Speech-language pathology (SLP) can be one of the most helpful supports a child receives. It can also be one of the most confusing. Families may hear new terms, face long waitlists, repeat the same story to new professionals, and juggle appointments across clinics, childcare, and school.
A 2024 study by Underwood and colleagues looked at speech-language services from the standpoint of families. Instead of asking only, “Did therapy work?” the researchers asked, “How does the system work around families—and what does that system ask families to do?” Their findings help schools, clinicians, and partners like TinyEYE think more clearly about what families experience and what we can do differently.
This matters because SLP is often the first formal service families access, and it tends to follow children across settings and years. In the study’s larger dataset, 91% of families accessed SLP at least once. That makes speech-language services a major “front door” into early intervention and school supports—and a powerful influence on how disability and development are understood.
What families experience: SLP is everywhere, but not always connected
One of the clearest takeaways from Underwood et al. (2024) is that SLP services are pervasive across early childhood and into school. Families described SLP showing up in multiple places:
- Hospitals and neonatal follow-up
- Public early intervention programs
- Private clinics (often paid out-of-pocket)
- Childcare or community early years programs
- School-based services (often consultative)
But “everywhere” does not mean “connected.” Families often experience gaps at major transition points, especially when moving from preschool services to school-based services. The study describes how early years documentation may not smoothly transfer into school systems, and families can find themselves re-starting the process: new referrals, new waitlists, new assessments.
From a special education standpoint, that lack of continuity can create two big problems:
- Children lose time—support pauses while systems catch up.
- Families carry the workload—coordinating, advocating, and repeating information becomes a second job.
The hidden workload: families do a lot of “system work”
In special education, we often talk about “parent involvement.” Underwood and colleagues help us see something more specific: families are required to do ongoing administrative and coordination work just to access services. That includes returning calls, completing intake forms, attending appointments, tracking reports, and managing schedules across multiple providers.
When services are limited, families may also feel pressure to pay privately. The study includes family perspectives that highlight an uncomfortable truth: access and intensity can depend on resources. If you can pay, you can often reduce wait time. If you cannot, you may wait—sometimes long enough that a child “ages out” of a program or misses a key service window.
For schools, this is a critical equity issue. If a child’s support depends on how much time, money, transportation, flexibility, and confidence a family has, then the system will predictably underserve families who already face barriers.
How professional language shapes family beliefs about children
The study also describes how SLP discourse—clinical terms, norm-referenced scores, and “delay” categories—can become the way families learn to talk about their child. Families may begin describing their child through test results and severity labels rather than strengths, relationships, culture, or communication preferences.
This does not mean assessments are “bad.” Schools need data, and many families want clear information. But the study raises an important caution: when systems rely heavily on deficit-based documentation to unlock services, families can feel pushed to present their child through problems in order to receive help.
In special education, we see this all the time. Eligibility pathways can unintentionally teach families that the only way to be heard is to prove how far behind their child is.
Culture, language, disability, and identity: what gets missed when “normal” is the goal
Underwood et al. (2024) place SLP within larger socio-political contexts. They point to how professional norms can reflect cultural values—such as prioritizing speaking over signing or other communication methods—and how disability, race, and colonial histories shape who is labeled and how.
The article highlights concerns raised in scholarship about disproportionate identification of speech and language impairments among Indigenous, Black, and racialized children, and it calls attention to the need for decolonizing approaches to assessment and service delivery.
For schools, this is a practical question, not just a philosophical one:
- Are we distinguishing difference from disorder?
- Do we understand dialect, multilingual development, and cultural communication styles?
- Are we supporting communication access (including AAC and sign) as valid, whole communication—not “second best”?
School-based SLP can feel like a restart button
Families in the study described school SLP as different from early intervention. Goals often shift toward academic language, reading, and writing. Services may become more consultative, and families may have less direct contact with the SLP.
Some families reported not knowing what was happening with referrals or waitlists. Others described rigid cycles of support, where a child might receive services for a period and then be required to wait before reapplying.
From a school systems perspective, this can create frustration on all sides:
- Families feel shut out or uninformed.
- Teachers feel responsible for implementing strategies without enough coaching or time.
- Students may receive inconsistent support.
What can schools do differently? Practical shifts that reduce burden and increase participation
Underwood et al. (2024) argue for possibilities where SLP can reduce family workload, increase children’s participation, and disrupt ableism in practice. Translating that into school-friendly action steps, here are changes that can make support feel simpler and more human.
1) Make continuity a design feature
- Build clear handoff processes between preschool providers and school teams.
- Use family-friendly transition meetings that focus on what supports work, not just what scores say.
- Create predictable timelines so families know what happens next and when.
2) Treat communication as access, not just “skill building”
- Support AAC, sign language, and multimodal communication as legitimate and valued.
- Prioritize participation goals: friendships, classroom belonging, being understood, self-advocacy.
- Align therapy targets with real school routines (arrival, centers, group work, lunch, recess).
3) Reduce the “prove it again” cycle
- When appropriate, accept recent external assessments and reports to avoid unnecessary duplication.
- Use dynamic, classroom-based observations alongside standardized tools.
- Focus on functional impact and supports, not just eligibility labels.
4) Use collaborative service models that support educators
- Offer short, practical coaching loops for teachers: try a strategy, collect quick data, adjust.
- Provide simple visuals, scripts, or routines that fit the classroom day.
- Build shared language across the team so families hear consistent messages.
5) Choose service delivery that expands access
This is where teletherapy can be a strong fit for schools. Online therapy can help address staffing shortages, reduce missed sessions due to travel, and increase consistency—especially when paired with school-based collaboration.
At TinyEYE, we see the best outcomes when online SLP is not a separate “island,” but part of the school team: coordinated goals, shared strategies, and clear communication with families.
If you’d like to explore how online therapy can support more consistent, school-connected services, you can learn more about TinyEYE here: https://tinyeye.com/.
A final thought: families want support that fits real life
Underwood et al. (2024) remind us that speech and language development happens in relationship—with people, routines, culture, and community. When services are organized mainly around deficits, paperwork, and repeated gatekeeping, families do more system navigation than child-supporting.
Schools can be the place where that changes. When we design SLP supports that are consistent, culturally responsive, and participation-focused, we reduce family workload and strengthen children’s belonging.
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