From SLP to SLP-BCBA: Kate Grandbois on Building a Niche Consulting Practice and Launching SLP Nerdcast

Kate Grandbois does one thing, and she does it well. She works with non-speaking individuals who have behavioral challenges, fits them for AAC tools, and trains the teams around them to actually use those tools in real environments. That's it. No fluency cases. No literacy referrals. One niche, owned completely.

What makes Kate's story worth your time isn't just the clinical focus. It's the way she built a private practice that looks nothing like a traditional caseload, then layered a continuing education podcast on top of it. Her path from outpatient SLP to dually certified SLP-BCBA consultant to podcast co-host is full of decisions that other practice owners can learn from.

Why She Went Back for Her BCBA

Kate spent years working across outpatient clinics and hospitals, always keeping a client or two on the side. When her first daughter was born, she made the full switch to private practice for the flexibility. It took off faster than expected.

But five or six years in, she hit a wall that clinical skill alone couldn't fix. Her clients, primarily non-speaking individuals, often had significant behavioral challenges. She could teach communication strategies all day long, but if a child was under the table or refusing to engage, none of it mattered.

"I could teach you to communicate, but I can't make you comply," she says.

In 2014, she went back to get her BCBA certification. By 2015, she was dually certified. That decision reshaped her entire practice model. Instead of carrying a traditional caseload of direct therapy clients, Kate shifted toward consultation, training, and AAC evaluations for schools, primarily private schools serving students with autism in the Boston area.

A Practice Without a Building

Kate's practice lost its brick-and-mortar space when the landlord sold the building. Within the same month, two school contracts came through. Instead of scrambling for a new lease, she leaned into the consulting model and never looked back.

It's a trade-off she thinks about regularly. Renting space means overhead. And overhead means you need a certain volume of direct therapy clients to break even. For a consultant whose value is expertise rather than session count, that math doesn't always work.

The COVID-19 pandemic only reinforced the decision. When everything moved to teletherapy, Kate's consulting work translated seamlessly. Watching videos, coaching parents, advising BCBAs and special education teachers, all of that worked just fine through a screen. The continuing education side of the business actually accelerated, since she suddenly had more time to research and record.

The Business of School Contracts and Niche Referrals

Kate's revenue comes from a mix of sources. Most of her work flows through school contracts, particularly with substantially separate private schools for students with autism. Some families hire her directly to consult on an IEP, train a team on a new device, or provide guidance on a complex case where speech and behavior intersect.

Word of mouth drives most of it. When you're one of the few people in a region who hold both an SLP and BCBA certification, administrators and parents talk. She's still technically in-network with Blue Cross and Harvard Pilgrim, but with no clinicians available to take direct referrals, those calls get redirected. That hiring gap was something she'd been working to close right before the pandemic shut everything down.

Her approach to initial family contact is worth noting. She takes phone consultations for free, no strings attached. If she can answer a quick question or point someone toward the right colleague, she does it. If the case is a fit, she books an appointment. That generosity with her time builds trust and feeds the referral pipeline without costing much.

AAC Evaluations Without a Device Cabinet

Fifteen years ago, an AAC evaluator might have needed a closet full of $7,000 devices. Kate's approach looks different. She keeps a handful of iPads loaded with communication apps, some low-cost switches, talking bricks, and GoTalkNow. For anything beyond that, she borrows from vendor lending libraries.

When a family needs a trial with a dedicated device, the vendor ships it directly through their funding department. Insurance or a third-party payer covers the trial. Kate doesn't have to buy, store, or maintain expensive equipment that will be outdated in two years.

"Technology changes so fast," she says. "With an iPad and a handful of adaptive equipment pieces, you can get a general sense of what direction you want to go in without needing to buy a $7,000 piece of equipment."

It's a practical model that keeps overhead low and lets her focus on the clinical decision-making rather than inventory management.

SLP Nerdcast: Continuing Education That Respects Your Time

The podcast grew out of a simple frustration. Kate and her longtime collaborator Amy Wonka noticed that most speech therapy podcast CEU options were cumbersome. Separate logins, slide downloads, clunky verification. They wanted something you could listen to while commuting or folding laundry and then grab your certificate with minimal friction.

Kate had a specific advantage here. In a previous role, she'd run a nonprofit that was an ASHA-approved CE provider. She knew the requirements inside and out. SLP Nerdcast episodes are at least an hour, evidence-based, rooted in clinical practice, and qualify for ASHA Certification Maintenance Hours. After listening, you go to the website, add the certificate to your cart, answer a quick quiz, and it's emailed to you.

With two clinical licenses requiring 60 continuing education hours every two years, Kate was personally motivated to make the process painless. "All of the cumbersome ways to get CEUs really irked me," she says. "I was personally very motivated to create this product for everyone out there."

The podcast also takes listener requests seriously. Someone asked for an episode on accepting and giving critical feedback, and they built one. A series on how AAC and ABA sometimes clash in practice was in the works at the time of recording.

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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 Jakstat, and thank you for joining me today.

Kadie: Thank you all for joining us for another episode of Clinic Chats. Today I have a really fun guest, Kate Grandbois. Kate is the owner of Grandbois Therapy and Consulting and also runs a podcast called SLP Nerdcast. So Kate's going to give us a rundown of both of these today. Thank you, Kate. How are you?

Kate: I'm fine. Thank you so much for having me. I'm a little nervous. I'm usually not the interviewee, so I'm really excited to be here today. Thank you again for having me.

Kadie: Oh, I'm not worried. We have plenty to talk about. You're going to be great. I would love to first get an idea of how this all began. So maybe we'll go in a sequential order of your experience as an SLP and at what point you decided to pursue private practice.

Kate: Sure thing. So I started out working in a variety of different work settings, outpatient clinics, outpatient hospitals, and I had always had a client or two on the side. When I had my first daughter, I decided to transition into private practice for the flexibility and it took off a lot quicker than I expected. I have done private practice since then exclusively and I've done a variety of different combinations. I've rented office space, I've taken insurance, I've been private pay. So it's been a little bit of a wild ride over the last, I'd say 12 or 15 years is how long I've been seeing private clients.

Kate: And about five or six years into being in private practice exclusively, I noticed that I was having a hard time getting a lot of my clients to participate fully in therapy. So my area of expertise is non-speaking individuals with behavioral issues, non-speaking individuals or individuals with limited speech. And I've always felt like I couldn't teach them to communicate if I couldn't get them to crawl out from under the table or I could teach you to communicate but I can't make you comply. So in 2014, I went back to get my BCBA. So I've been a dually certified SLP BCBA since 2015 and now my practice is pretty exclusively working with non-speaking individuals who have behavioral issues and need to be fitted for AAC tools and I pretty much exclusively consult to schools and do trainings and evaluations when needed.

Kadie: Oh, wow. So at this point, now that you have your specialization, you're not seeing a ton of clients directly week to week. You are more the specialist who's coming in and providing those services or an evaluation?

Kate: Yes. So that's my personal bag of tricks is what you could say. I provide a lot of training and consultation to educational teams and school facilities, training other speech pathologists and BCBAs in how to implement AAC tools in their naturalistic educational environment.

Kadie: Do you have a business partner or is it strictly a podcast partner?

Kate: So my private practice is mostly me and right before COVID-19 started, I was looking to hire somebody to do more of the individual treatment because there's just such a need out there. And I was having a lot of conversations with Amy Wonka. She was my mentor and longtime friend and pretty much taught me everything I know about AAC and we've done a lot of work and collaborating together over the years, speaking at conferences and things.

Kate: And we realized that there weren't a lot of continuing education opportunities out there in podcast form. There are a lot of really amazing speech and language pathology related podcasts, just like this one, but not very many of them were available for ASHA CEUs or other certificates. And we're so busy. I listen to so many podcasts while I'm commuting or while I'm washing my dishes or folding my laundry, and we really wanted to create a product that was really high quality. So something that was very evidence-based, very rooted in literature, very rooted in clinical practice, and was at least an hour long.

Kate: And in a former life, I ran a nonprofit that was an ASHA approved CE provider. So I know all about what goes into the actual CE process. And SLP Nerdcast was born. That was sort of also right before COVID-19 sort of happened. So since then, we've been, instead of hiring people to do individual treatment, we've been putting a lot of our efforts into creating content. So Amy really is my partner in terms of continuing education and giving me guidance in terms of what direction my practice goes in. And we've been having a lot of talks recently about doing more teletherapy together. She's really the brains behind the operations. She's a brilliant, brilliant woman. So I'm very lucky to be able to collaborate with her.

Kadie: Wow. Well, I'm just so excited that we have such a unique perspective that you're bringing today, very unique business model. So I'm kind of hopping back now to the private practice side of things. Is there a brick and mortar location? Or is this always you all going to someone for the services?

Kate: That's a great question. We had a brick and mortar location, and it was sort of a serendipitous situation. Our landlord decided that he was going to sell the building. So we were professionally homeless. And then within the same month, we got two school contracts. And so we sort of transitioned into doing more school contracts instead of individual private services. So we have not had a brick and mortar since then.

Kate: The question of the actual renting space and taking on all of that overhead is something that I toy around with all the time, but it always comes down to the budget. Anybody who runs a private practice will tell you that it always comes down to the budget. And I think a lot of those decisions moving forward are on hold because of this pandemic that we're in and sort of those questions of how this reliance on digital communication is going to impact our culture moving forward, you know, if teletherapy is going to be something that really sticks around. So we'll see.

Kadie: Yeah. There's so much unknown right now, but it sounds like, with the business going homeless there for a moment, that the transition was fine. You all are flexible and so nice that you have those school contacts and contracts. So I'm curious how, I feel like I have to touch on COVID every episode, which is getting frustrating, but how have you all been able to adjust or has the business side of things taken kind of a backseat right now while we wait? What's been going on on that front?

Kate: Well, we've been able to continue with business as usual for the most part. As consultants, that's our primary clinical role in all of our contracts really at this point. We're able to provide a lot of consultation to teams. So that's a lot of times watching videos and making observations, giving critical feedback about what aspects of a program to change, coaching parents, advising teams, advising BCBAs, advising special education teachers. All of that is pretty easy to do through teletherapy. We haven't had to deal with any of the direct therapy components.

Kate: I haven't yet been asked to do an AAC eval or make decisions about a communication tool since this all began. I have a feeling that day is coming and we will cross that bridge when we get to it.

Kadie: Yeah. And since another big component of the company is this continuing education piece. So your company, Grandbois Therapy and Consulting, has the subdivision SLP Nerdcast, and that's the podcast.

Kate: So recording podcasts and researching during a pandemic is pretty awesome, actually. I'm homeschooling my two kids, but reading articles in between and writing, researching, contacting people for interviews, the podcast component of the business has really sort of taken off. Just to have the time right now to actually spend and put some focus into it.

Kadie: I'm curious about typically what the contracting process looks like for you. If you have advertised for yourself previously or if it's just been word of mouth in your area, how do people find you and consult?

Kate: Well, that's a great question. It's really a mixed bag. I'd say the majority of our school contracts have been word of mouth. So because I'm a dually certified SLP, BCBA, it's a very niche thing. I do one thing. It's no longer in my scope of competence to treat somebody with a fluency issue. It's no longer in my scope of competence to take on literacy or language learning disabilities.

Kate: So often when a program has a need, this is a very specific kind of need, and word through administrators and parents does tend to travel fast when there just aren't a lot of resources. We've had a lot of great referrals for setting up mentoring programs and AAC evals. We're also still technically in contract with Blue Cross and Harvard Pilgrim. So I do get a lot of referrals for direct services through those channels, but we don't have any clinicians. Our caseloads are completely full with school contracts, so we tend to refer a lot of those individuals out, which is why we were looking to hire someone in February and March. Unfortunately, that part of our business has been put on hold.

Kate: And we do have a website, so I'm sure there are some calls we get from just regular Google searches and things. It's really a mixed bag.

Kadie: Absolutely. Well, it sounds like things have just taken off and it sounds like you all are full. That's all good news. For the most part, you all are paid through a school district?

Kate: It depends on the client. Most of our clients are schools, some private schools, and actually mostly private schools at this moment. So substantially separate private schools for individuals with autism. Here in the Boston area, there are a lot of them. I know that that varies widely across the country. We are very lucky to have a lot of resources in this area.

Kate: And I have taken some clients for AAC evaluations or just consulting. And in those situations, the payer is the family who has hired us to come in and consult to an IEP or consult to a team or conduct a team training for a device or help because it's a really complex case and they feel that having somebody with one foot in the speech world and one foot in the behavior analysis world would be helpful. We have one client who is a speech clinic who has contracted with us to help give some behavioral guidance for their speech pathologists who are having some behavioral issues with their clients. But for the most part, it's sort of a rare instance.

Kadie: Yeah. I personally loved AAC. That was my favorite to treat as well. But yeah, the behaviors are what got me. So you are definitely a valuable find.

Kate: The comorbidity between communication disorders and behavioral disorders is so high and it's not just autism. So I think every speech pathologist is familiar with behavioral issues and every behavior analyst is familiar with communication issues. So there really is a ton of room for collaboration in that area.

Kadie: Yeah. I'm familiar with behavior issues just from my toddler who's typically developing. I'm like, wait, let me pull out some of these tips and tricks.

Kate: I know. We were recording an episode recently on behavior management and speech therapy and we recorded during the pandemic when we were all stuck at home and my son was having this massive tantrum in the background and I kept saying, well, this is just an example. Behavior is everywhere.

Kadie: So true. I was going to ask if you have invested in having a plethora of devices for your evaluation or how you have handled that.

Kate: So that's a really good question. We have a handful of iPads and entirely too much software to go with those iPads. There are so many communication apps available to the general public now through the Apple Store. Our clients tend to not be individuals with complex bodies. They are complex learners, but generally speaking, the vast majority of them present with an autism spectrum disorder and therefore don't generally need alternative access methods. That's not always true, but to date we haven't had to invest in any other kinds of durable medical equipment or dedicated devices or complex switch components or wheelchair mounts or anything like that.

Kate: There are a handful of vendors out there who will let you borrow or that they have lending libraries and lending programs. So the instances where we have needed some of that equipment, we've gone through the vendors to borrow or go through their lending library to have them on hand for an evaluation. I've invested in a handful of things that are low cost, like a handful of switches and the talking bricks and GoTalkNow, those kinds of things that aren't too cost prohibitive. But for the most part, we use iPads and a handful of adaptive equipment pieces that go along with those iPads.

Kadie: Great. And are families ever lended those devices for a trial?

Kate: Families have definitely borrowed our iPads for a trial. If they're moving forward with a dedicated device that's being funded through insurance or another third party, they will tend to have that trial device funded directly through the insurance or through the vendor and it will ship directly from the vendor. So for example, if we've recommended a trial with an Accent from PRC, we go through their funding department and PRC ships the trial device directly to them. So we don't have to buy.

Kate: This is totally different than it was 15 years ago where you might have a cabinet full of devices that are either on loan to you or you've made an investment. I mean, technology just changes so fast. And generally with an iPad and a handful of pieces of adaptive equipment that you can purchase and have around your clinic without too much money, you can get a general sense of what direction you want to go in without needing to buy a $7,000 piece of equipment.

Kadie: Thankful for that, right?

Kate: Right. Exactly.

Kadie: Well, that all is such great information and I think we've all gathered a great picture of the business. You don't have to tell us your rate, but I'm assuming this is an hourly fee depending on whether you are on a phone call, observing, writing a report. Is that how it works?

Kate: Yeah, I mean, we'll tend to give a phone consult for free without charging families. There are so many families out there that just have questions and they get lost in an internet hole and want to talk to a professional just to have one quick question answered. I'm always open to speaking with families over the phone to get a sense for what they need and refer them out or refer them to a colleague in my community that I know of if there's something that I can't do for them. And of course, if it's something that I feel I can help with, I'm always available to book them for an actual appointment. But generally speaking, I'm happy to speak with families over the phone without an hourly fee.

Kate: So for our school contracts, we're fee for service. Every client has a different contract. Depending on the funding source and whether or not it's a public school or a private school, there are a lot of different ways to do it. And if it's a family that's in network with Blue Cross and they're looking for a service that is within their benefits, then that would be the funding source and that's a contracted rate or it would be a fee for service contract that we provide.

Kate: Doing your billing for the first time might be totally intimidating and you're terrified that you're going to make a mistake, but six months later, you do it with your eyes closed. We don't really get this training in graduate school for how to make sure you're operating within budget or make sure that you're staying in compliance with the law and all those kinds of things that can be really intimidating. But I'm always in support of people moving forward in this area. I think it's really important to not be intimidated.

Kadie: Well, I think our listeners in particular would love to find your podcast. It's www.slpnerdcast.com because we're nerds and we're happy about it.

Kate: Awesome. Amy and I have a long history of bonding over nerdy things like science fiction and speech pathology. So it felt as though it was a fitting name.

Kadie: Are you going to start a separate podcast as well for your other interests that you have in common?

Kate: No. One is plenty.

Kadie: Well, it's a great resource and I hope that our listeners will go out and find that. And do they simply, is it a fee for getting ASHA CEUs from listening?

Kate: Yeah. So one thing that we noticed through the other podcasts that were available for CEUs was that it was really cumbersome. You had to go to a separate website and log in and download the slides. And then it was like this whole thing. It was just very complex. So we actually contacted ASHA to make sure that we were offering something that would be honored for a CMH.

Kate: So ASHA delineates the CEUs. The word CEUs for ASHA can only be used for an approved ASHA CE provider, even though the word CEU is used pretty colloquially across many disciplines. In the world of ASHA, a CEU is really only for an ASHA CE provider. And CMHs, Certification Maintenance Hours, are the equivalent. So it's very overly complicated for no reason. They're the same thing.

Kate: But learning through podcasts counts. So we wanted to create something that was, like I said from my previous experience, up to snuff. It has all of the components of an ASHA CEU that you can listen while you drive or cook or whatever you're doing. And then all you have to do is go to our website, put your certificate in the cart, and the prompts will automatically put you through to answer a quick quiz to prove your attendance. And then the certificate is emailed to you. And it's cheap.

Kadie: Very nice. Well, I'm like you. I mean, I want to get my CEU while doing laundry or cooking or whatever it may be.

Kate: And so I have these two clinical licenses. So I have double. I have 60 I have to do every two years. So I'm trying to be as efficient as possible. And all of the cumbersome ways to get CEUs really irked me. So I was personally very motivated to create this product for everyone out there.

Kadie: Yes. What would you like to share before signing off today? You've really provided some valuable information and a fun experience of your own. Is there anything you'd like to send our listeners off with?

Kate: We love hearing from people. So if anyone out there has a question about starting a private practice or has a question about our CEU process, or I'm sorry, our CMH process, or has a question about any of the content on our website, please don't hesitate to email me. I really do love connecting with people and answering questions. And we would be happy to make that connection.

Kadie: And maybe even specific requests for content that they would like to see included in your podcast.

Kate: Yes, we've had a couple of those, which is great. We have an episode coming out soon on all the uncomfortable feelings related to accepting and providing critical feedback. That was something that someone requested. And we have a whole bunch of episodes coming up about AAC and ABA and how those two things can sometimes not play well together in the sandbox. So everybody, yes, when you want an episode, send us an email. We take them really seriously, and we will get right to work researching for you.

Kadie: Great. I'll definitely be tuning in myself. So I appreciate your time, Kate. Thank you so much.

Kate: Thank you so much for having me.

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 through private practice, please email me kadie at clinicnote.com. That's K-A-I-D-E at clinicnote.com.