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School Programs in

Speech-Language Pathology

Organization and Service Delivery

SIXth EdItIon

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Library of Congress Cataloging-in-Publication Data:

Names: Blosser, Jean, author | Means, Jennifer W., author

Title: School programs in speech-language pathology : organization and

service delivery / Jean Blosser, Jennifer W Means

Description: Sixth edition | San Diego, CA : Plural Publishing, [2020] |

Includes bibliographical references and index

Identifiers: LCCN 2018054951| ISBN 9781635501179 (alk paper) | ISBN

1635501172 (alk paper)

Subjects: | MESH: Speech-Language Pathology organization & administration |

School Health Services organization & administration | United States

Classification: LCC LB3454 | NLM WL 21 | DDC 371.91/42 dc23

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Disclaimer: Please note that ancillary content (such as documents, audio, and video, etc.) may not be included as published in the original print version of this book

Mainstreaming 8

3 Foundations of the School Speech-Language Pathology Program 31

Accountability 45

vi School Programs in Speech-Language Pathology: organization and Service delivery

Why Should SLPs Care About Education Goals and Academic Standards? 53

Tools: Technology, Equipment, Professional Materials, and Supplies 102

Evaluating Materials to Determine Quality and Applicability 114

Budgeting for Technology, Equipment, Materials, Supplies, and Professional 116 Development

Contents vii

A Philosophy: The Basis on Which to Build the SLP Workload and Caseload 148

Screening 157

Assessment 168

Scanning and Analyzing the Environment and People in the Environment 172

Matching the Right Student with the Right Services and Interventions 199

Inclusion 209

viii School Programs in Speech-Language Pathology: organization and Service delivery

Matching Service Delivery Options to Individual Student’s Needs 220Determining Dosage: the Amount, Frequency, and Duration of Intervention Services 221Taking a Different Perspective for Planning Services: The PAC Framework for 222 Determining Appropriate Models of Service Delivery

Identifying the Appropriate Assessment and Treatment Approach 271

Making Speech-Language Intervention Relevant to the Students’ Educational Needs 273

Motivation 279Evaluating the Effectiveness of the Intervention Approach and Therapy Session 281

Attention Deficit and Central Auditory Processing Disorders 286

Counseling 295

10 Interprofessional Collaboration: Creating Strong Partnerships 301

Contents ix

Interprofessional Education, Practice, and Collaboration (IPE, IPP, IPC) 302

The Bilingual Educator and/or English-as-a-Second Language (ESL) Teacher 332

The Guidance Counselor and Vocational Rehabilitation Counselor 333

Maintaining Ongoing Communication with Collaborative Partners 349

Recommendations for Making the Most of Your School Experience 360

x School Programs in Speech-Language Pathology: organization and Service delivery

References 425 Index 433

List of Tables

and Recommended Cognitive-Communication Intervention Strategies

List of Figures

of service delivery

disability conditions

services

the needs of children with communication impairments

Preface

Speech-language programs in the school setting

have changed drastically since they were first

initiated many decades ago Most of the changes

have occurred in response to the changing

edu-cation and legislative landscapes, and our

in-creased professional awareness of the critical link

between communication and learning Our roles

and responsibilities as school speech-language

pathologists (SLPs) have expanded as we and

others recognize the influence we can have on

the lives of children with communication

disor-ders, and the contributions we can make to en-

sure their learning success Fortunately, our

pro-fession has not only weathered the changes, but

has effectively adapted to them Working in the

school setting can be challenging Yet, it is also very

rewarding; especially when we travel the road

in partnership with our fellow SLPs, education

colleagues, students with disabilities, and their

families It can be energizing to reframe our

speech-language programs in response to the

evolving needs in education and special education

I am excited to introduce my coauthor,

Jen-nifer Means We joined forces to write this sixth

edition of School Programs in Speech-Language

Pathology: organization and Service delivery It has

been a joy to be able to discover and express our

mutual passion for the communication sciences

and disorders profession, and our career-long

desires to teach, mentor, and inspire future and

practicing professionals We both view schools as

the best opportunity for helping children achieve

their highest potential

The major premise and philosophy of this

book is simple to articulate, but complex to

implement: embrace your role and

responsibili-ties; fit into the school setting; be innovative and

educationally relevant in your service delivery;

strive to achieve positive outcomes; and most

importantly, collaboration is essential! With these

thoughts in mind, we create a framework for making a difference in schools and in the lives of those we serve

Our discussions of important topics include the historical foundation of speech-language ser-vices in schools, and a fresh perspective on many

of the practices and processes We’ve presented solutions to many of the challenges SLPs face today and we share innovative strategies and practical tools that can be implemented immedi-ately We hope our ideas and recommendations serve as a guide to graduate students who are preparing to work in schools, as well as expe-rienced practitioners, and SLPs transitioning to schools from other settings The following are some highlights Enjoy!

Each chapter begins with specific learning objectives and concludes with discussion ques-tions and learner activities to guide readers and assist instructors who are preparing school-based practitioners The web-based pedagogical features of chapter Power Points and summative assessment further enhance the learning and teaching experience Many reproducible forms and checklists serve as practical resources for both new and seasoned school-based SLPs

about the inception, growth, and development of speech-language pathology services in the school setting sets the stage for understanding the path

we have followed and how far we have traveled This chapter describes the need that led school administrators to establish speech-language and hearing programs into their schools, as well as some of the pioneers who shaped and grew the programs, and the quality improvement over time We present the evolution of the speech-language pathology profession over several

xvi School Programs in Speech-Language Pathology: organization and Service delivery

decades It demonstrates the many changes that

have occurred in the SLP’s role, focus, practices,

and response to emerging trends It also projects

changes that are on the horizon A brief overview

is provided of legislation that has impacted

edu-cation and our profession

ethical behavior is expected and mandated by

our colleagues, administrators, and the public

we serve SLPs must adhere to the Code of Ethics

of the American Speech-Language-Hearing

Association (ASHA), as well as certification

policies and licensing practices Professional

organizations that provide support and

facili-tate advancement and growth are discussed We

illustrate the breadth and depth of the profession

and explore the personal and professional

quali-fications demonstrated by successful

school-based SLPs

and state legislation impact SLP programs and

the professionals’ performance The chapter

pro-vides examples of ways case law, educational

trends, core curriculum, and national goals have

shaped special education and influence

speech-language services Prevalence and incidence

data, including caseload composition, are

pre-sented with an explanation on funding sources

and third-party reimbursement Various

orga-nizational frameworks of state departments of

education and school district configurations are

presented Resources and support personnel are

explained We introduce the SLP’s role in

inter-professional collaboration

many hats This chapter discusses the SLP’s role

as a leader and manager The importance of

plan-ning and setting goals is stressed We present a

strategic planning model for developing and

managing changes in programs Knowing that

time is a precious commodity, we also recommend

strategies for time management and establishing

program, personal, and treatment level goals

are required to succeed in any job This chapter

provides a comprehensive description of the

facilities for intervention, and the resources able for use by the SLP The use of technology for service delivery, and record keeping is explored Suggestions are made for using technology to access information and communicate with col-leagues and parents New directions in service delivery via telepractice solutions are explained

avail-We encourage practitioners to share resources with others, including parents, students, teach-ers, and administrators

accountabil-ity, and outcomes consume much of the SLP’s time and energy Yet, without these elements,

we would not be able to demonstrate our value and contributions These are key components

of speech-language pathology service delivery Treatment outcomes and the importance of mon-itoring and documenting changes in students’ functional communication and academic skills

as a result of treatment are highlighted within the context of an innovative School Speech-Lan-guage Outcomes Framework The essentials of report writing are explained

caseload issues can foster objective procedures for making decisions about students’ eligibility for services, intervention plans, and service com-pletion We explore several methods for assess-ing students within the context of the school setting, including teacher interviews and sur-veys, classroom observations, functional assess-ment, curriculum-based assessment, and more Information is included to help understand cri-teria for determining eligibility Caseload man-agement is discussed in view of the changing school environment and emerging national edu-cational goals and trends A section on special populations includes literacy, autism, behavioral disabilities, English as a second language, and transition to work Highlighted are the SLP’s role and strategies for providing service to different groups of students

providing services in the least restrictive ronment and be able to discuss this concept with education colleagues when making recom-

Preface xvii

mendations and decisions about services

Col-laborative service delivery is emphasized when

designing effective and efficient intervention

programs to meet students’ needs Various

ser-vice delivery frameworks and options are

dis-cussed within the unique PAC Model of Service

Delivery The SLP’s role within the educationally

based Multi-Tiered Systems of Support (MTSS)

is discussed The SLP’s role in MTSS emphasizes

communication, coordination, and collaboration

Specific examples for scheduling and integrating

services in various settings are provided

be educationally relevant if we are to embrace

our roles as personnel who can support students’

success We explain the SLP’s role in

develop-ing legally defensible individualized education

plans (IEPs), individualized family service plans

(IFSPs), and individualized transition plans

(ITPs) Specific emphasis is placed on gaining an

awareness of students’ academic performance,

and working with teachers to determine

com-munication strengths and needs The SLP can

play a major role in partnering with teachers to

facilitate development of communication skills

required for classroom success Specific

meth-ods for writing measurable goals and objectives,

as well as documenting treatment outcomes are

provided

chapter explores the concept of

interprofes-sional education, practice, and collaboration We

encourage SLPs to collaborate with other

profes-sionals and the student’s family The importance

of collaborating with others to develop creative solutions to students’ communication prob-lems is discussed The roles and responsibili-ties of various professionals are included, along with the methods for building interprofessional collaborative partnerships, and maintaining effective communication and interaction with educators, administrators, family members, and community members Useful tips are provided for coaching teachers and parents

Experi-ence is an exciting path along the way in the ney to becoming a qualified speech-language pathology professional Students can benefit from the mentorship relationship with supervi-sors as they pursue certification and licensure

jour-We explore ways for students to prepare for graduate externships, such as identifying team members’ roles and responsibilities, creating personal goals for experiences, and developing externship timelines

prep-aration for becoming a professional is seeking satisfying employment We offer suggestions for developing a portfolio to highlight skills and accomplishments and interview strategies for landing that first job Preparation for the job search, interviewing techniques, letters of appli-cation, and components of a resume are covered

It also discusses the importance of professional development and maintaining national and state credentials Career tracks within the profession, especially in the educational setting, are incorpo-rated in the chapter

pathol-It is impossible to devote the time and energy to researching and writing without the support of family and friends who helped us maintain a healthy balance between work, the

“book,” and enjoying life’s adventures They continually provided moral support and fidence We appreciate the insights and contributions of our many professional colleagues and coworkers

con-In Memory

This book is dedicated to Betty Neidecker (1920–2009) in appreciation for her commitment,

spirit, and vision Betty authored the first edition of School Programs in Speech-Language

her coauthor Betty was a visionary when it came to school-related services, writing about the roles and responsibilities of SLPs, collaboration, and educationally relevant intervention before the concepts became a trend in our profession Her philosophy and contributions have influenced the careers of many SLPs and, as a result, impacted the lives of thousands

of children Betty’s invitation helped shape my professional career and inspired me to invite Jennifer Means to be my coauthor I recognize the same passion in Jennifer as I believe Betty did in me I know Jennifer will continue to carry the torch throughout her career

— Jean Blosser

We also dedicate this book to our families for their constant love and support the Blossers: Renick, Megan, Zoey, Asa & trevor, Jennifer, Xzavier, Lennox, nixon

Jennifer’s Crew: dennis Miller, nicholas Means, Ethan Means,

Mary Lou Walsh Savery, and Bill Savery

We thank you for your positive reinforcement, and time spent together

so we could maintain a healthy work/life balance.

1

Evolution of Speech-Language Pathology Programs in Schools

Chapter Learning ObjeCtives

1 Describe the growth and development of the school-based SLP

2 Describe the overarching federal education laws that have helped

shape services

3 Compare historical practices to current trends and practices

4 Illustrate and explain the evolution of SLP services throughout

decades

5 Identify changes in school-based speech-language services that

have improved quality and effectiveness

6 Anticipate the future challenges in school-based services and the

SLP’s role

2 School Programs in Speech-Language Pathology: organization and Service delivery

This chapter provides a historical background of

the profession of speech-language pathology and

the development of services and programs within

the schools of the United States The philosophy

of education that invited speech, language, and

hearing programs into the schools is described

Also discussed is the expansion of school

speech-language programs, both professionally and

geo-graphically The chapter points out the role of the

school-based speech-language pathologist (SLP)

in the early days and the changes in that role

over several decades, as well as the factors that

influenced those changes Its also considers the

prevailing philosophy and legislation mandating

equal educational opportunities for all children

with disabilities and the implications for both the

programs of the future and the roles and

respon-sibilities of the school speech-language

patholo-gist Additional details regarding these laws are

further discussed in Chapter 3

earLy histOry

Although people have experienced speech,

lan-guage, and hearing problems since the early

his-tory of humankind, rehabilitative services for

children with communication disabilities were

not realized until the early part of the 20th

cen-tury The growth of the profession and the

estab-lishment of the American Academy of Speech

Correction in 1925 reflect the realization of the

needs and the special problems of individuals

with these disabilities It also acknowledges the

unique aspects of the profession and the

impor-tance of providing a community for education,

interaction, and exchange of ideas

According to Moore and Kester (1953), the

educational philosophy that invited speech

cor-rection into the schools was expressed in the

preface to a teacher’s manual published in 1897,

which contained John Dewey’s “My Pedagogic

Creed.” The preface, written by Samuel T

Dut-ton, superintendent of schools, Brookline,

Mas-sachusetts, stated:

The isolation of the teacher is a thing of the past The processes of education have come to be recognized as fundamental and vital in any attempt to improve human condi-tions and elevate society

The missionary and the social reformer have long been looking to education for coun-sel and aid in their most difficult undertak-ings They have viewed with interest and pleasure the broadening of pedagogy to make

it include not only experimental physiology and child study, but the problems of motor training, physical culture, hygiene, and the treatment of defectives and delinquents of every class

The schoolmaster, always conservative, has not found it easy to enter this large field for he has often failed to realize how rich and fruitful the result of such researches are; but remarkable progress has been made, and a changed attitude on the part of the educators

is the result (p 1)

Moore and Kester (1953) suggested that child labor laws influenced the growth of speech programs in the schools Barring children from work forced both the atypical and the typical child to remain in school, and teachers soon asked for help with the exceptional children

A few got help, including assistance with dren having speech defects

chil-According to Moore and Kester (1953), it was in 1910 that the Chicago public schools started a program of speech correction Ella Flagg Young, the superintendent of schools, in her annual report in 1910 said:

Immediately after my entrance upon the duties of superintendent, letters began to arrive filled with complaints and petitions by parents of stammering children — complaints that the schools did nothing to help children handicapped by stammering to overcome their speech difficulty but left them to lag behind and finally drop out of the schools; and petitions that something be done for

1 Evolution of Speech-Language Pathology Programs in Schools 3

those children It was somewhat peculiar and

also suggestive that these letters were

fol-lowed by others from people who had given

much attention to the study of stammering

and wished to undertake the correction of

that defect in stammerers attending the public

schools Soon after the schools were opened

in the fall, I sent out a note, requesting each

principal to report the number of stammerers

in the school It was surprising to find upon

receiving the replies that there were

recog-nized as stammerers 1,287 children A

recom-mendation was made to the committee on

the school management to the effect that the

head of the department of oral expression in

the Chicago Teachers’ College be authorized

to select ten of the members of the

graduat-ing class who showed special ability in the

training given at the college in the particular

subject and should be further empowered

to give additional training of these students

preparatory to their undertaking, under the

direction of the department, the correction

of the speech defects of these 1,287 children

The Board appropriated $3,000.00 toward the

payment of these students who should begin

their work after graduation at the rate of $65 a

month during a period extending from

Febru-ary 1 to June 30

Instead of gathering the children into

one building or into classes to be treated for

their troubles, a plan was adopted of

assign-ing to the younger teacher a circuit and

hav-ing her travel from school to school durhav-ing

the day The object of this plan was to

pro-tect the young teacher from the depression

of the spirit and the low physical condition

that often ensue from continued confinement

in one room for several successive hours at

work upon abnormal conditions It was soon

found that the term “stammering” had been

assumed to be very general in its application

and many children who had been reported

as stammerers had not the particular defect

reported, but some other form of speech

defect (pp 48–53)

The superintendent of schools in New York

in 1909 requested an investigation of the need for speech training in the schools Two years later, the following recommendations were pre-sented to the board of education First, the num-ber of speech-handicapped children was to be ascertained and case histories obtained Second, speech centers were to be established providing daily lessons of from 30 to 60 minutes Third, English teachers were to be given further train-ing and utilized as instructors Fourth, a depart-ment for training teachers was to be established

It was not until four years later, however, that a director of speech improvement was appointed

to carry out the recommendations (Moore & ter, 1953)

Kes-the MiChigan stOry

In their fascinating history of the early years of the Michigan Speech-Language-Hearing Asso-ciation, Costello and Curtis (1989) described the beginnings of the Detroit public school speech correction program

In 1909, Mrs Frank Reed, of the Reed School

of Stammering in Detroit, contacted the superintendent of the Detroit Public Schools and offered to train two teachers, free of charge, in the Reed Method of the Correction

of Stammering, provided the program would

be incorporated in the Detroit Schools A vey was made of the need and 247 cases were found In May 1910, Mrs Reed’s offer was accepted and during the summer, two teach-ers trained They were Miss Clara B Stoddard and Miss Lillian Morley In September 1910, two centers were opened in Detroit, one on the east side and one on the west side of the city Wednesday was kept free from classes to call on parents, visit children in the regular classroom and for other activities associated with their work In 1914, classes for children with other speech defects were begun

sur-4 School Programs in Speech-Language Pathology: organization and Service delivery

In 1916, Miss Stoddard recommended the establishment of a special clinic at which a

thorough physical examination and Binet test

be given to children who seemed to have

spe-cial problems Regular monthly staff meetings

were held and the latest literature on speech

was reviewed The cooperation of teachers

and parents was enlisted in the correction

of speech The speech department personnel

very early recognized the need for medical

care for some of the children A program for

the mentally subnormal in special rooms was

inaugurated in 1914 (Costello & Curtis, 1989)

earLy grOwth

During this same decade, there were an

increas-ing number of public school systems employincreas-ing

speech clinicians Among them were Detroit,

Grand Rapids, Cleveland, Boston, Cincinnati,

and San Francisco (Paden, 1970) In 1918, Dr

Walter B Swift of Cleveland wrote an article

entitled “How to Begin Speech Correction in the

Public Schools” (reprinted in Language, Speech

and hearing Services in Schools, April 1972)

To the state of Wisconsin goes the credit for

establishing, at the University of Wisconsin, the

first training program for prospective specialists

in the field, and for granting the first doctor of

philosophy degree in speech disorders to Sara

M Stinchfield in 1921 In 1923, the West

Ches-ter University of Pennsylvania Speech Clinic

opened under the leadership of Professor

Eliz-abeth S Tyson Although other colleges in the

state offered courses in speech correction, none

had established clinics Therefore, the West

Ches-ter University clinic is one of the oldest clinics in

the country In 1927, Professor Tyson began

offer-ing required speech correction courses to those

students enrolled in teacher education programs

Wisconsin was also the first state to enact

enabling legislation for public school speech

ser-vices, and to appoint, in 1923, a state supervisor

of speech correction, Pauline Camp Meanwhile,

other universities throughout the United States were developing curriculum to address speech disorders Until 1940, however, only eight addi-tional states added similar laws to their statue books (Irwin, 1959) By 1963, a study by Haines (1965) indicated that 45 of the states had passed legislation placing speech and hearing programs

in the public schools These laws provided for financial help to school districts maintaining approved programs, supervision by the state, responsibility for administrating the law, and the establishment of standards The laws described minimum standards, which the programs were expected to exceed (Haines, 1965)

The first state supervisors, in tion with the school clinicians in their respec-tive states, did a remarkably far-sighted job in establishing statewide programs with regard to the organizational aspects With no precedents

coopera-to follow, they established standards that have retained merit through many years The Vermont program (Dunn, 1949), providing speech and hearing services to children in rural areas, and the Ohio plan (Irwin, 1949), represent two such examples They incorporated topics such as find-ing children who need the services, diagnostic services, caseloads, scheduling group and indi-vidual therapy sessions, designating rooms for the therapist, equipment and supplies, planning time, summer residence programs, in-service training for parents and teachers, and periodic rechecks of children

expanding Our sCOpe Of praCtiCe

The decades of the 1940s and the 1950s were times of growth for all aspects of the profes-sion In 1943, the American Medical Association requested that a list of ethical speech correction schools and clinics be provided for distribution

to physicians During World War II, the entire membership was listed in the National Roster

of Scientific Personnel The organization that

1 Evolution of Speech-Language Pathology Programs in Schools 5

started life in 1926 as The American Academy of

Speech Correction, with 25 dedicated and

deter-mined individuals, changed its name in 1948 to

The American Speech and Hearing Association,

and in 1979 to The American

Speech-Language-Hearing Association (ASHA) Its membership

increased from the original 25 persons in 1926 to

330 in 1940, to 1,623 in 1950, and again to 6,249 in

1960 In 1964, the “associate” category was

elimi-nated and there were 11,703 members By 1975,

the membership had climbed to 21,435, with a

steady increase until the present time, where the

membership is over 190,000 ASHA is the

pro-fessional, scientific, and credentialing

associa-tion for its members who are speech-language

pathologists (SLP), audiologists (Aud), speech,

language, and hearing scientists, and

speech-language pathology assistants (SLPAs) Several

professional publications and journals published

by ASHA and related organizations are devoted

to the discussion of the nature and treatment of

communication sciences and disorders

hearing handicapped

Initially, programs for children with hearing

impairments were designed for children who

were deaf The needs of those with mild to

mod-erate hearing impairments were, for the most

part, neglected Educational programs for the

deaf were first established in the United States

in 1817, with the founding of the American

School for the Deaf at Hartford, Connecticut

(Bender, 1960) Children who were deaf received

their education in residential schools or

institu-tions until the establishment of special education

classrooms in regular schools The child in the

regular classroom with a mild- to moderate-,

or even a severe-hearing loss was dealt with by

the classroom teacher In his book, Speech

“substitutions and omissions were frequently

found in children with hearing loss and may be

attacked with articulatory principles employing

also visual and kinesthetic avenues of approach.”

Public school therapists began to include dren who were hard-of-hearing in their case-loads on the same basis as children with speech handicaps There were also classroom teachers of the hard-of-hearing in the public schools

chil-speech improvement programs

School programs designed to help all children develop the ability to communicate effectively

in acceptable speech, voice, and language terns were first called speech improvement programs The instruction was usually carried out by the classroom teacher, with the speech-language specialist serving as a consultant and doing demonstration teaching in the classroom Many such programs were initiated in the 1920s, 1930s, and 1940s, and were concentrated on the kindergarten and first-grade levels One of the purposes was to reduce the number of minor speech problems

pat-The programs were not considered part

of the school clinician’s regular duties in many states However, in some cities, speech improve-ment programs were carried out successfully, despite lack of state support

It was also during these decades that public school programs increased and expanded, both professionally and geographically School clini-cians found themselves wearing many hats In addition to selling the idea of such a program to the school system and the community, the clini-cian has had to:

n Identify the children with speech and hearing handicaps

n Schedule them for therapy at the most convenient time for all concerned

n Provide the diagnosis and therapy

n Keep records and prepare reports

n Work with the school nurse on locating the children with hearing losses

n Counsel the parents

6 School Programs in Speech-Language Pathology: organization and Service delivery

n Answer many questions from teachers

who were often totally unfamiliar with

therapy services

n Keep the school administration informed

n Confer with persons in other professional

disciplines

n Remain healthy, well groomed, trustworthy,

modest, friendly, cheerful, courteous,

patient, enthusiastic, tolerant, cooperative,

businesslike, dependable, prompt, creative,

interesting, and unflappable

n Furthermore, the therapist had to keep one

eye on the clock and the calendar and the

other eye on state standards

Language and speech

Speech-language pathologists have been dealing

with children with language problems for many

years Before research and experience sharpened

diagnostic tools and awareness, most children

were referred to as having “severe articulation

disorders,” “delayed speech,” or “immature

lan-guage.” During the 1940s, 1950s, and early 1960s,

there was considerable interest among

profes-sionals in articulation and speech sounds

The focus changed in the late 1960s and

early 1970s to an interest in syntactic structures

and sentence forms The past several decades

have increased both knowledge and awareness

of language problems Indeed, the title of the

professional organization was changed, in

rec-ognition of this, from the “American Speech and

Hearing Association” to The American

Speech-Language-Hearing Association.”

Accompanying the growing awareness of

language problems was the realization that the

school-based clinician had a commitment to

the students whose language is disordered or

delayed Soon, school practitioners realized that

language was the foundation for learning and

that language problems contributed to a

stu-dent’s difficulty in mastering reading or math skills In addition, language problems were rec-ognized as key characteristics in children who presented hearing impairments, developmen-tal delays, learning disabilities, physical and emotionally impairments, autistic, or environ-mentally disadvantaged Acknowledging that learning is language-based has led to rethink-ing the SLP’s roles and responsibilities in the school setting That realization has contributed

to changes in preservice academic and clinical curricula and experiences and changes in service delivery practices

improvement in Quality

The growth in numbers of speech therapists ing the schools was steady during the 1950s and the 1960s That era concentrated on the improve-ment of quality, as well as increasing the quantity

serv-of therapists by emphasizing increased training for clinicians to meet advanced certification stan-dards set by professional organizations

A major project geared toward improving speech and hearing services to children in the schools was undertaken by U.S Office of Edu-cation, Purdue University, and the Research Committee of the American Speech and Hear-ing Association (Steer, 1961) The primary objec-tives were to provide authoritative information about current practices in the public schools and

to identify unresolved problems Based on those findings, priorities were established for identifi-cation of urgently needed research Hundreds of clinicians, supervisors, classroom teachers, and university personnel collaborated to develop a list of topics for further study Research was then distilled by several work groups The following topics were given the highest priority: the col-lection of longitudinal data on speech; compara-tive studies of program organization and types

of services offered; and comparative studies of the use of various speech, voice, and language intervention protocols

1 Evolution of Speech-Language Pathology Programs in Schools 7

Six additional topics were also identified

and assigned a high priority: the development

of standardized tests of speech, voice, and

lan-guage skills; the development criteria for

selec-tion of primary-grade children for inclusion

in remedial programs; comparative studies of

speech improvement and clinical programs;

comparative studies of group, individual, and

combined group and individual therapy

pro-grams; studies of the adjustment of children

and their language usage in relation to changes

in speech accomplished during participation in

therapy programs; and comparative studies of

different curricula and clinical training programs

for prospective public school speech and hearing

personnel

The study also addressed such topics as the

professional role and relationship of the school

clinician, the supervision of programs, diagnosis,

and measurement, and the recruitment of

profes-sional personnel to meet the growing needs of

children with communication handicaps in the

schools Decades later, these issues continue to

be of utmost importance to professionals, ASHA

members, and school practitioners

the “Quiet revOLutiOn”

School programs changed rapidly in the 1960s

and early 1970s O’Toole and Zaslow (1969)

referred to that timeframe as the “quiet

revolu-tion.” SLPs became more outspoken and began

to talk about taking steps to break the cycle of

mediocrity They discussed lowering caseloads,

giving high priority to the most severe cases,

employing intensive versus intermittent

sched-uling patterns, extending programs throughout

the summer, utilizing diagnostic teams, and many

other issues The emphasis had shifted, slowly but

surely, from quantity of services to quality

Several events occurred in the late 1960s

and 1970s that attest to the recognition of public

school speech-language specialists as a large and

important segment of the profession The ican Speech and Hearing Association named

Amer-a full-time stAmer-aff member to serve Amer-as AssociAmer-ate Secretary for School/Clinic Affairs In 1971, a

new journal was initiated, Language, Speech and

Spe-cial Interest Division 16: Issues in School Service Delivery was initiated and focused on practice

in the schools Subsequently, many task forces and committees have worked diligently to fos-ter better understanding of school-based ser-vices, children with disabilities, the role of SLPs

in the schools, the impact of communication

on learning success, and challenges to quality These steps attest to the importance of school-based practice and have resulted in changes in the qualifications needed to practice in schools, the focus of intervention, improved procedures, and collaboration with our educator colleagues.Simultaneously, outside influences also asserted pressure on professionals to change the way they provided services to children in schools Of great significance were changes that occurred in the philosophy and conditions surrounding the American education system Influences that had the greatest impact included population increases, growing demographic and cultural diversity, limited school budgets, the importance of literacy, children’s right to a fair and appropriate education, attention to popu-lations with special needs, and the adoption of Common Core Standards for education

federaL LegisLatiOn

In 1954, the U.S Supreme Court’s decision in the

case of Brown v Board of Education set into motion

a new era and struck down the doctrine of regated education This decision sparked inter-est in issues such as women’s rights, the right

seg-to education and treatment for the handicapped, and the intrinsic rights of individuals, including African Americans and other minority groups

8 School Programs in Speech-Language Pathology: organization and Service delivery

the parC Case

An extension of the Brown v Board of

(1976), was the consent decree established in

the case of the Pennsylvania Association for

Retarded Children This decree stated that no

matter how serious the handicap, every child

has the right to education The PARC case

estab-lished the right of parents to become involved

in making decisions concerning their child and

stipulated that education must be based on

prob-lems appropriate to the needs and capacities of

each individual child In their 1976 article about

special education in the past, present and future,

Reynolds and Rosen explained that parent

orga-nizations had long been a catalyst in bringing

about change, and in the case of children with

disabilities, they were certainly no exception

By the time of the PARC case, they had been

organizing for over 30 years to obtain facilities

and act as watchdogs over the institutions that

served their children with disabilities After

con-centrating on political action, the parent

organi-zations began to turn to the courts for solutions

Reynolds and Rosen believed that step resulted

in many of the changes in special education that

have occurred in the past and will potentially

occur in the future

MainstreaMing

One of the unexpected aftermaths of the PARC

case was to place the stamp of judicial approval

on mainstreaming According to Reynolds and

Rosen: “Mainstreaming is a set or general

predis-position to arrange for the education of children

with handicaps or learning problems within the

environment provided for all other children — the

regular school and normal home and community

environment — whenever feasible” (p 558)

The intent of mainstreaming was to

pro-vide children with disabilities an appropriate

educational program in as “normal” or lar” environment as possible Thus, depending

“regu-on the nature and/or severity of the c“regu-onditi“regu-on, the child may be in a self-contained classroom or

a regular classroom for all or part of the tional program In other words, the child should

educa-be taught in the “least restrictive environment” (LRE) allowed by the condition

Mainstreaming had special implications for the regular classroom teacher, as well as other personnel involved in the education of children with handicaps Reynolds and Rosen said:

Obviously, mainstreaming makes new demands on both regular classroom and spe-cial education teachers In the past, a regu-lar education teacher was expected to know enough about handicapping conditions to be able to identify children with such problems for referral out of the classroom into special education settings At the same time, spe-cial education teachers were trained to work directly with the children with certain spe-cific handicaps (as in the days of residential schools) in separate special settings

Under mainstreaming, different roles are demanded for both kinds of teachers The trend for training special education teachers for indirect resource teacher roles rather than narrow specialists is well established in many preparation centers Concurrently, programs are underway to provide regular education teachers with training in the identification

of learning problems At the local school level, regular and special education teach-ers in mainstreamed programs are no longer isolated in separate classrooms They work together in teams to share knowledge, skills, observations, and experiences to enhance the programs for children with special problems, whether the children are permanently or tem-porarily handicapped Thus, it has become essential for special teachers to learn the skills

of consultation and for both teachers to learn techniques of observation as well as commu-nication (pp 557–558)

1 Evolution of Speech-Language Pathology Programs in Schools 9

united states

departMent Of eduCatiOn

In 1967, Congress created the Bureau of

Educa-tion for the Handicapped and began a program of

grants to speed the development of educational

programs In 1974, Edwin W Martin, the director

of the Bureau of Education for the Handicapped,

in an address to the members of the American

Speech and Hearing Association, stated that he

did not feel we were successfully integrating our

roles as speech and hearing specialists in the

edu-cational system He urged that speech-language

pathologists and audiologists in schools must be

actively involved in interdisciplinary efforts with

parents, learning disability specialists,

adminis-trators, guidance counselors, classroom teachers,

and all educational colleagues

Over the years, the Bureau has evolved into

its present form as the United States Department

of Education The mission of the department is

to ensure equal access to education and to

pro-mote education success The Department

con-sists of many divisions and supports numerous

programs and initiatives The most relevant to

the field of speech-language pathology services

in the schools is the Office of Special Education

and Rehabilitation Services (OSERS) The

depart-ments within OSERS support programs that

assist in providing education to children with

special needs, providing for the rehabilitation of

youth and adults with disabilities, and

support-ing research to improve the lives of individuals

with disabilities

To carry out its functions, OSERS consists of

three major program-related components The

Office of Special Education Programs (OSEP)

is responsible for administrating projects and

programs that relate to the free appropriate

pub-lic education of all children, youth, and adults

with disabilities, from birth through age 21 The

Rehabilitation Services Administration (RSA)

oversees programs that help individuals with

physical or mental disabilities to obtain

employ-ment through the provision of support services

such as counseling, medical, and psychological services, job training, and other individualized services The National Institute in Disability Rehabilitation Research (NIDRR) supports a comprehensive program of research related to the rehabilitation of individuals with disabili-ties One can learn much about the education-related legislation, the goals of education, and support systems in place for professionals by visiting the U.S Department of Education’s web-site (https://www.ed.gov) Generally, the United States government defines priorities for educa-tion for current time periods These priorities are stimulated by trends and have impact on the opportunities, funding, and practices for special education, including speech-language pathol-ogy We explore some of the priorities that are currently driving education and special educa-tion in Chapter 3

eduCatiOn refOrM and federaL LegisLatiOn

Parents, educators, and lawmakers continue to campaign for education reform Their initiatives inevitably have profound impact on the face of the public education Each initiative ultimately will also impact the practice of speech-language pathology in schools The past several decades have seen emphasis on important educational initiatives, including: inclusion of students with disabilities in all facets of the education system; greater focus on increasing graduation rates and preparing students for the world of work; increased involvement of parents in the decision making about educational programming; alter-native types of schools; limited funding; and the development of specialized programs to deal with students with autism, behavioral/emotional disorders, and school bullying and violence

Many key statutes relating to the education

of students with disabilities have been mented over the past several decades Among the laws that have had the greatest effect on

imple-10 School Programs in Speech-Language Pathology: organization and Service delivery

education in America is The Elementary and

Secondary Education Act (ESEA), which was

originally enacted in 1965 and reauthorized

numerous times since then

Special education laws, and amendments

to update them, have greatly influenced special

education and speech-language pathology

ser-vice delivery They include: the Education for All

Handicapped Children Act of 1975, (the original

Public Law 94-142); an updated version of PL

94-142, called the Education of the Handicapped

Act Amendments of 1986 (Public Law 99-457);

the most recent version, called the Individuals

with Disabilities Education Act (IDEA)

Amend-ments of 1997 (Public Law 101–476, later revised

as 105-17); and the Rehabilitation Act of 1973

(especially, section 504) The key aspects of these

laws are briefly described in the following

sec-tions and presented in greater detail in Chapter

3 Although the laws are complex, the intent of

supporting positive outcomes for students with

disabilities, and the mandated guidelines within

the laws, provide an excellent framework for the

provision of quality services Throughout this

book, you will find recommendations that are

responsive to the goals of these laws

pL 89-10: the elementary and

secondary education act (esea)

Funding for primary and secondary education

was provided through the Elementary and

Sec-ondary Education Act Originally, funds were to

be directed toward professional development,

instructional materials, resources to support

education programs, and parental involvement

Like other federal legislation, ESEA has been

subjected to review and reauthorization every

several years Subsequent reauthorizations

include several “Title” programs that focus on

specific educational initiatives, such as education

of children of low-income families, supplemental

resource centers, educational research, and

train-ing, improving schools, and providing education

to children with limited English proficiency

pL 94-142: education for all handicapped Children act

The most sweeping and significant changes concerning the education of children with dis-abilities took place on November 29, 1975, when President Gerald Ford signed into law The Edu-cation for All Handicapped Children Act (Public Law 94-142) The major intent of the law was to assure full appropriate education for all chil-dren between the ages of three and twenty-one with disabilities It provided for Individualized Education Programs (IEPs), due process, the use of evaluation procedures for determining eligibility, and education in the least restrictive environment

Through the years, the overall impact of Public Law 94-142 has continued to be beneficial and substantial It changed not only the educa-tion for students with disabilities, but also influ-enced the entire system of education As state laws and regulations changed, the parents of chil-dren with disabilities became more involved in educational decisions Advocacy groups evolved and influenced education philosophy, providing opportunities at the local and state levels Train-ing institutions established programs to prepare educators to research instructional methods Par-ents and guardians of all children who are dis-abled are guaranteed legal due process regarding identification, evaluation, and placement

Public Law 94-142 also created a pervasive and profound effect on public school speech-language and hearing service delivery Before the passage of the law, individual states had enacted

legislation permitting speech and hearing services

in the schools However, PL 94-142 mandated

ser-vices for children with speech-language or ing impairments In addition, the law established

hear-a leghear-al bhear-asis for services hear-and provided finhear-ancihear-al assistance The scope of speech-language pathol-ogy and audiology services are defined in the provisions of the law and mandate the identifi-cation and evaluation of children with communi-cation disabilities, as well as the development of

an Individualized Education Program (IEP) and

1 Evolution of Speech-Language Pathology Programs in Schools 11

its implementation The regulations also cover

the provision of appropriate administrative and

supervisory activities necessary for programs

planning, management, and evaluation

pL 99-457: amendment to

include early intervention

In 1986, President Ronald Reagan signed into law

Public Law 99-457, which are ammendments

to the Education of the Handicapped Act (PL

94-142) and focus on implementing early

inter-vention initiatives These amendments expanded

and strengthened the mandate for providing

ser-vices to children with handicaps by assisting

in-dividual states to plan, develop, and implement

state-wide interagency programs for all young

children with disabilities, from birth through age

two The law includes those infants and toddlers

who demonstrate developmental delays in the

areas of physical development, including vision

and hearing, language and speech, psychosocial

development, or self-help skills The law also in-

cludes infants and toddlers who have a diagnosed

physical or mental conditions that have a high

probability of resulting in developmental delay

Section 619 of PL 99-457 creates enhanced

incentives for states to provide a free and

appro-priate public education for eligible three- to

five-year olds with disabilities Parental training,

family services, and variations in child

program-ming are encouraged by law

reauthorizations of pL 94:142:

individuals with disabilities

education act (idea)

In 1990, Public Law 94-142 was further amended

The changed legislation was called Individuals

with Disabilities Education Act (IDEA) or

Pub-lic Law 101-476 The law resulted in additional

major changes Two new categories of disability,

autism and traumatic brain injury, were added

In addition, a “person-first” language was

intro-duced, changing all references to handicapped children to “children with disabilities.” Another change mandated that schools provide transi-tion services to support movement from school

to postschool activities

The IDEA act was again revised and signed into law by President William Clinton in 1997 (Public Law 105-17) In May 1999, the final reg-ulations were in effect The IDEA regulations for Part B of the amendment apply to services

in school settings Individual states have the responsibility to establish their own educational requirements This legislation will continue

to impact school programs for the foreseeable future It is likely that additional revisions will

be made, as philosophies and knowledge about education for students with disabilities contin-ues to evolve

In 2004, IDEA was reauthorized as the viduals with Disabilities Education Improve-ment Act (IDEIA) The changes addressed how schools identify children with learning disabili-ties, how IEP policies should be developed, the establishment of qualified teacher requirements, and the required planning and preparing high school students’ transitions to post-secondary experiences

Indi-reauthorization of esea

The 2001 reauthorization of The Elementary and Secondary Education Act was titled the No Child Left Behind Act (NCLB), and had great impact

on educational services, educators, and special educator teachers, including SLPs NCLB (often referred to as “nicklebee”) supports standards-based educational reform This implies that set-ting high standards and establishing measurable goals can improve the quality of educational outcomes Reading, language arts, science, tech-nology, and mathematics are considered core academic subjects Schools must take steps to measure students’ performance in reading and math on a regularly scheduled basis Schools must demonstrate how students are performing,

12 School Programs in Speech-Language Pathology: organization and Service delivery

and are rated by overall performance Schools

with a high number of failing students must

make formal plans for improving their

educa-tional practices

In 2010, President Obama reauthorized

NCLB to provide additional funding to states in

order to implement a broader range of

assess-ments beyond reading and math, to evaluate

advanced academic skills, and engage in

scien-tific investigations to promote technology and

research By promoting incentives, the intended

results were to reduce the high school dropout

rate, and thus increase graduation rates In 2012,

President Obama granted school waivers from

NCLB requirements to several states who agreed

to raise their standards, improve accountability,

and implement teacher effectiveness reform

In April of 2015, PL 114-95, Every Student

Succeeds Act (ESSA), was introduced to

Con-gress to replace NCLB The purpose of this bill

was to afford states more flexibility with setting

their own standards and measuring school

per-formance The law was signed in December of

2015, allowing states to develop programs and

outcome measures that better prepare students

for college and careers Following are some key

components that impact our services:

n Equity for disadvantaged,

underrepre-sented, and special needs students

n High academic standards to prepare

student for college and careers

n Evidence-based practice to support

intervention

n Alternate achievement standards for those

with cognitive disabilities

n Standards for English language

proficiency

As a result of NCLB and ESSA,

speech-language intervention services changed

dra-matically from intervention that focused on

modifying specific speech and language skills to

more functionally oriented intervention that is

linked to the educational curriculum Treatment

is focused on improving communication skills to help students perform better in learning situa-tions and educational settings

terMinOLOgy:

what’s in a naMe?

The historical development of school programs

in speech and language is interestingly revealed

in the occupational titles to which they have been referred over the years The earliest professionals called themselves “speech correctionists.” Some who had previously worked in school systems in this capacity were known as “speech teachers,” although they were more concerned with reha-bilitation than with elocution During the 1950s and the 1960s, we became “speech and hearing therapists” and “speech and hearing clinicians.” All these changes caused no end of trouble, espe-cially in trying to explain the professional’s role

to others

During the 1970s, we became known as

“speech pathologists,” and in 1977, The can Speech-Language-Hearing Association in a preference survey found that “speech-language pathologist” was the choice of professionals in the field

Ameri-How did we get from “speech ist” and “speech teacher” to “speech-language pathologist?” The answer is not simple, but per-haps a review of the focus of clinical practice may shed some light

correction-In the 1930s, a few universities began grams to train people for clinical roles in pub-lic schools and universities We were “speech correctionists” and “speech teachers.” Stutter-ing problems were the major focus during the earliest days, along with articulation problems Clinicians were aware of language systems, but problems in that area were treated as speech problems When faced with students who did not talk, therapists attempted to stimulate speech by targeting vocal play and babbling

pro-1 Evolution of Speech-Language Pathology Programs in Schools 13

Speech clinicians weren’t without their

Bryngel-son Glaspey Speech Improvement Cards (1941)

or Schoolfield’s book, Better Speech and Better

Reading (1937)

Children who did not talk or who had little

speech were viewed as having “organic”

prob-lems, meaning those related to the brain or

neu-rological systems Children whose problems in

communication yielded to therapy were said to

have had “functional” problems Children who

had even minimal vocalization, such as cerebral

palsy or hearing impairment, were treated as

speech problems It was at this time the

occupa-tional titles of “speech therapists” and “speech

and hearing therapists” were used

Very young children with “delayed speech”

and mentally retarded children were excluded

from therapy as it was thought they had not

reached the proper stage of development to

ben-efit from treatment

This clinical model was followed for about

30 years, until the late 1950s and early 1960s,

when Noam Chomsky’s “generative grammar”

theories set the stage for the beginning of the

profession’s understanding of language and

language behavior Although Chomsky offered

little help in solving clinical problems, it was at

this time that B F Skinner’s behavioral theories

appeared Speech clinicians still used the

func-tional approach to therapy: however, they did

include language-handicapped children on their

caseloads for the first time

One result of these two widely divergent

schools of thought was to move the speech

clini-cian’s focus away from concentration on

prob-lems and articulation

During the 1960s and the 1970s, the

stim-ulus-response and reinforcement strategies as

well as “precision therapy” methods were used

to elicit language and speech productions from

children during therapy sessions These

behav-ior modification methods were widely accepted,

and speech clinicians freely used a token reward

system to motivate students Chomsky’s

gram-mar and Skinner’s behaviorism prepared the

way for the profession’s increase their attention

on the area of child language with particular emphasis on semantics and pragmatics During the 1970s, the profession expanded the knowl-edge base and expanded upon the foundation that had been established in the 1960s This had the effect of developing new concepts about lan-guage behavior and its component parts

During the early 1980s, those children ously excluded from therapy were now included Although children with articulation problems were still a large part of the speech-language pathologist’s caseloads in the public schools, individuals with severe language deficiencies, language-learning disabilities, mental retarda-tion, motor handicaps, and hearing impairments were added for speech therapy services Adding impetus to this development was the passage implementation of IDEA, Public Law 94-142

previ-Although some may view the trouble with terminology as an identity crisis affecting an entire profession, it might also be construed as symptomatic of gradual shift in focus from a pre-occupation mainly with articulation problems,

to an interest in language-learning behavior It also indicates an expanding scope of services

to include prevention as well as remediation,

to hone and fine-tune our individual sional skills, and to see that these skills are uti-lized in the most efficient way to the appropriate consumers

profes-the eMerging rOLe

Of the sChOOL sLp

Traditionally, in U.S schools, speech, language, and hearing services have been offered as a part of the educational program, and over half

of ASHA members have been employed in the school setting Unlike the delivery system in other countries, wherein speech, language, and hearing professionals have followed the “medi-cal model,” and have provided services through health and medical facilities such as hospitals, the United States’ delivery system has followed

14 School Programs in Speech-Language Pathology: organization and Service delivery

an “educational model,” and provides services

within the public schools Our system

undoubt-edly reflects our democratic philosophy of

educa-tion, whereby children have a right to educaeduca-tion,

and our function in school is to prevent, remove,

and alleviate communication barriers that

inter-fere with the child’s ability to benefit from the

education offered

Furthermore, the schools constitute an ideal

setting in which to provide speech-language

intervention services; there is an identified

popu-lation that is the “consumer” of the services, there

are legal mandates for implementation and

car-rying out the services, and there are local, state,

and federal support systems Competency in oral

and written communication is one of the

pri-mary objectives of the school system, and today,

in many states, and with the encouragement of

federal government, assessments are mandated

in these areas Speech, language, and hearing

services are the primary support systems in the

achievement of these competencies

Figure 1–1 illustrates the evolution of

speech-language pathology service delivery

over the past several decades, and projects it

into the future For each decade, Row 1 indicates

the areas of communication that were the SLPs’

focus for treatment Row 2 shows the roles

cli-nicians have assumed in service delivery Row

3 lists the emerging issues under professional

consideration This chart shows that changes

in service delivery models, and the clinicians’

roles have paralleled the increased

understand-ing of communication disorders, and its impact

on learning As issues have emerged, and

clini-cal environments changed, clinicians have

attempted to modify their practices to adapt to

new demands

The profession is at a new turning point in

the evolutionary process In fact, it appears that

the field of speech-language pathology is

cur-rently undergoing a metamorphosis in service

delivery Significant changes are taking place

in educational settings that are forcing SLPs to

reflect on their options or models for service

delivery In educational forums, public

educa-tion laws and policies are being rewritten to ify the meaning and intent of providing services within the classroom setting and in the least restrictive environment Current perspectives propose an expansion of service delivery options based on goals to achieve functional communi-cation and to serve all children in the learning environment that best fits their individual needs There is growing support for employing multi-ple systems of support for children with learning challenges, including those with communication disabilities

clar-At present, speech-language pathologists in school settings are moving toward using inclu-sive models of service delivery that merge speech and language services with educational pro-gramming Inclusive practices can be described

as intervention services that are based on the unique and specific needs of the individual, and that are provided in a setting that is least restric-tive Individual states are reevaluating services and acceptable service delivery options for all children with special needs Personnel working

in educational settings must demonstrate that their services will support the student so that

he or she can participate to the maximum extent possible in social and learning contexts Based

on these directions, the best practice for language pathology services delivery within the school setting would indicate that the general education classroom should be the first step in the continuum of service delivery to students with communication disabilities

speech-Success is defined in terms of helping dents reach measurable, functional outcomes so they can participate in community, family, work, and learning activities Service delivery has been expanded to include families, where possible.The critical roles of the speech-language pathologist, as described in ASHA’s document entitled, Roles and Responsibilities of Speech-Language Pathologists in Schools (2010c) included: working across all levels; serving a broad range of disorders; ensuring educational relevance; pro-viding unique contributions to the curriculum; supporting students’ acquisition of language

Focus of Services SLP Role Emerging Issues Treatment Considerations

1970s • Mechanistic view

of language • Specialist model • Language use is important

1980s • Pragmatics • Expert model • Language and

learning are linked

Collaborative-• Efficacy

• Accountability

• Outcomes

Use Form

Content

Collaboration C

Learning Communication

Phonology Semantics

• Multiple certification levels

• Data oriented

• Common Core Curriculum Standards

• Communication for work/college

• Integrate technology

• Integrate services into classrooms

• Evidence based 2020s • Academic and

• Identify based treatment

evidence-• Team collaborator

• Broaden knowledge of other disciplines

• Interprofessional practice and collaboration

• State and local policy and funding sources

• Intervention strategies to improve Literacy

• Engage in MTSS

• Addressing complex workload issues

Activities A Providers

Context

Technology T Relevance Evidence

IP Collaboration C

Educational Relevance

Figure 1–1 Evolution of school-based SLP services

16 School Programs in Speech-Language Pathology: organization and Service delivery

and literacy; and provide culturally competent

services This comprehensive list demonstrates

the important contribution the SLPs make in the

educational setting

The school-based SLP plans, directs, and

provides diagnostic and intervention services to

children and youth with communication

disabili-ties He or she works with articulation, language,

voice, dysfluency, and hearing impairments, as

well as speech, language, and hearing problems

associated with such conditions as autism

spec-trum disorders, traumatic brain injury, cerebral

palsy, English as a second language (ESL),

devel-opmental delay, emotional and behavioral

dis-turbances, and swallowing disorders

The speech-language pathologist serves

high-risk infants and toddlers from birth to age

five in community or school district-operated

child developmental centers, Head Start

pro-grams, early intervention preschool programs

schools, or home settings Also served are

chil-dren with severe disabilities or multiple

impair-ments in various settings, as well as elementary,

middle, and secondary school grades

An important aspect of the school

speech-language pathologist’s duties include

coopera-tion with other schools and health specialists,

including teachers, audiologists, nurses, social

workers, physicians, dentists, special education

teachers, psychologists, and guidance

counsel-ors Collaboration and cooperative planning

with these individuals on a regular basis results

in effective diagnostic, facilitative, and

educa-tional programs for children with

communica-tion problems

The school speech-language pathologist

works with general and special education

teach-ers, administrators, and other educators to

imple-ment procedures and generalize communication

skills Working with parents in order to help

them alleviate and understand problems is also

a part of the clinician’s function School

admin-istrators are often the key to strong, educational

programming for children, and the school

speech-language pathologist works with both principals

and program directors toward that end

The school SLP may also serve as a resource

to colleagues and organizations in the nity, providing public information about com-munication disorders and the availability of services for parents and families

commu-Many school clinicians lead the way in their field by engaging in research to provide evi-dence of the effectiveness of specific treatment methods In addition, they initiate best practices for program organization and management, as well as service procedures The field of speech-language pathology is constantly broadening, and the school SLP must keep abreast of current information by: reading professional journals and publications; attending seminars and con-ventions; enrolling in continuing education pro-grams; and sharing information and ideas with colleagues though state, local, and national pro-fessional organizations

Because the school speech-language ogist is considered an important part of the total educational program, the size, and structure of the local school district will have much to do with the organizational model used, as well as with the nature of the services provided Often SLPs travel from school to school throughout the week Others are assigned to a single school building, whereas others may work in special classes, resource rooms,

pathol-in classrooms with teachers, or self-contapathol-ined classrooms They may be a full-fledged member of the student services team or even work as admin-istrators of speech and language programs

As the SLP’s role as a collaborator or tant becomes more prevalent, their expectations and responsibilities increase General education classroom teachers, special teachers, and person-nel in other specialized fields may depend on the school speech-language pathologist to pro-vide information on diagnoses, assessment, and treatment of children with communication disor-ders As a result, the school-based SLP must be knowledgeable about the school curriculum, the impact of communication disabilities on school performance, and the necessary strategies to ensure that students’ performance will improve, and meet the required educational standards

consul-1 Evolution of Speech-Language Pathology Programs in Schools 17

future ChaLLenges

What is the future role of the speech-language

pathologist (SLP) in the schools? Speech-language

pathologists working in the schools in the future

will need to demonstrate strategies for coping

with change They will need to be well educated,

skillful, and flexible Given the complexity of

American society, the SLP will need to

under-stand and respect the cultural and social

back-grounds of their students and communities They

will need to incorporate evidence-based practices

for evaluating and treating students They will

need technology proficiency so they can

incorpo-rate technology into their diagnostics,

interven-tions, and documentation Some clinicians will

implement telepractice to deliver services

Diverse workloads will require the SLP to

establish priorities and master time-management

skills Undoubtedly, the federal laws related

to special education often serve as a catalyst to

create effective speech, language, and hearing

school It is evident that education legislation

has enhanced students’ access to services, and

enabled more parental involvement in the

edu-cational decision-making process

Many of the most significant challenges of

working in the school setting have been

iden-tified by SLPs during interviews and surveys

conducted over the past several years First and

foremost, SLPs indicate that the changing size

and composition of the caseload places new

demands on their time, skills, energies, and

knowledge base The type of documentation

required to verify compliance with the laws has

resulted in increased paperwork, placing great

demands on the clinician’s time Perhaps one of

the most difficult matters to resolve is the lack of

adequate funding necessary to offer quality

pro-grams As America becomes more

consumer-ori-ented, professionals are required to be more and

more accountable for their decisions and actions

Administrators and parents are seeking

verifica-tion of the benefits of speech-language services

and treatment outcomes

Demands such as these can lead to out and stress for clinicians Staying abreast of emerging trends in treatment, attending profes-sional conferences, working with professionals from other disciplines, and trying new and dif-ferent strategies in therapy are all positive steps clinicians can take to maintain their interest and energy To help alleviate the financial constraints, SLPs can work closely with their administration and advocate for change through their profes-sional organizations and political arenas

burn-Although there are many problems faced by school SLPs and the profession as a whole, there are also exciting and challenging developments

It is difficult to predict how speech-language pathology will be different in the future, but we can make some educated guesses The makeup

of the caseload in schools has already shifted from preponderance of articulation problems to mainly language and learning disabilities The prevalence and incidence of disabilities, such

as autism spectrum disorders, is skyrocketing More and more children from diverse back-grounds will be enrolled in the school systems

It will be necessary to develop programs that meet the growing and diverse needs of our mul-ticultural society There will be an extension of services to preschool children, and, at the other end of the line, services to high school students will focus on preparing them for graduation and employment Children with severe or multiple disabilities will be placed in general education classrooms and many of these children will have speech and/or language problems

The role of the SLP as a collaborator and consultant will be greatly expanded, as will the role as a team member in diagnosis, assess-ment, and placement decisions There will be increased demand for services designed to help children acquire the skills of reading, writing, and spelling, as well as in speaking and listen-ing As has been true in the fields of medicine and dentistry, there will be an emergence of spe-cialists in speech-language pathology Funding streams for services may be an altered greatly Speech-language pathologists will be expected