Leanne Sherred, M.S., CCC-SLP
In Roanoke, the medical hub of largely rural southwest Virginia, families have several ways to get speech therapy—though they often travel for in-person specialists. This guide covers your local and virtual speech therapy options.
Key takeaways
When you’re considering speech therapy, think about where you want therapy delivered, how you’ll pay, and what credentials and therapy approach matter most to you.
Consider your child’s age. Under age 3, Infant & Toddler Connection of the Roanoke Valley offers free early-intervention evaluations (540-204-9699). Age 3 and older, Roanoke City Public Schools must evaluate and treat speech needs for free (Child Find: 540-853-1438).
Understand the full set of speech therapy options: early intervention, school-based therapy, private clinics, local universities, and virtual care.
Be sure to ask about waitlists. They’re common in speech therapy.
Know that most speech therapy is covered by Medicaid (Cardinal Care), FAMIS, or commercial insurance: You can also pay for therapy yourself via private pay. Ask if the speech therapist accepts your payment method, but weigh other factors such as location and therapy approach when comparing.
Concerned about your child's speech?
We're here for you. Get matched with a speech therapist who's experienced in your child's area of need and available when you are.
Find a speech therapistYour speech therapy options in Roanoke
Roanoke is the largest city in southwest Virginia, with about 100,000 residents. It’s the medical hub for a wide, largely rural region, so families routinely drive in for specialty pediatric care at Carilion Children’s—often facing therapist shortages and long waitlists. Some speech therapy options are free public programs; others are private or virtual. If you’re new to speech therapy and want to understand how it works, start with our ultimate guide to speech therapy for children.
Infant & Toddler Connection (early intervention)
For children up to 36 months, many families start by contacting Virginia’s Infant & Toddler Connection—the state’s birth-to-3 early-intervention program under federal law (the Individuals with Disabilities Education Act, or IDEA, Part C). Locally, it’s run by Infant & Toddler Connection of the Roanoke Valley, serving the cities of Roanoke, Salem, and Vinton plus Roanoke, Botetourt, and Craig counties. (You can also reach Virginia’s central early-intervention line at 1-800-234-1448.)
Who it’s for: Babies and toddlers with a developmental delay or diagnosed condition.
Cost: Evaluation, service coordination, and IFSP development are free. Ongoing services may bill insurance or Medicaid and use an income-based sliding fee. No child is denied for inability to pay.
How to start: Call 540-204-9699. Parents can refer their own child, no doctor needed.
Are there downsides to early intervention? It’s a great program for many families, but there are tradeoffs to keep in mind:
It ends at the third birthday. Early intervention is birth-to-3 only. At 3, your child transitions to receiving speech therapy at school, sometimes with a gap in between. This can be hard after building a relationship with a speech therapist.
You have to qualify. Your child has to have a measurable developmental delay (or a qualifying diagnosis). A child with a milder delay may not be eligible, even if they’d benefit from therapy.
Access isn’t guaranteed. Some early intervention programs face funding and staffing challenges, with waitlists in certain areas.
It’s not always free. The program may bill your insurance, and out-of-pocket costs follow an income-based sliding scale. Depending on your plan and income, some families find it isn’t much cheaper than a private clinic.
School division (Roanoke City Public Schools)
Once a child turns 3, federal law (IDEA) requires public schools to evaluate and serve children with disabilities at no cost—first through early childhood special education, then school-age services. In Roanoke, this is handled by Roanoke City Public Schools.
How school-based services work through the Roanoke City Public Schools Child Find office (540-853-1438):
You or a teacher submit a written referral.
The division gets your written consent, then has up to 65 business days to evaluate your child and decide whether they are eligible.
If eligible, an IEP (Individualized Education Program) meeting is held within 30 calendar days to write your child’s plan.
The IEP can include speech therapy.
Tip: You can look up any Virginia division’s special education record through the Virginia Department of Education’s annual determination letters. In a state review, the Virginia Department of Education found Roanoke City Public Schools out of compliance because its procedures didn’t let IEP teams fully consider speech therapy services. The division was directed to retrain staff and re-check affected students’ files. It’s a fair thing to ask about during your child’s evaluation.
Are there tradeoffs to school-based therapy?
A child qualifies only if their speech or language issue affects school performance. A concern that doesn’t clearly hurt schoolwork may not get services, even if you’d like speech therapy for it (such as social communication, feeding, or a speech sound error that doesn’t affect learning).
Speech therapy is often done in groups, not 1:1. With so many kids needing therapy, services are often delivered in small groups. Your child may get less individual attention than in a private clinic.
Your child may not get as many sessions as they need. Because of speech therapist shortages, your child may get only 30 minutes of therapy a week, which isn’t enough for some kids.
Scheduling is driven by the school. Therapy happens during the school day on the school’s schedule. Children are sometimes pulled out of class for therapy sessions. Therapy usually pauses over the summer unless your child qualifies for extended-school-year services.
You usually can’t attend sessions. School therapy happens without you, which makes it harder to reinforce skills at home. The more your child practices speech skills at home, the faster they’ll make progress.
If your child receives school speech therapy, learn when private therapy might also be needed, plus info about speech therapy costs and finding a therapist.
Online speech therapy
With virtual speech therapy, your child meets with a licensed speech-language pathologist over video, from home (here’s how online speech therapy works).
For most Roanoke families, the barriers to speech therapy can include the commute, long waitlists, and finding a speech therapist who takes their insurance. Virginia names special education among its critical shortage areas, and speech therapists are in short supply in many schools—one reason local waitlists can stretch for months. As the medical hub for southwest Virginia, Roanoke draws families from surrounding rural counties. That’s one reason online speech therapy has caught on.
Online speech therapy gives you access to therapists across the state of Virginia, instead of only the clinics near you. There’s often less of a waitlist, and there’s no commute needed.
Most notably, research shows virtual therapy is as effective as in-person care for most speech, language, and communication needs. Because sessions happen in the child’s own home, parents are part of the process rather than waiting in a lobby.
Online speech therapy gives you access to therapists across Virginia, instead of only near you. There’s no commute and often less of a waitlist.
Expressable is a virtual speech therapy provider built around that last point. Its licensed speech therapists work directly with your child and you. That way, you can reinforce the right speech strategies during everyday routines, not just during the weekly session. Parents attend sessions and leave each visit with techniques to practice and personalized home activities.
Because so much of a child’s progress happens at home, during everyday communication, this caregiver-led model tends to lead to faster progress. Plus, it’s available across Virginia regardless of where in the Roanoke area you live.
Is there a downside to online care?
Online therapy isn’t the best fit for the most hands-on needs. For instance, some children with severe feeding and swallowing needs may need in-person care. After the evaluation, your speech therapist will recommend whether virtual care is appropriate.
It works best with a caregiver nearby. Caregiver attendance matters, especially for younger children. It’s what makes real progress happen—but it does take some of your time.
You need the basics. For online speech therapy, you’ll need a device like a computer or tablet, a decent internet connection, and a quiet spot in your home.
Discover the top 5 reasons online speech therapy may be a better choice than in-person speech therapy for you and your family.
Private clinics
A number of private speech therapy clinics operate across Roanoke, serving families through insurance or private pay. Availability, specialties, and wait times vary clinic to clinic. It’s worth calling a few to compare how soon they can start and whether they treat your child’s specific need.
Hospital and university clinics
You can also receive speech therapy through hospital outpatient programs and university teaching clinics. Children’s hospitals are best for complex or medical needs, or children who need a team of specialists. University clinics, where graduate clinicians treat under licensed faculty supervision, are often the most affordable. But they tend to have the longest waitlists and run on the school calendar.
Carilion Children’s Pediatric Therapy offers speech, feeding, and swallowing therapy as the region’s pediatric referral center for southwest Virginia. 4348 Electric Road, Roanoke. 540-769-0974.
There’s no university teaching clinic in Roanoke; the nearest (usually a lower-cost option) is the Radford University Speech-Language-Hearing Clinic, about 40 miles southwest in Radford.
Make the most of your next meeting with your child’s speech therapist with these tips from the experts.
How to pay for speech therapy in Roanoke
It’s important to sort out how you’ll pay for speech therapy. Most speech therapy is covered by Medicaid or private insurance. Roanoke’s uninsured rate (about 10%) runs higher than Virginia’s average, so it’s worth confirming coverage early. Here’s how the main options work.
Medicaid (Cardinal Care). Virginia’s Medicaid program is Cardinal Care, delivered through managed care plans. Families choose among Aetna Better Health of Virginia, Anthem HealthKeepers Plus, Humana Healthy Horizons, Sentara Community Plan, and UnitedHealthcare of the Mid-Atlantic. Speech therapy is covered when medically necessary. (Note: Plan options can change—confirm your plan is active and your speech therapist is in-network before you enroll.)
FAMIS (Virginia’s CHIP). Children who don’t qualify for Medicaid may be eligible for FAMIS, which also covers speech therapy.
Commercial insurance. Most private plans cover medically necessary speech therapy, though coverage for “developmental” delays varies by policy (what insurance does and doesn’t cover). Anthem Blue Cross and Blue Shield is among the most common commercial insurers in Virginia. Always confirm your speech therapy benefit and any annual visit limits before starting.
Private pay. The cost of speech therapy varies by provider and setting. Considering virtual speech therapy? Expressable accepts 250+ insurance plans, including Medicaid in Virginia. About a third of its patients are on Medicaid, and most families pay $0–$21 per visit after insurance.
Free and low-cost options. Beyond insurance, free or income-based speech therapy in Roanoke includes:
Your school division (free, age 3 and up)
Infant & Toddler Connection (sliding scale, under age 3)
The Radford University Speech-Language-Hearing Clinic (about 40 miles southwest)
Head Start/Early Head Start, run locally by Total Action for Progress (TAP), which screens young children and can catch speech delays early.
Learn the pros and cons of private pay versus using insurance for speech therapy for adults and children, plus free options for young kids.
In-person vs. online speech therapy: Which is right?
Both in-person and online speech therapy have been proven to work. The best fit depends on your child’s needs, your family’s schedule, and how quickly you need to begin.
In-person speech therapy tends to be the better fit when:
The need is truly hands-on: Nearly all communication disorders can be treated just as well online. However, severe feeding and swallowing disorders likely require the therapist to be in the room.
You’ve found the right local provider: There is a local speech therapist who’s experienced with your child’s specific needs, able to show real outcomes, involves you as the caregiver, and fits your schedule.
You’re prepared to wait: Clinics at hospitals or universities often have long waitlists, so check before counting on them.
Online speech therapy (teletherapy) works especially well when:
You want to start sooner: Providers like Expressable often have near-immediate availability. You can start in days, not months.
Travel or scheduling is a barrier: Care happens from home, with flexible scheduling (including evenings and weekends). You get a Virginia-wide pool of speech therapists instead of only nearby clinics.
You want to be involved: In teletherapy, sessions happen at home with the caregiver present. Research shows this is one of the best ways for children to make progress in therapy.
Learn more about how online speech therapy works and why teletherapy is as effective as in-person care.
How does online speech therapy work? Learn how virtual speech therapy helps children and adults improve communication skills from the comfort of home.
What to expect: Evaluation and first sessions
Most speech therapy starts with an evaluation. The speech therapist assesses your child’s speech, language, and sometimes feeding, then recommends whether therapy is needed and how often. If speech therapy is recommended, your therapist will create a custom care plan.
Sessions are typically 30-45 minutes, once or twice a week. For young children, sessions look a lot like structured play, since play is how kids learn communication. You should get progress reviews and goal updates as your child improves. Here’s more on how long speech therapy usually takes.
How to choose the right speech therapist
You and your child will build a relationship with this person, so you want someone experienced who fits your needs. Here’s a short checklist for finding a speech therapist:
Parent involvement: Does the therapist involve you in sessions? A child may spend only 30 to 60 minutes a week in speech therapy. Research shows that caregiver coaching drives the fastest progress. Ask whether the therapist will coach you and provide ways to practice at home between sessions.
Patient outcomes: Will the speech therapist track your child’s progress toward their goals and share results with you? Do they have outcomes data they can share from their other patients?
Credentials: Your therapist should be a licensed speech-language pathologist (SLP), licensed to practice in Virginia, with a Certificate of Clinical Competence (CCC-SLP) from the American Speech-Language-Hearing Association (ASHA). You can verify a license through the Virginia Board of Audiology and Speech-Language Pathology.
Specialty match: Speech therapists treat a wide range of people, from autistic toddlers to older people with voice problems. Make sure your therapist is experienced with your child’s specific needs. If your family speaks a language other than English at home, ask whether bilingual therapy or interpretation is available.
Insurance and cost: Is your speech therapist in-network with your plan? Does your insurance have any limits on how many speech therapy visits it will cover?
Wait time: Ask the speech therapist how soon they can actually start. The length of time can vary a lot!
Expressable is built around the first two items. Caregiver coaching is its primary therapy model, and it publishes its outcomes. At Expressable, 96% of patients make measurable progress within five sessions, as tracked on standardized assessments.
Speech therapy that gets results
At Expressable, our research-based care model delivers meaningful outcomes for kids and adults. See our results from more than 13,000 clients.
See our outcomesBilingual speech therapy services
In Roanoke, about 11% to 12% of residents speak a language other than English at home. Spanish is the most common. If you need bilingual speech services, Virginia’s Infant & Toddler Connection provides interpreting at no cost, and university clinics often offer bilingual services. When you call a speech therapy provider, ask whether bilingual therapy or on-demand interpretation is available.
Local resources and parent support in Roanoke
Navigating care for your child can be stressful. These Roanoke-area and Virginia organizations help families understand their rights, connect with other parents, and find support.
Local advocacy and support
The Arc of the Greater Roanoke Valley — Advocacy and support for families of children with intellectual and developmental disabilities. (540) 613-5020, arcofroanoke.org
Statewide resources (open to every Virginia family)
disAbility Law Center of Virginia (dLCV) — Virginia’s federally funded legal advocate for people with disabilities. (800) 552-3962, dlcv.org
Parent Educational Advocacy Training Center (PEATC) — Virginia’s Parent Training & Information Center; free help understanding IEPs and special-education rights. (800) 869-6782, peatc.org
Parent to Parent of Virginia (Center for Family Involvement) — Matches parents of children with disabilities with trained peer supporters. (877) 567-1122, centerforfamilyinvolvement.org
VirginiaNavigator / 2-1-1 Virginia — A statewide directory of local disability and family services; dial 2-1-1 for referrals. virginianavigator.org
Please note that contact details, program offerings, and program availability may change.
Not sure your child needs speech therapy?
If you’re still deciding whether to look into speech therapy, a good first step is to see how your child’s speech and language compare to typical milestones. When in doubt, an evaluation is the surest way to know. Check out these guides as well:
Speech milestones by age
Learn more about speech therapy
The complete guide to speech delays in toddlers and young children
Take our free quiz: does your child need help with speech and language?
Frequently asked questions (FAQs)
If your child is under 3, call Infant & Toddler Connection of the Roanoke Valley at 540-204-9699 (or Virginia’s early-intervention line, 1-800-234-1448). You can refer your own child, and the evaluation is free. If your child is age 3 or older, contact your school division’s Child Find office (Roanoke City Public Schools: 540-853-1438).
There’s no minimum age. Early intervention often leads to the best outcomes. In Virginia, children under 3 can be evaluated for free through the Infant & Toddler Connection. If you notice warning signs, it’s better to evaluate early than to wait.
Yes. Speech therapy is covered when medically necessary under Cardinal Care (Virginia Medicaid) and FAMIS. Families choose among managed care plans that include Aetna Better Health of Virginia, Anthem HealthKeepers Plus, Humana Healthy Horizons, Sentara Community Plan, and UnitedHealthcare of the Mid-Atlantic. Confirm your plan is active locally and your therapist is in-network.
Yes, through the Infant & Toddler Connection (for kids under 3, free evaluation and income-based fees) and your public school division (free speech services from age 3 and older). University and hospital clinics offer lower-cost options but may have long waitlists.
They vary widely. Some university and hospital clinics have reported long waits, while virtual speech therapy providers and some private clinics can start much sooner. Ask about wait times on your first call.
Virginia’s Infant & Toddler Connection serves children birth to 3 with family-centered services and a free evaluation. At age 3 and older, your school division provides free, IEP-based speech services.
Yes, research shows teletherapy is as effective as in-person care for most speech and language needs, with the added benefit that caregivers are involved in every session. Only a small subset of children—typically severe feeding and swallowing needs—may require in-person care.
Article sources
ASHA — communication milestones
Cleveland Clinic — speech therapy overview
Georgetown Center for Children & Families — child health coverage trends
Virginia Department of Education — special education evaluation & eligibility
Virginia DMAS — Cardinal Care managed care
Infant & Toddler Connection of Virginia — program overview
Expressable — published outcomes
WDBJ / VDOE — Roanoke City Schools special-education compliance review; Carilion Children’s — pediatric therapy
Last reviewed August 2026. Program contacts, Medicaid plan availability, and waitlists change over time; we re-verify periodically.
How Expressable Can Help
Concerned your child isn't reaching age-expected milestones? Looking for communication support from a professional? Expressable is a national online speech and occupational therapy practice serving children and adults. We treat all major areas of communication, feeding, and developmental skills, offer flexible hours including evenings and weekends, and accept most major health insurance plans. We’re proud to have earned more than 4,500 5-star reviews from our clients (4.83/5 average).
Our therapy model is centered on parent and caregiver involvement. Research proves that empowering caregivers to participate in their loved one’s therapy leads to better outcomes. That’s why we combine live, 1-on-1 speech and occupational therapy with personalized education and home practice activities for faster progress.
