a fully licensed slp commonly read as: ma, ms, or med, ccc-slp (e.g.: jane doe, ma, ccc-slp), indicating a practitioner's graduate degree and successful completion of the fellowship year/board exams to obtain the "three cs" the certification of clinical competence, in speech–language pathology. methods of assessment for many parents, the decision of whether or not to enroll students into school-based speech therapy or privately practiced therapy is challenging. speech–language pathologists work as part of a team alongside teachers, counselors, social workers and parents when in a school setting. because school-based speech therapy is run under state guidelines and funds, the process of assessment and qualification is more strict. to qualify for in-school speech therapy, students must meet the state's criteria on language testing and speech standardization. due to such requirements, some students may not be assessed in an efficient time frame or their needs may be undermined by criteria. for a private clinic, students are more likely to qualify for therapy because it is a paid service with more availability. clients and patients speech–language pathologists work with clients and patients who may present with a wide range of issues. infants and children infants with injuries due to complications at birth, feeding and swallowing difficulties, including dysphagia children with mild, moderate or severe: genetic disorders that adversely affect speech, language and/or cognitive development including cleft palate, down syndrome, digeorge syndrome attention deficit hyperactivity disorder autism spectrum disorders, including asperger syndrome developmental delay feeding disorders, including oral motor deficits cranial nerve damage hearing loss craniofacial anomalies that adversely affect speech, language and/or cognitive development language delay specific language impairment specific difficulties in producing sounds, called articulation disorders, (including vocalic /r/ and lisps) pediatric traumatic brain injury developmental verbal dyspraxia cleft palate united states in the us, some children are eligible to receive speech therapy services, including assessment and lessons through the public school system. if not, private therapy is readily available through personal lessons with a qualified speech–language pathologist or the growing field of telepractice. teleconferencing tools such as skype are being used more commonly as a means to access remote locations in private therapy practice, such as in the geographically diverse south island of new zealand. more at-home or combination treatments have become readily available to address specific types of articulation disorders. the use of mobile applications in speech therapy is also growing as an avenue to bring treatment into the home. united kingdom in the uk, children are entitled to an assessment by local nhs speech- and language-therapy teams, usually after referral by health visitors or education settings, but parents are also entitled to request an assessment directly. if treatment is appropriate, an educational plan will be drawn up. speech therapists often play a role in multi-disciplinary teams when a child has speech delay or disorder as part of a wider health condition. the children's commissioner for england reported in june 2019 that there was a postcode lottery; £291.65 a year per head was spent on services in some areas, while the budget in some areas was £30.94 or less. in 2018, 193,971 children in english primary schools were on the special educational needs register needing speech-therapy services. children and adults puberphonia cerebral palsy head injury (traumatic brain injury) hearing loss and impairments learning difficulties including dyslexia specific language impairment (sli) auditory processing disorder physical disabilities speech disorders (such as oral dyspraxia) stammering, stuttering (disfluency) stroke voice disorders (dysphonia) language delay motor speech disorders (dysarthria or developmental verbal dyspraxia) naming difficulties (anomia) dysgraphia, agraphia cognitive communication disorders pragmatics laryngectomies tracheostomies oncology (ear, nose or throat cancer) adults adults with mild, moderate, or severe eating, feeding and swallowing difficulties, including dysphagia adults with mild, moderate, or severe language difficulties as a result of: motor neuron diseases, alzheimer's disease, dementia, huntington's disease, hearing loss multiple sclerosis, parkinson's disease, traumatic brain injury, mental health issues stroke progressive neurological conditions such as cancer of the head, neck and throat (including laryngectomy) aphasic adults seeking transgender-specific voice training, including voice feminization and voice masculinization