcoaching.com

Music: Daniel Chui

Transcript

Welcome And The Big Shift

Sarah 0:02

Welcome back to the Aligned SLP. I'm Sarah Dowling. If you're new here, this is where school-based SLPs stop being clinical islands and start being collaborative partners. We're ditching the impossible caseload, embracing the workload approach, and reclaiming our joy as professionals aligned with the education world.

Medical Language And Its Traps

Sarah 0:26

Today we're going to talk about medical versus educational language. So in the medical context, we often talk about clients, wait lists, prioritization, referral, therapy, and discharged. Client is the student. There's often no broader context, we're just focused on the difficulties and often using a fix-it approach. The wait list is something that the SLP carries. It's overwhelming. It doesn't take into consideration the actual capacity of the SLP's staffing levels. Prioritization

MTSS And The School As Client

Sarah 1:07

is often done in isolation, with minimal school-based information using a medical disorder focused model. Referral has an assumption that once a form has been filled, that the SLP now has responsibility to do something, often done with minimal awareness or involvement of the SLP. Therapy is often done in isolation, without considering the curriculum or the teacher goals. And discharged implies that there is an end to the intervention for this student, that something has been fixed. Within the multi-tiered systems of support model, or MTSS, the client is the school who is providing an education to the students. The goal is to support the teacher, to provide an education to the student. I often compare this to a family-centered approach. We ask the family for their goals. We transfer this practice to our schools and teachers. What are their goals for this year, for this student or group of students? We learn more about what teachers want to learn about and what they want to implement in their classrooms. They may know the problem, but we can help them with a solution they didn't know about. We can support with universal design for learning, inclusion, neurodiversity, and evidence-based practice. Prioritization is no longer done in isolation, it's done jointly with the school. The school decides with your input based on assessment and other data. There is no wait list as the school works out what supports they would like from the SLP when you have availability. The SLP is honest and open about what capacity they actually have. There is no mass referral in September with unrealistic expectations of how much work you can do. The request for service implies a discussion and an active process. When you meet with the school team, there is no longer an automatic expectation of a direct referral. There is an understanding that you are part of a specialist team that is supporting the classroom teacher to support the student. We are reducing the anxiety, overwhelm, and uncertainty that teachers might have about that student or group of students. We are inspiring them to feel more confident and more competent with their students. We are building capacity.

Defining The Work Across Tiers

Sarah 3:58

Instead of therapy, we talk about a defined piece of work. The goal is to support the teachers, to support the students. This is based on the questions in the request for service. There is a clear aim and a clear conclusion. This can be for the whole school year if needed, can be anything from Tier 1 to Tier 3 supports, with Tier 3 resembling the closest to traditional therapy, with the proviso that the goal is to support the teacher to support the student. It can be providing professional development, pilot projects, joining in the school professional learning community, all the way to a specific intervention or assessment at Tier 3 in order to support Tier 1 collaboration. So what happens when the piece of work is complete, the goals are achieved? You write a report if it was at Tier 3. If it's collaboration at Tier 1, this work is tracked however the administration and SLPs decide. It can be hands-off with minimal data to a system that can show the work provided to support the schools outside

Tracking Work And Sharing Responsibility

Sarah 5:18

of Tier III. I worked in a system in which the SLPs didn't collect data on Tier 1 and Tier II, as these are school-based supports to develop UDL, neurodiverse friendly approaches and inclusion. We were embedded in the education system as members of staff. The schools were documenting in their systems. Even if we were part of an IEP meeting, we were not responsible for any goal implementation. The goals were for the class teacher and the school team. We had helped them develop different ways of thinking and evidence-based ideas. We may agree to accept a tier three piece of work to support any ideas generated in the meeting. But these could range from observation to some direct assessment of the student, but always with the goal to support the class teacher to support the student.

Redesigning Services Without Burning Out

Sarah 6:18

These ideas all have to be considered within your local systems, but the key principles that I have outlined apply across all types of systems and historical practices. The SLP team and their administrators will need to take these ideas and reflect how to implement these basic principles within your context. Are you going to tweak and go for gradual change? Or are you going to decide a starting date and work towards a total revamp? How will you involve your education colleagues and administrators in this redesign of your services? I hope that you can take these ideas and imagine what it could look like and feel like in your context. These are profound mindset shifts, and you will need time to understand what the implications are of these both philosophically and practically. And you will definitely be hearing more about these ideas in future episodes. Thank you for spending time with me today.

Key Takeaways And Invitation To Share

Sarah 7:27

Here's what I want you to take away. You're not failing. The system is asking you to do the impossible, and you're doing the best with what you have. But there is a different way. And remember, you're not alone in this. We're building something new together. One conversation, one collaboration, and one small change at a time. If this episode resonated with you, I'd love to hear about it. Share your experiments, your questions, your a ha moments, because your experience matters and may be exactly what another SLP needs to hear. Until next time, stay curious and be kind to yourself. I'm Sarah Dowling, and this has been the Aligned SLP.