Pro Bono

In many industries working for free would be met with disbelief, but whether it’s the big heart of the therapist or the fact that many of us truly love and believe in what we do, it’s not uncommon to find the SLP that has provided services free of charge.

There are lots of reasons that arise.  Sometimes you come across a family that is so high in need and so without financial resources you can’t turn them away, sometimes it’s a story so heartbreaking you find yourself volunteering to step in.  Other times the situation is more practical.  Sometimes you have an opportunity to gain more experience in an area you’re branching into and not charging for services seems the most prudent course of action.  Sometimes it might be that you are working to build a practice and feel that some positive word-of-mouth will go a long way.

I’ve faced the dilemma myself, and am offering a few thoughts on the subject, but please  understand these are my opinions.  When making decisions for your own business, use a healthy dose of common sense and ask advice from your personal financial and legal advisors if appropriate.

  1.  My understanding is that you cannot claim your time on your tax return, however you can itemize both mileage and materials.  It’s worth confirming this and keeping track.
  2. Draw out a simple term of agreement, even if it’s informal, to make sure neither party feels slighted.
  3. Request confidentiality of the arrangement, and if (when) the word gets out that you’ve been working for free, have a statement ready that succinctly explains your policy not to discuss clients or payment arrangements.

Before you make the offer, “Please let me help.  Don’t worry about the cost” think about how you’d like the situation to work out long term.  While there isn’t a fee schedule, these families need to be treated the same as any other in terms of what you say and what you provide.  Considerations might include:

  1.  Duration:  Will the arrangement be indefinite or will there be an end date?  You might consider a year or during a specific time period (preschool, before they have access to in-school therapists for example).
  2. Frequency:  What will you do if you’ve offered a once a week option and then a new diagnosis comes down the line that best practices indicates a much higher frequency of service.   Know if your schedule and attitude (not to mention bottom line) can absorb an increase ahead of time.
  3. Recommendations:  Be ready to make recommendations to other therapists/medical personnel if needed.  You may know that the family will be unable to follow up, but they need to be treated as any other client and hear the recommendations you’d make under different circumstances.
  4. Policies:  If you enforce a strict attendance policy for all your paying clients, one that doesn’t pay shouldn’t be exempt.  I would still have them sign any policies involving attendance and/or behavior and stick to it.
  5. Scheduling:  While you might feel like the non-paying customer should be more flexible, I’m not sure I’d agree.  Scheduling and re-scheduling of these clients should be no different than any other.  For example, if I take a week off for vacation and don’t see or reschedule any clients, I wouldn’t try to provide a “make-up” for my non-paying clients.  On the other hand, if I miss a day due to illness and am trying to accommodate make-up sessions, I’d schedule make-ups for all of my clients, paying or not.
  6. Competency:  If I offered to take on a student free of charge because their area of need was one I felt less experienced in, I’d be sure to make that clear and, ideally, I’d be offering “extra” assistance implementing the plan of a more experienced clinician.  (i.e.  beginning to learn (re-learn) sign or beginning to work with a slightly different age group.)  Depending on the situation, you may also want to consider a liability waiver.  Be prepared to step out if you feel the situation is beyond your abilities.

I’m curious to hear your story and words of wisdom.  Are you seeing any non-paying clients currently?


This Post Has 8 Comments

  1. mtmarySLP

    I have taken a couple of pro-bono clients. Each of them were adults, I typically work with pediatrics in the schools. Unfortunately, for both of them they were in a position where they were within a year of graduating from college with a teaching degree, when told they would be unable to get a teaching degree because of their articulation.

    One had received speech services as a child, until 6th grade, but after that no speech services were offered even though articulation errors remained. This client and I worked on /r/ (all variations), “sh”, “ng”, “th”, and a couple of other things. Thank goodness for motivation! When this client left the area, we were working on conversation and carry-over skills. I’m hopeful the incredible progress remained.

    The second one was a situation where there were “only 2 errors so I didn’t qualify for help.” Yeah…2 errors, /r/ and /s/. When this client left the area, we had most of the sounds down in sentences and some in conversation. (if you can tell these people are why I’m SO adamant that we need to treat kids early on in school…They should NEVER have been able to get all the way through 3 years of college with a speech error.)

    I completely agree with keeping things the same as for paying clients. I remember talking with a well-respected research friend about doing pro-bono work, she said we should “always” charge something – even if it’s only $5 a session so that they value the session time as much as we do. I can see merit in that (but I didn’t do it).

    1. admin

      Mary, Thanks for taking the time to respond. Don’t even get me started on the importance of both treating kids early and articulation in general! I’m going to mull over the idea of always charging something. Oddly, I feel like a “gift” would sometimes be more valued than something priced as low as a Starbucks coffee….like everything, it probably comes down to each specific situation. Kim

  2. Paula Gallay

    Thank you for your article.
    I’d like to share my experience with you. For the last 3 years I’ve worked pro bono in a church-based ESL program that meets 2 mornings a week from September – May. When financial times are tough, I think finding paying clients for accent modification is difficult. This opportunity gave me ready access to students and allowed me to improve my skills.
    I rotate lessons to each class from beginners to advanced. If students are absent, there is no make-up lesson. I plan for each class level and consider teacher input. Many teachers can identify pronunciation problems their students have, such as /r/ and /l/, -ed endings, and incorrect stress.
    Many (but not all) of our immigrant students are poor, and cannot afford speech therapy, or American accent lessons. By volunteering, I feel that I am giving back to the community AND strengthening my skills as a therapist.
    Having a speech pathologist gives our ESL program an advantage over many programs like it. I have received a few referrals from students who want to purchase private lessons, and I find ESL students are the most grateful, appreciative clients I have ever worked with. The joy of serving others in this capacity, even without pay, has been worth it.

    1. admin

      This is so beautiful! Thank you for sharing! Kim

  3. Scott Harmon

    Some great tips here. I agree that if you take on a pro bono client that you should treat that client like a paying client, paperwork and professionalism included.
    That being said, I would not take on a client pro bono. Everyone has a little they can pay and most of us think that if we are paying nothing then the service must be worth very little.
    Here is where you can run into a little trouble with charging different clients a different amount for you services. For the most part it is illegal to do so but their may be a work around for clients who show a financial need. You may want to have them demonstrate this need by keeping on file their last years tax records or at least a letter from the client of why they cannot pay at all or cannot pay the full rate.
    The other work around you can try is to give a same day pay discount. If you are billing insurance for other clients, that insurance company will not like it that you are giving away therapy or discounting it. You can extend them the same offer of a same day pay discount. Do you think they will pay you the same day? No way!
    I would also suggest a shorter time period that you agree to do the free or discounted therapy. Let them know that at least every 6 months you will have to re-assess the situation.
    Taking on a free or discounted client should be rare. In our state there a few options and programs to help pay for therapy. Don’t take on to many clients at a discounted rate just because you need the work. It is not a good way to do business. That being said, if you come across a hard luck case, do all you can to help.
    Great article Kim.

    1. admin

      Scott, Thank you for the thoughtful comments. I think the idea of a “sliding scale” would probably cover the financial issues or you might be able to offer a “scholarship” of some sort (check with legal/financial professionals please!), but I agree the situation should be rare. Kim

  4. Lynda

    I have taken one pro bono client. He is a DCD young adult that lives at a rural home with his parents. He has used up all of his thearpy insurance for his lifetime, and his parents don’t have the means to afford private pay. But if he doesn’t get a bit of speech-language therapy, nobody at his part-time job can understand what he is saying. His parents also have a harder time understanding him at home. We work on his articulation and some sentence formation so that he can communicate his needs and thoughts with others more clearly and efficiently. He’s a wonderful young man that is working to be as independent as possible. His mom is very appreciative as he won’t work with her on these things.
    (It probably isn’t totally pro bono as they often send me home with fresh eggs or produce from their garden.)

    1. admin

      What a wonderful service you’re providing and I’m pretty jealous about the fresh eggs/produce!

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The views expressed in this blog are my own and are intended to inspire other speech-language pathologists in their own practice. If you are a parent, teacher or other educator, these ideas are not intended to take the place of treatment by a certified clinician. Read full disclaimer here.