The Missing Link in Speech Therapy: Mary Frances on Orofacial Myology and Building a Practice Around Prevention
"Orofacial myology, in my view, is the complete missing link for us in our field."
That's Mary Frances, owner of Teach Speech and one of the first clinicians in the United States to open a dedicated thumb-sucking clinic. She didn't arrive at that conviction through a textbook or a conference keynote. She arrived at it through her own son's sleep apnea diagnosis, a two-year treatment journey she never would have caught without the training she'd pursued out of pure curiosity.
Mary Frances's story on Clinic Chats is about more than a niche clinical specialty. It's about how burnout nearly pushed her out of the field entirely, how early intervention work pulled her back in, and how following a thread of professional curiosity led to an entirely new direction for her practice and her family.
From Burnout to a Fresh Start
Mary Frances knew she wanted to own a private practice from the moment her fluency professor described his own clinic during grad school. She still has those notes tucked away with her old exams. But real life had other plans first.
She spent five years in the public school system, always working a part-time position at a local practice on the side. Then her husband's job took the family overseas, and she stepped away from speech therapy completely. By the time they returned to the States, she wasn't sure she wanted to come back to the profession at all.
"If you told me 10 years ago, when we moved back to the States and I wanted to work at Starbucks and just make coffee all day, that I would have moved forward to this 9 years later, I would have said, no way, never ever."
She contracted with an early intervention agency as a placeholder while she figured things out. Working with toddlers and preschoolers again reminded her why she'd entered the field in the first place. Within a year, she opened Teach Speech. Her boys were four and two. It was a learning curve, but it was hers.
Discovering Orofacial Myology Through Her Own Child
The pivot to orofacial myology didn't come from a business plan. It came from a continuing education class in Chicago, the IOM course by Christy Gatto, that Mary Frances took because she's the kind of clinician who never stops learning.
Partway through the training, something clicked. She recognized the signs of an orofacial myofunctional disorder in her own son. That realization launched a two-year sleep apnea journey, and it reshaped her entire clinical focus.
Orofacial myology examines how the lips, tongue, and jaw muscles work together, or don't. When those systems are out of sync, the effects ripple outward: open mouth posture, mouth breathing, tongue thrusting, improper swallowing, and disrupted facial growth. And the dysfunction often starts shockingly early.
"Whether it's at birth, perhaps they were born with a tongue tie, or they have allergies at three years old that are not addressed, they've enlarged tonsils and adenoids. Majority of the time, those little ones, the first identifiable oral myofunctional disorders are enlarged tonsils and adenoids."
Mary Frances explains that while formal myofunctional therapy typically begins around age seven, clinicians working with younger children can identify the warning signs early enough to intervene through feeding therapy and appropriate referrals. For a practice built around toddlers and preschoolers, the fit was natural.
The Quarterback Model: Why Collaboration Is Everything
One of the most useful frames Mary Frances offers is the idea of the orofacial myologist as a quarterback. After evaluating what's happening inside a child's mouth, the therapist coordinates referrals to ENTs, allergists, pediatric dentists, and other specialists who can address structural or medical issues before therapy begins.
"We're kind of like the quarterback, actually. We start everything, we have the plays, and then we put everything in action."
That model requires relationships, and Mary Frances is blunt about what building them takes. She dropped off pamphlets at offices. She included baked goods. She followed up multiple times. When a new referral source she didn't know sent a patient her way, she reached out to introduce herself and explain her approach.
For private practice owners handling their own documentation and referral communication, the quality of your evaluation reports matters enormously in this model. A thorough, well-written evaluation is what earns credibility with medical professionals who may be unfamiliar with orofacial myology or even speech-language pathology as a whole.
"When you write a really detailed, thorough evaluation, a medical professional should be able to interpret that and understand it. But there's always going to be questions, so you have to be prepared to educate."
Opening the First U.S. Thumb-Sucking Clinic
After her initial orofacial myology training, Mary Frances pursued a year-long mentorship with Carla Laharga, a thumb-sucking elimination expert based in Australia. That mentorship led to the opening of her own thumb-sucking clinic, the first of its kind in the United States.
The personal connection runs deep. Mary Frances was a prolonged thumb sucker herself, until age ten. She now understands the cascade of consequences: two rounds of braces, enlarged tonsils and adenoids, chronic mouth breathing throughout childhood. Had someone intervened early, much of that could have been prevented.
At the time of recording, she and Carla were planning a 2020 residency course called "Secrets of the Thumb-Sucking Clinic," designed to train speech pathologists, dental hygienists, dentists, orthodontists, and physicians in thumb-sucking elimination techniques. For Mary Frances, education and mentoring have become as central to her mission as direct patient care.
Growing a Practice on Relationships, Not a Secret Sauce
Teach Speech is intentionally small. Two speech-language pathologists in the office, both also certified orofacial myologists, plus a team of five early interventionists. Mary Frances keeps it that way on purpose so she can stay close to every family and therapist on her team.
Her marketing philosophy is equally straightforward. She's tried speaking events, preschool open houses, MOPS groups, and Facebook marketing. None of it is a silver bullet.
"There's not a secret sauce to advertising. The secret sauce is being good at what you do and working really hard."
The highest-value referrals, she says, come from graduated families. Parents who are satisfied tell their friends. They notice the same issues in other children and know exactly who to recommend. That kind of word-of-mouth referral is earned, not bought.
Her advice for anyone considering the leap into private practice? Don't expect it to be easy, but know that the hard work has a payoff.
"Good mentors, good people around you, a good support system, and honestly, a great accountant. You have those things in place, you can be successful."
Running a specialty practice means your documentation has to speak for you. ClinicNote is a HIPAA-compliant EMR built for private practices and university clinics, so your evaluations, SOAP notes, and referral reports are thorough, organized, and easy to share with the professionals on your team. See how ClinicNote works.
Transcript
Kadie: You are listening to Clinic Chats, the speech therapist's private practice podcast, a podcast full of personal journeys where we not only talk about success stories, but also real life struggles of small business startups. Clinic Chats is sponsored by ClinicNote, a HIPAA compliant, cloud-based EMR platform used specifically by private practice owners and university clinics. I'm your host, Kadie Jackstat, and thank you for joining me today.
Kadie: So today I have Mary Frances with me, the owner of Teach Speech. I can't wait to hear about your journey. I'm super interested in your specialties, so why don't you start from the beginning and kind of explain how you got into the private practice setting.
Mary Frances: Okay. Well, thank you for having me. I'm excited to be here. I'd have to say my journey in private practice started from the very, I would say grad school. I can remember sitting in grad school taking every detailed note during class and my fluency professor who actually had a private practice and was a professor at the college I went to, the grad school. And he was sharing about private practice and his journey and all that it entailed. And to this day, I think I'd mentioned to you earlier, I actually still have those notes. They're hidden away with all my graduate school notebooks and exams and things like that, but I still have that information.
Mary Frances: But I think it always was in my mind to do private practice. But of course, when you get out, you think about just getting a job right away. So I feel like my journey took a couple of years to get into it, but I would have to say I started in the public school system the first five years of my career. And within that time, I was always working a part-time position in a local private practice.
Mary Frances: And then it took moving overseas after five years of being working in the school district. My husband and I went overseas for his position and I ended up, you know, just staying at home with my kids for a few years. And when he came back to the States, I wasn't really quite sure where I wanted to work or even if I wanted to continue with speech language pathology, because to be honest, I got high burnout towards the end of my career before he moved out of the country.
Mary Frances: And I decided, you know what, I'm just going to, until I can figure out really what I want to do, I think I'm just going to do some early intervention. So I contracted myself to an agency and, you know, kind of fell back in love with it because toddler and preschoolers have always been my niche throughout my career. And I think because of that experience within the first year, I decided that I was going to open up my own private practice and specialize, of course, in toddlers and preschoolers.
Mary Frances: In 2010, I opened up my doors to Teach Speech and we started off with just me providing private therapy to toddlers and preschoolers because I did want it to work around my family, my growing family at that time of two really young boys. My boys were four and two when I first started. So it was definitely a bit of a learning curve, but that's kind of where I ended up starting my journey in private practice again. And I kind of went from there.
Kadie: Once you found this passion with the young toddler population, then how did you end up really finding a specialty as an orofacial myologist?
Mary Frances: To be honest with you, orofacial myology, in my view, in my opinion, is that it's the complete missing link for us in our field. And I know everybody has their varying opinions, but I would think actually when I was working in private practice way back when in my earlier part of my career, I worked underneath an orofacial myologist and she had taught me a little bit, but I didn't work a lot with that clientele because I didn't go in, I didn't receive the training.
Mary Frances: So you know, years fast forward as I'm working with Teach Speech and I, you know, just always on top of research and new things and new advancements, I found this field of orofacial myology. So I went and took a class because I like learning. I had this thing of continuing education nonstop. And I realized, I was like, oh my God, I think my son has this orofacial myofunctional disorder. And sure enough, that kind of led, threw me into learning more about the field, becoming a certified orofacial myologist, all because I wanted to, of course, fix my own child.
Mary Frances: So because of, you know, learning about that, my now 11 year old, we spent the past two years on a sleep apnea journey trying to remediate his sleep apnea. And so far we've been successful, but it's been a long process. And had I not taken that class a few years ago in Chicago, I took the IOM course by Christy Gatto, I would have never known my son had this problem.
Kadie: Yes. And we've spoken a little bit previously about just how many different issues can go along with this.
Mary Frances: Orofacial myology is kind of the study of how the lips, the tongue and the jaws, the muscles of the mouth and tongue and the jaw work together and how they work together in harmony or I call it disharmony, right? So good oral function leads to proper swallowing, proper articulation, proper oral rest position. Right. And a lot of kids who have these oral myofunctional disorders, it can range, I'm just going to give you some examples, you know, the open mouth posture, open lips posture, mouth breathing, tongue thrusting, whether it's caused by an oral habit or prolonged sippy cup use, prolonged pacifier use, sippy cup, you know, we have some lip lickers, finger suckers, those all fall under oral habits.
Mary Frances: But a lot of the times working with toddlers and preschoolers, I can tell you that I see the beginning stages of these oral myofunctional disorders. And when they're identified early enough, we can prevent, reduce, you know, just like language disorders, early identification and remediation can eliminate or reduce lifelong issues.
Mary Frances: And in the case for oral myofunctional disorders, the dysfunction starts early. It starts really early, whether it's at birth, perhaps they were born with a tongue tie or they have allergies at three years old that are not addressed, you know, they've enlarged tonsils and adenoids. Majority of the time, those little ones, the first identifiable oral myofunctional disorders are enlarged tonsils and adenoids. And when they're really enlarged in their face, they have to open up their mouth and their tongue drops low and forward and thus creates this beginning of this dysfunction.
Mary Frances: So it really made so much sense for me professionally, not only personally for helping my own child, or in both of them actually, but professionally as well. I mean, catch them early, you know, because what happens is when these disorders, oral myofunctional disorders are not identified early enough, it can hinder, you know, growth of the face, growth of the mandible, the dentition and how the dentition comes in, the palate, you know.
Mary Frances: Your tongue is, you know, your free retainer, your free palate expander, if it's sitting up on the spot nestled up in the palate. And your lips, they're your free retainer because they keep your teeth where they need to be when they're both of your lips are closed.
Kadie: Yes. And I personally have some experience in, well, zero professional experience actually, but in my own personal child from the beginning, you know, it started with a tongue tie. Then we fell into having allergies. Now we can't get rid of the binky and excess saliva and drool for a nearly two-year-old. And I don't have the training as a specialist in orofacial myology. Really in my private practice, I got calls all the time where I would have to refer out for things related to this, such as oral posture, open mouth, tongue thrust.
Kadie: I'm so glad we connected because you can kind of bring a light to this, whereas a lot of people don't have that formal training. So has this specialty taken off and is this what you're primarily treating?
Mary Frances: Well, the big thing is to understand that actually true myofunctional therapy begins normally around seven years of age, but we can do myofunctional therapy with five-year-olds if they are compliant and can understand. However, for those younger ones, it does fall under feeding therapy, but also the biggest thing for us to do when the kids are little, especially like your child, who has some concerns, is to refer him out to the right people.
Mary Frances: And that's kind of our goal in oral myofunctional therapy. After we figure out what is going on inside there, we then refer to the appropriate professionals to help make sure that the issue isn't structural, or they don't need tonsils and adenoids, or they don't need to address their allergies, or they don't possibly need to address some gut health and digestion and things like that.
Mary Frances: So we're kind of like the quarterback, actually. We start everything, we have the plays, and then we put everything in action. And we can't do it alone. We're not an island, and as a speech pathologist and a myofunctional therapist, we do need to collaborate with other professionals. It's imperative for successful treatment.
Kadie: How does that look in the private practice? To make referrals elsewhere, do you typically send a fax or provide a patient a hard copy of a referral? What do you do to refer out?
Mary Frances: Well, I think it starts with building relationships with other professionals. Sometimes it could be as simple as reaching out to an email, or seeing them at a conference, or actually going to their office. I mean, when I first started my practice, my biggest form of advertisement was actually going to each office, dropping off pamphlets of information, sometimes including some bribery of candy or baked goods, but actually reaching out to them, saying, hey, this is what I do, I'd love to hear what you do, how we could work together to best help our patients.
Mary Frances: Because a lot of people, professionals too, we're talking pediatricians, otolaryngologists, some pediatric dentists, they don't truly understand the field of speech pathology, but most definitely are still learning about orofacial myology. So it starts with just reaching out to them, and it may take several times, trust me, several times to build that relationship.
Mary Frances: But I also, upon parents' permission, fax the reports to the referring agencies, and so when you write a really detailed, thorough evaluation, a medical professional should be able to interpret that and understand it. But there's always going to be questions, so you have to be prepared to educate, help educate the community, the parents, and the professionals.
Kadie: And so, as you've made these connections, has that been your primary source of marketing, or have you done anything else out in the community?
Mary Frances: Over the years, I've tried many, many things, obviously speaking, a lot of speaking events to local MOPS groups, local schools, being at preschools or daycares for their open houses, as well as Facebook, Facebook marketing. There's not a secret sauce to advertising. The secret sauce is being good at what you do and working really hard, and continuing to encourage that relationships with anyone that your patient brings to you.
Mary Frances: I will get lots of referrals from professionals I don't know, like an ENT or a pediatric dentist, so then I take the time to reach out to them to explain who I am, and how I'm working with this patient, and how I can best help their patient or help them, and if they have any questions. I mean, there's so many different ways to market, and there may be easier ways, to be quite honest, but I haven't figured them out yet. A lot of it is build relationships.
Kadie: Yes, you're absolutely right. I don't know if there's an easy way around building those relationships. It does take time, and it does take guts to put yourself out there, but I'm sure over the years, people in your community have heard your name, seen your face. Have you been able to grow with any hiring?
Mary Frances: Yes, I have. I actually have, in my office, there's two of us total, myself and another colleague, and she is also a speech-language pathologist and orofacial myologist, so our practice does do now a lot more myofunctional therapy than we do speech therapy. We also have a team of early interventionists, and there are five of them now, so we do keep it small.
Mary Frances: For me, that works, because I like knowing who my therapists are working with and their families as well, so that we can touch base weekly about our sessions and so forth, but I will tell you that the highest referral I can get is from graduated families, families that are satisfied and happy.
Kadie: That's right. They're going to tell all their friends, they're going to take what they've learned and point it out to other people and say, guess who you should go to. There's a lot of private practices in my area, and the way I look at it is there are plenty of children and now adults that I work with that need help, and so to me personally, it's not a competition. I just keep my head down, keep doing what I'm doing, try to do it the best that I can, and collaborate with individuals in my area, other speech-language pathologists.
Kadie: You have a team that goes out to clients' homes doing early intervention work, then the others are in your brick-and-mortar office, and then you have recently branched out or are just beginning a new thumb-sucking clinic, is that correct?
Mary Frances: Correct. So, after my orofacial myology class, where I learned a little bit more about thumb and finger habit elimination, I knew it was my calling. I was a prolonged thumb sucker to the age of 10 for many, many reasons now I know, but I knew that had I had somebody like myself help me when I was little, I probably wouldn't have had two sets of braces and large tonsils and adenoids and chronic mouth breather majority of my childhood.
Mary Frances: So, after this orofacial myology initial class, I mentored with a thumb-sucking elimination expert, Carla Laharga, in Australia in the thumb-sucking clinic, and I did a year-long mentorship and decided to open up my own thumb-sucking clinic, and it's the first one of its kind in the United States.
Mary Frances: In 2020, Carla and I will be teaching in the United States. We are still pending locations in late April, early June. We're going to be providing a two-day residency course, Secrets of the Thumb-Sucking Clinic, to professionals. That would be speech pathologists, orofacial myologists, RDHs, dentists, orthodontists, you know, nurse practitioners and physicians, so we're really, really excited about that, and I think my favorite part of what we do is education and educating, mentoring, so I feel like this movement towards, you know, helping other professionals help other people is like what my life calling is.
Kadie: That is amazing that you went from feeling a little bit of burnout, in all honesty, and since found a passion, and I just think that's so cool because sometimes we can feel stuck doing the same thing day-to-day and not looking beyond.
Mary Frances: You just have to keep looking, you have to keep your eyes open. Our field, I mean, granted most health professionals, it's high burnout, but speech-language pathologists, we do amazing work and we can feel under-appreciated pretty easily. I don't think people realize how rewarding yet challenging our job is, you know, you put your heart and soul into it.
Mary Frances: So yes, I mean, if you told me 10 years ago when I wanted to go, when we moved back to the States and I wanted to work at Starbucks and just make coffee all day, that I would have moved forward to this 9 years later, I would have said, no way, never ever.
Kadie: Yes, and look, it all worked out for the best. That is amazing. So are there any words of advice that you could tell someone who's interested in maybe taking a leap into private practice?
Mary Frances: I'm going to tell you with brutal honesty, it is not for the faint of heart, but if you can get through those first couple of years of really hard work, you know, and being able to be resilient and work many hours, once you get it to where you want it to be, private practice is the most rewarding area that I think that you can be. I can do what I love and still have time for my family.
Kadie: Exactly.
Mary Frances: Honestly, once you find what really, really is your true passion, it's not hard work. Good mentors, good people around you, a good support system, and honestly, a great accountant. You have those things in place, you can be successful.
Kadie: I love that. Well, I want to thank you for spending time today kind of explaining your journey. I find it a very interesting one, and I appreciate you sharing your story.
Mary Frances: Thank you. Thank you for having me. I really appreciate it.
Kadie: Thank you for joining me and listening to Clinic Chats, the speech therapist's private practice podcast. If you have a moment, please leave a five-star review for Clinic Chats to help other SLPs find our podcast. If you'd like to share your own personal journey through private practice, please email me at kadie at clinicnote.com. That's K-A-I-D-E at clinicnote.com.