From Playground Push to Social Skills Empire: Rhonda Osisek on Building a Group Therapy Practice
A boy pushed another kid off a swing. When Rhonda Osisek asked him why, he said, "Well, Miss Rhonda, I wanted a turn on the swing." Just like that. Matter of fact. It never occurred to him to use his words.
He had solid language skills. No articulation issues, no vocabulary gaps. But somewhere between knowing the words and using them socially, there was a disconnect. That moment on the playground in 2004 launched what would become Social Butterflies Club, a private practice built entirely around social communication group therapy, now serving 175 kids weekly across multiple locations in Virginia Beach.
Rhonda's path to this point was anything but linear. It wound through hospital floors, a husband's ALS diagnosis, single motherhood, and the slow realization that the thing she was best at was also the thing the field needed most.
When the Textbooks Don't Have a Chapter for It
In 2004, social communication disorder didn't exist as a formal diagnosis. Rhonda went looking for programs that could help her young client and came up mostly empty. The materials she found were narrow: one lesson on eye contact, another on body language. Isolated skills taught in isolation. It wasn't moving the needle.
So she went back to basics. She pulled from her years running language groups in the school system and reframed social skills as what they actually are: language skills, organized developmentally.
"Don't be scared of it," she tells other speech therapists. "If you break it down into language terms, it's everything that we already do."
That reframe became the foundation of the Social Butterflies curriculum, a color-coded, trademarked system she developed over years of trial and error. She copyrighted it, built trainings around it, and now sells it to other SLPs who want to run social communication groups but don't know where to start.
The Business Model That Emerged from Necessity
Rhonda didn't set out to build a group-only practice. She started with a traditional outpatient clinic called Atlantic Speech Therapy, billing insurance, seeing individual clients. The social groups were an add-on. But as demand grew, the groups became the practice.
Today, Social Butterflies Club runs three to five groups per day. The team includes a full-time SLP, occupational therapists, and early childhood educators. They service private schools and preschools during the day and run afterschool groups in the evenings, with sessions running from about 9 AM until 6:30 or 7 PM.
The interdisciplinary model matters. When they go into preschools, the SLP, OT, and educator work together, pulling the play-based and social-emotional curriculum into what the school is already doing. It's not pull-out therapy. It's enrichment, and it reaches kids who aren't on anyone's caseload yet.
"There's been a real shift in preschool," Rhonda explains. "They're focusing on academics. But what children were made to do is play. And that's where language develops."
Why She Stopped Billing Insurance for Groups
Here's a lesson that cost Rhonda real money and real client relationships: she used to bill insurance for the social communication groups through her former practice. Then the denials came. Thirty days later, parents were staring at bills they didn't expect.
The problem is two-fold. First, many insurance companies won't reimburse for group therapy at all, or they'll only reimburse for adult groups. Second, the social communication disorder code in the DSM is classified as developmental, and insurers will flag it as not medically necessary.
"That's one mistake we made with Atlantic Speech Therapy," Rhonda says. "We were billing insurance for these groups, and then 30 days later, the denials came back, and the parents had this giant bill."
Now, Social Butterflies Club operates on private pay. But Rhonda is quick to note they still function as a medical health provider. That means HIPAA compliance across the board, an electronic health record system that supports both SLP and OT documentation, and all the backend billing and record-keeping that comes with running a legitimate clinical operation.
The Billing Change That Fixed Attendance
Rhonda made another business shift that transformed how her practice runs: she moved from per-session billing to monthly billing in advance.
"It's amazing how the parents will show up when they've already paid."
Families commit to a semester of 12 to 15 weeks. They pay each month upfront. If they withdraw before finishing, they don't get a refund. The policy is laid out in a contract signed at enrollment.
It sounds strict, but the reasoning is clinical: consistency matters for progress. Kids need to show up week after week for the skills to build. And makeup sessions are available for legitimate cancellations. The result is better attendance, better outcomes, and a practice that can actually plan its finances.
Group According to Skill, Not Age
One of the most practical takeaways from Rhonda's two decades of running groups: do not group kids by age.
"I think that's where a lot of speech pathologists give up, because they put kids together that are five years old, but clearly, every five-year-old has different skill sets."
Instead, she groups by skill level. For the youngest kids (three to five), groups cap at four, always with two clinicians present. As kids develop stronger joint attention, groups expand to six or eight. Beyond that, the teaching breaks down.
This approach extends to her work in collegiate schools and gifted programs. Plenty of kids have the academics locked down but can't navigate a conversation with a peer. Social Butterflies fills that gap regardless of grade level or IQ.
Scaling Through Community, Not Just Marketing
Rhonda hasn't relied on traditional advertising to grow. Instead, she built referral relationships with pediatricians, neurodevelopmental pediatricians, and outpatient occupational therapy and speech therapy practices in the Virginia Beach area. Those clinicians handle the one-on-one therapy and then refer families to Social Butterflies for the group component.
She also serves a large military population, doing promotional events and community outreach with military families at the multiple bases in the area.
The newest branch of growth is education. Rhonda launched a private Facebook group called Communication is Social, where she fields questions from SLPs who want to start social communication groups. She sells her curriculum through Teacher Pay Teacher, has done in-person trainings at schools and private practices, and is building out virtual training options to reach clinicians who can't travel.
"As speech pathologists, we discount our knowledge," she says. "We know so much. We have so much that we're trained in and we discount that."
Her accountant keeps her honest on that front. 2020, she said, was the year to stop giving it all away for free.
Running group therapy means managing scheduling, documentation, and billing across multiple clinicians and disciplines. ClinicNote is a HIPAA-compliant EMR built for private practices and university clinics, with support for SLP and OT workflows, progress notes, and client billing in one system. See how ClinicNote works.
Transcript
Kadie: You are listening to Clinic Chats. Clinic Chats is a multidisciplinary therapy podcast that was created for students, professionals, clinic directors, and supervisors. Clinic Chats is bridging the gap between graduate programs and professionals, sharing personal journeys of the smallest of private practice startups, large and expanding practices, as well as university clinic triumphs and tribulations. We hope you'll find our podcast informative and helpful in your career endeavors. Clinic Chats is sponsored by ClinicNote, an electronic medical record company for private practice and university clinics. ClinicNote was designed to make scheduling, documentation, report writing, and billing effective, efficient, and HIPAA compliant. Our featured sponsor this week is Therapy Marketing Kit, the perfect solution to creating professional marketing materials for your business. Today I'm joined by Rhonda Osisek, and she is the owner of Social Butterflies Club. Rhonda, I'm excited to hear it sounds like you have your specialization in social language. So why don't you jump on in and tell me how all of this began?
Rhonda: Oh, wow. What a story I have for you. Well, I have been practicing since 1998. I started in the school system with my bachelor's degree, and I worked there for a few years and obtained my master's degree. And I just felt like the caseload back then was just, I had 75 kids on my caseload. It was just overwhelming, and I wasn't really feeling like I was making a difference. So I took a job at a local hospital as an outpatient speech language pathologist, and little did I know, I was the only one for about 75 miles. So I did a little bit of everything in that position.
Kadie: Wow.
Rhonda: Yeah, it was a great experience. And I think if I would have known ahead of time, I probably wouldn't have accepted the position because I wasn't as comfortable with my skill sets at that point. I was still a new grad. But anyway, so I did everything from infant feeding all the way up to adult feeding. And I did outpatient speech. We serviced the school system. So I did a little bit of everything, but got an amazing experience, and something that you wouldn't get in an internship. And that's where I met my husband. He was a physical therapist, and we met at the hospital, and we decided to get married and start a family. So when we did start a family, I said, I think I'm going to work for myself. I could spend some time with my baby. And I was able to do that with his help. Another little side note, and this is why things happen. He was diagnosed with ALS, which is Lou Gehrig's disease. So I had to work for myself so I could take him to his doctor's appointments. And be a speech pathologist at home to help him with his swallowing and all the communication stuff. So I feel like I look back now, and I feel like there was a reason why I started my practice. And it was a speech pathology practice, and we just did outpatient speech and language. We billed insurance. That was called Atlantic Speech Therapy was the name of that practice.
Rhonda: And in 2004, one of my little guys I was seeing at a local private school, I was seeing him for a lisp, and he had really great language skills. The teachers came to me and said he was having behavior issues. And I was a little surprised because I knew the boy, and I couldn't imagine what types of behavior issues he would have. But they said, he's on the playground, he's pushing kids off the swing. And I said, okay, well, let me go see what's happening and see if I can refer you to a behavior therapist or something. So I went out and I watched him. And sure enough, he walked up to the boy and he literally pushed him off the swing.
Kadie: Oh no.
Rhonda: So I went up to him and I said, so why did you just do that? And he said, well, Miss Rhonda, I wanted a turn on the swing. And just very matter of fact, like, you should know this. And I said, okay, well, why didn't you use your words and ask him? And it just never occurred to him to use his words. And I knew he had solid language skills. So I'm thinking, why in the world is he doing this? So that was my beginning. That was my journey. I did so much research at that point and discovered later that he was diagnosed with, back then it's called PDD-NOS, which now would be on the autism spectrum. But he was super high functioning, but he just was lacking the social skills. So I started my very first social group for him. And we called it Social Butterflies Club. That's when my passion started. And we just kept adding them into the practice and it kept growing. And then for 10 years, we had the Social Butterflies Club groups.
Kadie: Whenever you began with that first client, obviously as a speech pathologist, you have the skills to train in social language anyway, but is there any certain program you decided to go with? Or did you kind of develop your own?
Rhonda: Yeah, so this was 2004. This was before there was even a diagnosis of social communication disorder. So I had to go back and do a lot of research. I tried several different methods that I could find on the market, but nothing really worked for him because they were very specific. Like you can work on eye contact or you can work on body language in the lesson, but it wasn't making a difference. It wasn't helping me get him to where he needed to be fast enough. So I ended up kind of just using tools that I had learned over the years. And honestly, a lot of them were from the school system when I worked in groups of language kids. And as speech pathologists, when I talk to other speech pathologists about social communication and social skills, I tell them, don't be afraid of it. It's very overwhelming at first, but if you break it down into language terms, it's everything that we already do. You just have to kind of break it down developmentally. So I learned that over the years. And since I didn't have anything that worked for me specifically, I created my own curriculum, which is the Social Butterflies curriculum. And it is, there are a lot of tools that speech pathologists use, but we just kind of group them together and there's a way to do it. There's steps in how to do it to make progress and to get them to the next level.
Kadie: Is this a program that you've documented and is systematic?
Rhonda: Yeah, so I'm kind of type A and I like for things to be very organized. And that's the thing with social skills, they're very abstract and unorganized. So I had to organize it myself so that I could teach it in an organized manner. So yes, I copyrighted it. Probably about six years ago and it's trademark copyrighted. I went through that whole long process of doing that. And I do trainings and I do sell the actual curriculum after the trainings, because you need the trainings to understand how the program is structured, if that makes sense. And it's a color coded system.
Kadie: I love something black and white like that.
Rhonda: Yes, and that's what social skills are. They're so in the gray. They're so abstract.
Kadie: I can't handle it.
Rhonda: Yeah, and I think that's why a lot of us as speech pathologists get so overwhelmed with it because where do you start? How do you organize it? So this was a long time, obviously, that it took me to get it all organized. But once I did, it's like, yes, this is it. I tried this and it didn't work. And I tried this and it didn't work. And I put the stuff together that did work. And then it started rolling. And now actually that's all we do, our social communication groups. That's my whole practice is just group therapy.
Kadie: Wow, so how many groups do you run?
Rhonda: Well, we have 175 kids that we see every week. So we run, yeah, it's anywhere from three to five groups a day. And we also service local private schools and preschools during the day to kind of fill up my clinician's schedules during those times. And then we see afterschool kids.
Kadie: I was going to say, I bet social language groups tend to be primarily afterschool hours. So has that kind of been a challenge for you or is it what you preferred?
Rhonda: Well, for me, I preferred it, especially in the beginning when my husband was sick and I was home with my son. But now that my son is 17, he's older, my husband ended up passing about nine years ago.
Kadie: I'm so sorry.
Rhonda: Yeah, thank you. But I look at it as it was a gift because that's when I said, okay, what do I want to do? What's my passion? And that's when I just started shifting just to doing social communication groups and Social Butterflies. And so I sold Atlantic Speech Therapy and this is where I am now. And I have been for the last nine years and I love it. It's everything. So to answer your question, it was good for me at the time because my son was still young and now he's older. And I've started adding in the private schools during the day to fill up the schedule. So we start a little bit later. We start about nine or 10 o'clock and then we run until about 6:30 or seven is our latest group, I think, in the evenings.
Kadie: And did you say you have some hired speech pathologists under you? How many do you have at this time?
Rhonda: Well, so I have a speech pathologist full-time. So it's me and my one clinician, but then I have occupational therapists who work for me as well. And educators. So when we started going into the preschools, I needed an early childhood educator to come in as well because it's more of an enrichment program. So it's like a team approach. So I have a speech, the early childhood educator, and the OT. We all go in and we do the group together and it kind of just pulls everything that the preschools are working on together.
Kadie: That's an interesting business model. So you don't only work with kiddos who are developmentally delayed. You might be working just on normal developmental skills that everyone can benefit from.
Rhonda: Yes, and so what's happened in the last few years is there's been a real shift in the preschool and that, as you may know, having a young child, that they're really focusing on academics. And what preschool was made to be and what children were made to do is play. And so they're not getting that in the preschool because the parents are pushing the preschool directors to get the academics in before they get to kindergarten. So we are left to teach the social skills, the play skills in the kids. And that's where language develops, as you know, as a speech pathologist and an occupational therapist, we're like, you gotta teach them the play skills. This is where they learn crucial skills. So yes, that's why we've had to go in there. And I think the shift is starting to turn back to play-based preschools. Now that we have these kids in elementary school and middle school who have no social skills, they're just really struggling.
Kadie: Well, I hope it's going to go back to that because I'm struggling with that right now with my two-year-old. I sent him to a preschool, also in-home daycare, but I wanted him to get lots of peer interactions, just lots of play time. And they're boasting about him knowing colors and letters. And I'm like, I don't care. Can he share?
Rhonda: No. Exactly. That's exactly it. And that's exactly what happens. And so these preschool directors are like, my teachers can't teach the play skills. They can't do play. They have to do academics. So can you help with the play and the academics? So we go in and do the groups for that.
Kadie: So it's a contract then with the school rather than with the families.
Rhonda: Well, a little of both. So we service quite a few preschools in the area and private schools. So some of the schools we contract with the school and some is an optional enrichment program that the parents would pay for. And we also have a lot of kids in collegiate schools or gifted programs, again, that have the intelligence and have all the academics but don't have the social interaction. So we help them with that as well. We go into those schools. So yeah, it's a big market.
Kadie: Have you had to do a lot of marketing or is it just taking off organically over the years?
Rhonda: Well, I think in the beginning it was, we pulled the kids that we were seeing for speech and language that we identified as having pragmatic language delays. And then over the years, I've worked with local pediatricians and neurodevelopmental pediatricians in the area as well as other therapists. So we have a great relationship with the other outpatient speech language pathologists and occupational therapists in the area. So they'll do the one-on-one therapy and then they'll refer the parents to us to do the group to pull it all together. So we do a lot of promotional events and we're there just to kind of help parents understand and we try to support the community. We also have a big military population here. We're in Virginia Beach and it's a huge base for several bases here. So we do a lot of promotional stuff with the military families as well.
Kadie: As far as the business side of things, do you have to spend a lot of your weekly hours allocated to paperwork, business tasks, or maybe at this point, it just all kind of runs smoothly and it's part of your routine, but how much time do you think you spend on that?
Rhonda: Well, I spend, as the director, probably more than half of my time with the business side because even though, and this is another thing, we don't bill insurance for the social communication groups and I can talk about that for speech pathologists who want to know, but we still are considered a medical health provider so we still have to be HIPAA compliant with everything we do, even though we don't bill insurance. So I have to make sure that all of our records are HIPAA compliant, we use an electronic health record system that has OT as well because we do OT groups and we have occupational therapists who come in and will do goals. So our speech pathologists still have to do all of their documentation. I have to stay on top of it, make sure it's submitted. We have to do billing to the parents. So there's a lot that I still have to do on the backend. That's not my favorite, but yes, my experience from Atlantic Speech Therapy and my previous jobs helped me and it does run a little bit smoother than it did in the beginning.
Rhonda: We're starting to do more satellite locations at some of our colleagues' outpatient clinics. So what we'll do is we'll rent space from them and we'll do groups on site. After the therapy is done, we go in and we do the group. So we're starting to branch out a little bit more with that and then I have recently, to add to my plate, created a Facebook group called Communication is Social where I take questions from speech pathologists who are wanting to run social communication groups and so I'm doing some trainings and trying to help them figure out how to get the groups up and running because I see a lot of times in the groups and I see how much the speech pathologists are overwhelmed with starting a group and how to get it going and grouping the kids and all that. So I want to be able to help them because it's so much easier than it appears to be. So that's another way I think we're taking the company. I want to do some online trainings because I've done some offsite training, but it's a lot to travel and do the trainings and then get back.
Kadie: And with your group on Facebook, has it allowed you to sell and market your program?
Rhonda: Yes, so we're starting to do that, yes. And of course me, as a speech pathologist, I just want to help. But my accountant, she kind of keeps me honest and she says, you need to make sure that you're billing for your time. And I think, again, as speech pathologists, we discount our knowledge. I mean, we know so much. We have so much that we're trained in and we discount that. So I'm really, 2020 is my year to really take account of that. And I want to help people, but we are starting to market my curriculum and sell it to speech pathologists and help them kind of grow.
Kadie: So is it on your website, Social Butterflies Club?
Rhonda: Well, it is not because we have a free membership for professionals. If you go to Social Butterflies Club, there's something called Social Butterflies Club Pro. And it's a membership and you can be a parent or a professional and I have free materials posted there. So what we're doing is we're going to market it through our private Facebook page, Communication is Social. So we're trying to take what we have and open up kind of a new branch of Social Butterflies and have that just be the learning division of the company. So if people want to access it, they have to go through, either sign up to be on the membership, the free membership and they'll get an email about it or they have to go through the private Facebook page.
Kadie: Have you been in contact with Bill Connors who's on some of the Facebook private practice groups?
Rhonda: I've seen him pop up and I've thought about it. Is he somebody that we should follow up with?
Kadie: Yeah, well, he's primarily in teletherapy like with adult world. So not because of your therapy specialty but he has like three different branches, one for the teletherapy side, a website, one for materials to purchase as a website. So just interesting, maybe he could help develop the direction of how to kind of outline all of that.
Rhonda: Yes, and that's exactly what we're doing. You're absolutely right because I have seen his website and that's what we're doing. We're kind of trying to take this and with all the virtual learning that's available now, I want to make sure I put this out and have it accessible to speech pathologists who can't make offsite trainings. My materials, I do have on Teachers Pay Teachers. So I have a Social Butterflies Club store on Teachers Pay Teachers that is active and they can download the curriculum and I have free materials there. So we're just going to link that up to the training. So they can access it through that.
Kadie: And you've done some trainings in person or have you done any online yet?
Rhonda: I've done quite a few in person. It's just, it takes a lot to travel. And as a single mom, it was just a lot on my son having to be here by himself. So it is something that I love to do. I love to teach and I've done school systems. I've done private practices. I've gone and trained them in the program and taught them how to do billing and assessment and that type of thing. So yes, I have, but I'm trying to get away from that and do more virtual.
Kadie: Is there any words of advice for someone who's just starting out, scared to jump in? What would you tell them?
Rhonda: I would say, don't be scared. We're speech pathologists. We are superstars. We're rock stars. We know so much about so much. And this is what I tell when I do my trainings. I tell them, just go back to your toolbox and break it down as language skills. And that's where the social skills lie. They lie within language and they start from birth and they develop through play, which is what we do when we work with the young kids. We play and we teach them the language through play. So don't be scared. If you want to incorporate it into your practice, it's a wonderful addition and it's a way to make additional revenue.
Rhonda: I will talk to you about the billing though, because some insurance companies will not reimburse for group therapy. And that's what you have to code it under is group therapy when you have more than one. So you might have to do private pay, which might conflict with your contract with insurance companies. So if you do bill insurance, you might want to check into that first before you start the group.
Kadie: Like if that client carries an insurance that you're in contract with, sometimes you're legally not allowed to take their private pay money.
Rhonda: Yes, exactly. So that's why we contract with some of the private outpatient clinics, because they're not allowed to bill for the group. So you just have to look back through your contracts and figure that out. Now, this may change with all the autism insurance reform. So just keep an eye on it. But historically, it was always kicked back because, well, for two reasons. One, it's group therapy, and typically it's only reimbursed for adult group therapy. And two, the new social communication disorder code in the newest DSM is a developmental code. So they will say it's developmental, it's not medically necessary. So you just have to know your insurance companies and do a little research before, because it's one mistake we made with Atlantic Speech Therapy is we were billing insurance for these groups, and then 30 days later, the denials came back, and the parents had this giant bill that they had to pay out of pocket to go to their deductible, and they weren't happy about it. So again, it's lessons we learned. So that's one thing. If you're just doing private pay, I say go for it. If you're in the schools and you want to do a social group, I say go for it, because they're so easy to incorporate into your therapy caseload.
Rhonda: And here's the other tip. Do not group according to age. Group according to skill level.
Kadie: Good tip.
Rhonda: Yes, I think that's where a lot of speech pathologists give up, because they put kids together that are five years old, but clearly, every five-year-old has different skill sets. So you're going to group according to skill level, not according to age.
Kadie: And what's your ideal group size?
Rhonda: Oh, that's a good question. Again, another thing that I figured out over time. So with the littles, littles meaning three, four, even five, we keep them around four in a group. And that's with me and an OT or an SLPA. So I have two of us at all times. So don't make it any more than four for the basic groups. And then as they get older and are able to, their joint attention goes up, you can have them in like six to eight kids in a group. But if you start getting bigger than that, you're not going to be able to teach the concepts.
Kadie: No, exactly. It's just not going to happen. It's too much. Do you mind sharing, I think that there's probably no right way to do this, but do you prefer to bill in one large chunk for like a 10-week program, or are they paying per session?
Rhonda: Well, that's a great question too. Again, another mistake that we made. We used to let them pay per session, but if they didn't show up, we would lose money. So what we did was we started billing in advance. So they have to pay the month in advance. This increases the attendance. It's amazing how the parents will show up when they've already paid. It increases attendance, and it also, for us, it helps the kids gain the skills because you need to be consistent with any therapy. So we bill in advance monthly. We also run by semesters. So we have anywhere from 12 weeks to 15 weeks, depending on what time of the year it is. So they have to commit to the semester because we tell them the reason you're committing is because this is how long we need to make progress. And we give them a progress note at the end of the semester. If they don't complete the semester, they can withdraw, but they don't get their money back. So that's kind of one of our billing requirements.
Kadie: So I'm sure you have all this in a contract, like you're signing up for this semester, you will pay at the beginning of each month for four sessions.
Rhonda: Yes, exactly. And of course, if there's extenuating circumstances, we will let the people out of their contract. But for the most part, everyone sticks to it. And I think that's when we changed the billing procedures, that's when it all started happening.
Kadie: Well, that is smart. I know those cancellations can get you.
Rhonda: Yes, absolutely. And of course, right now, we're all in the middle of the flu here in Virginia. So we've had a lot of cancellations, but we'll offer makeup sessions for parents too, who have valid reasons.
Kadie: All right. Well, is there anything else that you wanted to add? I love your story and you're really great at telling it. So thank you.
Rhonda: Thanks. Well, I just, like I said before, don't be scared. As a speech pathologist, I feel like we don't get a lot about social communication in college. I think that's changing with the increase of autism and technology. I think that if you want to start, do it, try it, and use the tools that you've already been taught and that you have in your toolbox. And I'm happy to help. Anybody can email me if they want more information, and I'm happy to help them get rolling. I've done it for many speech pathologists, and it's just something that I love to do.
Kadie: Will you share your email address for us?
Rhonda: Sure. It's rosisek@socialbutterfliesclub.com.
Kadie: Awesome. Well, thank you for your time, and enjoy doing what you love.
Rhonda: Thank you so much, Kadie. I've enjoyed telling my story.
Kadie: Thank you for joining me and listening to Clinic Chats. 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, please email me, kadie@clinicnote.com. That's K-A-I-D-E at clinicnote.com.