SLT or nursing, or both?

Hm, a list of SLT related jobs. Do you mean all the different specialisms? How long have you got? lol

Here's this for starters:

Dysphagia practitioner – focuses nearly exclusively on swallowing disorders and can be either community or hospital based. Does bedside swallow assessments, FEEs, video fluoroscopy assessments, some swallowing therapy as well. Can be paediatric or adults but adults are more common.

Stroke and neurorehabilitation. Covers dysphagia, motor-speech, language and communication disorders or dysfunction as a result of stroke or brain injury. The acute setting focuses more on assessment than therapy, but often plays a role in facilitating capacity assessments. Has some role in therapy but this is usually handed over to the community rehab teams or the specialist neurorehabilitation teams, which are subacute.

Adult neurological disorders. Focuses on maintaining or sometimes restoring functional communication and swallowing in adult patients with degenerative neurological disorders e.g. Huntington's, MS, Parkinson's disease, MND/ALS, Muscular atrophy etc. or focus on rehabilitation of stroke survivors.

Neurorehab. Can be community based or takes place in a specialist unit, depending on the severity. Covers brain injury and stroke and again is split between swallowing and communication/voice/language disorders. Roles in both adults and paediatrics are available, but the latter are rarer.

Adults with learning disabilities. This a broad are which every other SLT specialism needs to be aware of because, guess what, Adults with learning disabilities get brain injuries, strokes, neurological disorders, dysphagia, head and neck cancer just like everybody else so adult practitioners have to be aware of these and paediatric practitioners need to know the ALD pathway for some of their clients. But it is also a specialism and a growing one at that. Supporting ALD with decision-making, accessing services and facilities etc and also dealing with the dysphagia side of things which is huge in ALD. Overlaps with SLTs working in the justice service and with offenders. Can work in specialist colleges, community or specialist hospitals.

Voice. Often quite a niche area and one that might overlap with other specialisms as some trusts don't offer a full time Voice service. Supports adults with voice disorders. Key in rehabilitating after laryngeal injury, voice restoration, working with male-to-female voice transition (a growing area). Significant overlap with Head and Neck Cancer.

Palliative care. An area I know very little about but these SLTs may be specialist or may branch out from other roles in enabling communication among people in their end of life care.

Mental health. Not necessarily a specialism but SLTs may be involved with these services in another capacity. I know one SLT who does two days a week in a psychiatric hospital doing assessments of dysphagia and communication. Fairly niche but necessary work.

Head and Neck Cancer. Supports voice and swallow rehabilitation for patients undergoing radiochemotherapy for head and neck cancers or those who are post-surgical i.e. laryngetomees (people who've had their larynges removed). One of my favourite areas, but quite niche. Often overlaps with services providing dysphagia, dysfluency and dysphonia services.

Fluency (Stammering). Adults and children alike may access these services. May come under a broad umbrella paeds or adult service within a trust rather than a specialism. Often, but not always, quite specialist but probably the one that the public are most aware of.

Intermediary/medico-legal work. A niche but growing service working with both adults and children who require support to access the justice system. Usually but not always working with people with learning disabilities who are over-represented among offenders but also with anyone with a communication difficulty who needs communication support within the courts. SLTs may also act as expert witnesses within the court system.

Prisons/Young offenders institutions. Crucial sector, SLTs in these services have a vital role in prevention of reoffending and enabling offenders to access education and rehabilitation services. Have a significant role in assessment of offenders as well, which informs other decisions made regarding the placement or rehabilitative pathway of an offender.

Children with complex needs. Often subdivided by age, these services work with children with significant developmental delays or disabilities. Covers disabilities such as Down's syndrome, cerebral palsy, epilepsy, CHARGE etc. May cover both swallowing and communication or just communication. Usually less therapy, more assessment and family or setting support. Like all the specialisms, it's heavy on the multidisciplinary aspect. Does quite a lot of work in special schools.

Cleft palate. Quite niche, highly specialist. Working with the speech and swallowing needs of children born with cleft-palates, which often require significant rehabilitation many years after an initial surgical repair. Children with cleft-palate often have some additional learning needs as well so there may be additional support required around their communication needs. Mainstream and clinic-based SLTs may find they encounter these children once they've been discharged from the specialist service.

Deafness and hearing disabilities. Fairly niche, have to say, and one which I've had virtually nothing to do with, although every SLT needs the awareness of hearing disabilities and how they affect communication as, again, hearing disabilities and deafness does co-occur with other disorders, injuries and illnesses. Teachers of the Deaf have a more significant day to day role than SLTs but SLTs may have to do quite a lot of work around social communication, which can be delayed among children with hearing disabilities.

Clinic. SLTs who are clinic based will see every child who walks through the door for initial assessment, usually but not always for language delay. Likely also to cover stammering, speech sound disorders etc. Very few SLTs get stuck in clinic but it's often a setting where band 5 SLTs cut their teeth. Fairly even mix between assessment and therapy.

Mainstream schools. By far the broadest field with the most members, but with significant scope for specialism. Covers every communication and language disorder you can imagine. It's the general practice or the general surgery of SLT but it's very rewarding, providing it's done well and the clinicians are given their head by the schools. Private companies and the NHS trade their services to schools and the schools use a portion of their SEND budget to buy these services in.

Autism. I mention this as its own category because there are a significant number of schools that provide specialist services for children (and adults) with autism. Often provided by charities.

Private Practice. There is scope for most paediatric and some adult services to set up as private practitioners providing assessments and therapies to those families with the means or the desire to go beyond the local offer of therapy. Probably more lucrative than working for the NHS or even a private company in terms of the hourly rate; you have to be a minimum band 6, whose hourly NHS rate is about £20 an hour, and a private practitioner can charge upwards of £40 an hour with no overheads. There's less paperwork, too. However, there are costs involved in setting up on your own and things you might take for granted such as the invisible admin angels who send out appointment letters and invoices and reorder stock etc. are things you have to do yourself, on the whole. But you're free from the restrictions that often go with providing the local offer and you may not have to work such long hours.

As you can see, it's a very diverse field, although the same core skills underpin every specialism. Most people find something that they enjoy and gravitate towards it early on. There's a certain amount of overlap between many of these roles, bear in mind. Some roles are more competitive than others to get into. Paediatric roles outnumber adult roles 3:1 in the NHS. But I've realised there are no glamorous roles. It's all pretty challenging stuff and the level of responsibility you're tasked with early on is ridiculous. I've not been doing it long but I keep thinking, am I allowed to do that??

You'll find your niche, if you decide to do it. Hope this helps.

Sorry, I haven't been on here in a while but I am overwhelmed by your reply. Thank you so much for all of this information!!! So helpful, I really appreciate it. What a vast field. Going to pursue SLT and see where it takes me. Thanks!

Hey, i know its been 3 years, but how are finding speech and language therapy? Do you enjoy it? Do you feel like you made the right decision to take speech and language therapy over nursing?