March 18, 2022, by Caroline Braun, M.S., CCC-SLP
As a speech-language-pathologist and a human who spends time on social media, I’m well aware of just how crowded the internet is with professionals eager to help families who are concerned about their children (and professionals also eager to make a profit).
Unfortunately, many professionals are using social media to sell parents products and services while breaking ethical guidelines and providing poor quality content that actually harms kids.
As more and more social media platforms become available, professionals across disciplines find additional places to share their (sometimes self-proclaimed) expertise. Instagram, Facebook, Youtube, and more are filled with dietitians, social workers, SLPs, OTs, BCBAs, ‘holistic healers’ and others who all have something to say about language development, “picky” eating, and the best way to raise children. They also often co-opt terms like “neurodivergent-affirming” and “responsive feeding” to do it.
Within every aspect of child development – communication, toileting, sleeping, and more – it seems that there are multiple professionals hawking how-to guides and online courses for profit.
And their marketing often targets the parents of disabled children with unique needs.
I’ve seen so many of these influencers’ brightly colored ads and the ways they try to lure parents in. As they flash their credentials, they make bold claims about changing the course of autism (don’t get me started on how problematic the language is on this one), transforming your child into an adventurous eater, or ending meltdowns for good. Most concerningly, many of them sweeten the deal on their courses and resources by offering parents access to their social media pages or private forums where parents can ask the professional specific questions about highly individualized and potentially significant concerns like hitting, biting, feeding challenges, and language delays.
And this is not okay. Why?
Because these professionals are often not just bending the rules regarding ethical provision of therapy services – they are blatantly violating the ethical obligations of their professions and actively providing unethical, poor quality therapy services that harm families and their children.
And it’s time we start talking about it.
Before diving into what unethical and irresponsible online conduct can be for therapists, it’s important to highlight what it looks like when therapists are using their social media platforms for good.
Ethical and responsible providers typically provide information and parent resources that are free to caregivers. In addition to being either free or low cost, resources like public articles, YouTube videos, blog posts, and podcasts all have something very important in common: the transfer of information only goes one way.
This means that you, as the parent, can access this information, but you do not interact with the professional directly to share information about your child’s specific needs. Because you are consuming information without corresponding with the therapist, no therapy or presumption of therapy is taking place.
However, that is often not the case with many therapy influencers.
More and more “influencer” therapists and professionals across disciplines are developing courses and private pages, all marketed to parents, in which they offer to answer questions and provide tips and tricks related to your child’s specific needs.
They often have catchy ads and website advertising services with names like:
- Parent Coaching
- Mealtime Coaching
- 1:1 Training
- Educational or Informational Sessions, and more
This is all very different from the one-way transfer of information described above.
As soon as you are:
a.) paying a speech-language–pathologist (or some other related professions) and interacting with them
b.) the professional is answering specific questions about your family’s routines, your parenting strategies, and your child’s needs, then they are, technically, providing therapy.
Even if they swear up and down on their promotional material that is not what they are doing.
And this is often very problematic and highly unethical for two key reasons.
- Practicing therapy outside of a provider’s state/s and country of licensure is often unethical conduct on the part of that provider.
From a technical standpoint, parent coaching and education fall within the clinical scope of practice for certified speech-language pathologists in the United States (and several other disciplines as well). The American Speech-Language-Hearing Association (ASHA) clearly states:
“Consulting with clients and/or coaching families in person or via telecommunications is a clinical service; it is just a different service delivery approach from direct intervention. ASHA’s Scope of Practice for the profession of speech-language pathology includes elective services (e.g., accent modification), prevention, wellness, advocacy, outreach, and education as part of a speech-language pathologist’s (SLP’s) practice domains in addition to consultation, assessment, and treatment.”
Therefore, parent coaching and providing guidance on a particular child’s case is considered a provision of therapy services.
This means that the provider offering these services is ethically bound to state and national licensing rules, which often require the SLP as well as professionals from other disciplines to be licensed in both their state and the state that the family they are coaching lives in.
In an effort to get around this and increase their profit margins, influencer therapists may put disclaimers on their sites stating that their services are “educational in nature” or “not actually therapy.” They may also claim that they are not providing medical advice.
However, this is just not true.
If you buy a course or purchase coaching services from an SLP (or providers with similar ethical requirements) and they interact with you to answer specific questions about how you should structure routines, address your child’s behaviors, introduce new activities to your child, or develop new skills, then they are providing therapy services. Plain and simple.
Even if they interact with you via phone, video conferencing, email, or messaging and never in person.
Even if they never lay eyes on your child.
Even if they tell you that they aren’t actually providing therapy.
If the therapist providing these services is not licensed in your state, and your state, like many, requires the therapist to be licensed to practice there, they have violated the ethics of the profession by practicing speech-language-pathology (or their respective discipline) without appropriate licensure.
Some may read this and think that my concern is a rather trivial one. After all, these therapists are providing the same services to clients in their states, so what’s the big deal if they bend the rules a bit and do the same thing with clients elsewhere?
Well, that brings us to problem #2.
- They may not actually be providing the same services they would be providing to clients formally on their caseload in their state/s of licensure.
When you sign up for one of these programs and start interacting directly with the therapy influencer, they are assuming the role of your child’s therapist. They are, in fact, providing therapy services (even though they won’t call it that).
But they often aren’t actually providing the ethical, high-quality therapy that keeps you and your child safe.
As a feeding specialist, the presence of influencer therapists within the area of feeding is particularly concerning and illustrates the problems inherent within the service delivery model provided by therapy influencers. An ethical feeding therapist’s ability to deliver quality parent coaching requires several things that aren’t included in influencers’ “educational” packages, including:
- Collecting an extensive medical history
- Conducting a parent interview
- Consulting with the child’s medical team and related providers
- Completing a thorough assessment of the child’s feeding skills, often through direct observation of the child
Even though there are certainly many cases in which a therapist can successfully complete these vital tasks virtually, the influencer therapist you are getting coaching (i.e. therapy services) from probably didn’t get all of this information before meeting or messaging with you to share fun “tips and tricks” for helping your child eat. And this is a HUGE problem.
Even though this type of “coaching” is happening online, it can have very real-world consequences.
Feeding is deeply complex, and your child’s feeding needs are unique to them. Your feeding experiences as a parent and your family’s mealtimes are also unique. To provide quality feeding therapy, the provider needs to get to know you, your child, and your family to provide the individualized plan that will work for your child. Someone who has never observed your child or studied their medical history is absolutely not qualified to provide that.
As a feeding therapist, I’ve worked with families who have sought the services of therapy influencers. It doesn’t always end well.
In one case, a child with significant feeding needs came to me for a speech and language evaluation. He had difficulty communicating, was suspected to be autistic, and had significant oral motor delays and sensory concerns. Most concerning of all was the fact that he had completely fallen off the growth chart and wasn’t gaining weight.
When I presented my concerns about feeding to the family, they assured me they had it under control.
You see, they were taking online classes from a dietitian advertising herself as a “feeding therapist” online, and she was giving them all the information they needed to get their child’s eating on track. Best of all, she was always available to answer any questions they had about the course she sold them and their child’s feeding challenges.
The influencer dietitian/therapist had feeding covered, according to the family. By their request, I was there to address communication and communication only. This was my first experience working with a family who was also seeing an influencer therapist, so I wasn’t sure what to do. I wish I had reported it, but, instead, I wanted to respect the family’s wishes.
And, of course, I didn’t want to get another professional in trouble. I wanted to be nice, even though it put my client at risk.
Despite repeatedly bringing up my concerns about feeding, this family clung to their online nutrition guru who had never once seen their child in person or online, with disastrous results.
After several months, the child still hadn’t gained weight. His oral motor skills had not improved. Worst of all, he had become incredibly selective in his eating and was now rejecting preferred foods and even entire meals. Only then did the family agree to seek direct feeding therapy with an appropriately licensed local provider.
While making money off of this family and offering “helpful tips” under the guise of “education” rather than actual therapy, this influencer provided poor quality feeding therapy and contributed to making a bad situation far, far worse.
If she had taken an extensive medical history, as a professional typically does at the onset of feeding therapy, she would have known that this child had medical complications early in life that may be contributing to eating challenges now.
If she had ever watched him interact with his parents, she may have noticed that he might be neurodivergent and, as a result, may need different recommendations to accommodate his needs and learn new skills.
If she had observed him eat, she would have noticed the delayed oral motor skills that made eating challenging.
If she had been acting ethically, she would have been aware of the child’s food refusal and the doctor’s concerns.
However, if she had been acting ethically, she never would have taken this family on. She wouldn’t be communicating with families directly about their child’s feeding outside of her educational online course modules. She wouldn’t have been providing feeding therapy without upholding the obligations that a feeding therapist has to a family and their child.
But, if she’d been acting ethically, she also wouldn’t have made as much money.
And, at the end of the day, that’s what a lot of therapy “influencers” are after: exploiting vulnerable families to benefit their own bottom line and their online image. And it’s time that professionals and parents begin talking about it and pushing back.
When parents have concerns about their child, whether they are concerned about feeding or another aspect of development, therapists have an obligation to act ethically and in the best interest of that child.
Therapists shouldn’t exploit parents’ fears to peddle their how-to guides, manuals, and online courses for several hundred dollars a pop.
Therapists shouldn’t be using social media to counsel parents of children they’ve never evaluated.
Instead, therapists should uphold the ethics of their professions and validate parents’ concerns by directing them to resources they can use to find qualified, licensed therapy providers in their area who can provide services and advice that are individualized to their unique needs.
Lots of therapists want to diversify their incomes and that’s fine – sell the worksheet on Teachers Pay Teachers, write the book, give the presentation for professionals.
But don’t commodify the Neurodiversity Movement, a HUMAN RIGHTS CAMPAIGN, to do it.
And please don’t imply that your online course or materials for parents are a substitute for high-quality therapy with a qualified professional.
Recognize that, when you sell a course or material that offers to teach parents how to teach their child speech sounds/feeding skills/toileting/etc. AND you then interact with them directly, you are implying that your course is a substitute for therapy. Because, by offering that two-way interaction, you ARE providing therapy. By sharing the information you have gained through your training and experience as a therapist, you are acting as a therapist, even if that’s not what you intended.
Be mindful to ensure that the transfer of information goes one way and one way only – once parents start asking you specific questions about their child and you start answering them, be aware that you could be unethically providing a therapy service and a poor quality one at that.
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- Influencer Therapists: Dubious Ethics & Poor Quality Services - March 18, 2022
- Ableism in Speech Pathology - January 24, 2022
- Case Study in Neurodiversity-Affirming Care: A Toddler with Childhood Apraxia of Speech - December 21, 2021