Guidelines for the Roles and Responsibilities of the School-Based Speech-Language Pathologist

Guidelines • Roles and Responsibilities of the School-Based Speech-Language PathologistGuidelines 1999 / III - 249

American Speech-Language-Hearing Association

These guidelines are an official statement of the Ameri- Current Model can Speech-Language-Hearing Association (ASHA). They II. Roles and Responsibilities were approved by ASHA’s Legislative Council in March Prevention 1999. They provide guidance for school-based speech- Identification language pathologists but are not official standards of the Assessment Association. The guidelines were prepared by the ASHA Ad Evaluation Hoc Committee on the Roles and Responsibilities of the Specific Evaluation Considerations School-Based Speech-Language Pathologist: JoAn Cline, Eligibility Determination chair; Susan Karr, ex officio; Jacqueline Green; Ronald IEP/IFSP Development Laeder; Gina Nimmo; and Ronnie Watkins. Nancy Caseload Management Creaghead, 1997–1999 vice president for professional practices in speech-language pathology, served as monitor- Intervention for Communication Disorders ing vice president in 1997; Crystal Cooper, 1994–1996 Intervention for Communication Variations vice president for professional practices in speech- Counseling language pathology, served as monitoring vice president Re-evaluation in 1996 and consultant in 1997–1998. Committee members Transition have extensive experience providing direct speech-language Dismissal pathology services in school settings. The contributions of Supervision ASHA members, committee members, and staff peer review- Documentation and Accountability ers are gratefully acknowledged and have been carefully con- III. Additional Roles and Opportunities sidered. Additionally, the committee wishes to thank those Community and Professional Partnerships who shared state handbooks and district procedure manu- Professional Leadership Opportunities als from the following states: California, Connecticut, Advocacy Florida, Georgia, Illinois, Iowa, Kentucky, Maryland, IV. Summary Michigan, Nevada, New York, North Carolina, Ohio. References Bibliography Table of Contents Appendices I. Introduction A. ASHA Code of Ethics Purpose B. ASHA School Related Resources Guiding Principles C. Goals 2000 Educate America Act: National Educa- Definitions tion Goals History D. School Reform Issues Related to Speech-Language Pathology Reference this material as: American Speech-Language- E. Advantages and Disadvantages of Types of Assess- Hearing Association. (2000). Guidelines for the roles and ments responsibilities of school-based speech-language pa- F. Developmental Milestones for Speech and Language thologist. Rockville, MD: Author. G. Examples of a Severity/Intervention Matrix Index terms: Caseload (service delivery), documentation H. Signs and Effects of Communication Disorders activities, Individuals with Disabilities Education Act, I. Example of an Educational Relevance Chart practice scope and patterns, schools (practice issues), ser- J. Example of Entry/Exit Criteria for Caseload Selec- vice delivery models, speech-language pathology tions Document type: Standards and guidelines K. Example of Dismissal Criteria Chart III - 250 / 1999 ASHA 2002 Desk Reference Volume 3 • Speech-Language Pathology

Guidelines Quick Reference

WHO Definition of speech-language pathologist WHAT Core roles WHEN Eligibility determination WHERE Caseload management/Service delivery options WHY Guiding principles HOW “How to” techniques for each of the core roles are learned through pre-service training and clinical practicum experiences. In-service learning continues via clinical fellowships, continuing education programs, literature review, mentorships, Special Interest Division or other professional affiliations, study groups, and research.

I. Introduction families,3 speech-language pathologists, teachers, school administrators, legislators, and lobbyists may School-based speech-language pathology services find the information helpful when advocating for qual- have changed dramatically during the past decades ity services and programs for students with commu- because of numerous legislative, regulatory, societal, nication disorders. This document may also be used and professional factors. Meanwhile fiscal con- as a resource by program administrators and supervi- straints and increased paperwork have made it more sors who wish to support and enhance the profes- challenging to provide effective services. In order to sional growth of individual speech-language provide appropriate speech and language services, it pathologists. is important to understand and consider the corre- sponding changes in the development and manage- Guiding Principles ment of the school-based speech-language pathology The following premises guided the development program. of this document: The current roles and responsibilities of the school-based speech-language pathologist require clarification, expansion, and readjustment. Core roles and responsibilities are described in Section II, while additional roles and opportunities are suggested in 1 The ASHA School Services Division receives approxi- Section III. mately 100 requests each year for such guidelines. Many requests represent the interests of entire school districts Purpose or local and state education agencies. Additionally, requests for this type of information are received by other The purpose of this document is to define the roles divisions at the ASHA National Office for use in state and delineate the responsibilities of the speech- and federal advocacy efforts. language pathologist within school-based speech- 2 Within this document parent refers to the biological language programs. parent(s), legal guardian(s), or surrogate parent(s). These guidelines were developed in response to 3 Within this document family may include relatives or indi- requests by speech-language pathologists, school ad- viduals with a common affiliation, such as caregivers or ministrators, lobbyists, and legislators who seek guid- significant others. ance from the American Speech-Language-Hearing 4 Further citations of the U.S. Congress 1997 Amendments Association (ASHA) for a description of the roles and to the Individuals with Disabilities Education Act (IDEA) responsibilities of school-based speech-language pa- will be denoted by section numbers only. Unless other- wise stated, IDEA refers to the IDEA 1997 Amendments. thologists.1 These guidelines can be used as a model At this writing, the final federal regulations for the IDEA for the development, modification, or affirmation of 1997 legislation have not been promulgated by the 2 state and local procedures and programs. Parents, Department of Education. Guidelines • Roles and Responsibilities of the School-Based Speech-Language Pathologist 1999 / III - 251

• “Disability is a natural part of the human ex- ate student communication problems within perience and in no way diminishes the right of the educational environment. individuals to participate in or contribute to so- • A student-centered focus drives team decision- ciety. Improving educational results for chil- making. dren with disabilities is an essential element of • Comprehensive assessment and thorough our national policy of ensuring equality of evaluation provide information for appropriate opportunity, full participation, independent eligibility, intervention, and dismissal deci- living, and economic self-sufficiency for indi- sions. viduals with disabilities.” (U.S. Congress, 1997 [Sec. 601(c)]).4 • Intervention focuses on the student’s abilities, rather than disabilities. • Society’s trends and challenges affect the role of speech-language pathologists. • Intervention plans are consistent with current research and practice. • Educational success leads to productive citi- zens. Although speech-language pathologists are bound by federal mandates, state regulations and guidelines, • Language is the foundation for learning within and local policies and procedures, they are also influ- all academic subjects. enced by ASHA’s policy statements. School-based • School-based speech-language pathologists speech-language pathologists are encouraged to refer help students maximize their communication to ASHA’s Code of Ethics (Appendix A) when mak- skills to support learning. ing clinical decisions. As indicated in Figure 1, • The school-based speech-language patholo- ASHA’s Code of Ethics encompasses all ASHA policy. gist’s goal is to remediate, ameliorate, or allevi-

Source: Scope of Practice in Speech-Language Pathology. (ASHA, 2001) III - 252 / 1999 ASHA 2002 Desk Reference Volume 3 • Speech-Language Pathology

The guidelines in this document are consistent vices. . . as may be required to assist a child with a dis- with ASHA’s Scope of Practice, Preferred Practice Pat- ability to benefit from special education. . .and includes terns, and position statements, yet are specific to issues the early identification and assessment of disabling relating to school-based speech-language pathologists. conditions in children” [Section 602(22)]. Speech- Additional complementary documents, such as ASHA language pathology is considered special education guidelines, technical reports, tutorials, and relevant rather than a related service if the service consists of papers, are available through the ASHA National Of- “specially designed instruction, at no cost to the par- fice (see Appendix B). ents, to meet the unique needs of a child with a dis- These guidelines reflect the Committee’s review of ability, including instruction conducted in the current law related to providing services to students classroom, in the home, . . . and in other settings.” State with disabilities; policy and procedure documents standards may further specify when speech-language from a variety of geographic areas; current professional pathology services may be considered special educa- literature; contemporary practices from rural, subur- tion rather than a related service. ban, and urban areas; and extensive feedback from peer According to the IDEA definition, speech- reviewers in the profession. Likewise, the terminology language pathology includes: used within this document mirrors current wide- • identification of children with speech and/or spread use; however, regional or geographical varia- language impairments tions may occur. In the interest of clarity, the various • appraisal and diagnosis of specific speech aspects of school-based speech-language pathologists’ and/or language impairments roles and responsibilities are discussed separately. However, school-based speech-language pathology • referral for medical or other professional atten- services are interrelated, as are all aspects of commu- tion necessary for the habilitation of children nication. with speech or language impairments The field of speech-language pathology is dy- • provisions of speech and/or language services namic and evolving, therefore the examples within for the prevention of communication impair- this document are not meant to be all-inclusive. Addi- ments or the habilitation of children with such tional emerging roles or responsibilities should not be impairments precluded from consideration if they are based on • counseling and guidance for parents, children, sound clinical and scientific research, technological and teachers regarding speech and/or lan- developments, and treatment outcomes data. guage impairments. Definitions IDEA similarly identifies the early intervention services provided by speech-language pathologists for The range of the profession of speech-language pa- children from birth to age 3 with communication or thology has been defined by many sources, including swallowing disorders and delays. In Part C of IDEA, ASHA, federal legislation, and such other sources as early intervention services are defined as being “de- the World Health Organization. signed to meet the developmental needs of an infant ASHA Definition or toddler with a disability in any one or more of the Speech-language pathologists are professionally following areas: physical, cognitive, communication, trained to prevent, screen, identify, assess, diagnose, social or emotional and adaptive development” [Sec- refer, provide intervention for, and counsel persons tion 632(c)]. An infant or toddler with a disability may with, or who are at risk for, articulation, fluency, voice, also include, at a state’s direction, at-risk infants and language, communication, swallowing, and related toddlers [Section 632(5-8)]. disabilities. In addition to engaging in activities to re- World Health Organization Definitions duce or prevent communication disabilities, speech- School-based speech-language pathologists pre- language pathologists also counsel and educate vent, identify, assess, evaluate, and provide interven- families or professionals about these disorders and tion for students with speech, language, and related their management (ASHA, 1996c). impairments, disabilities, and handicaps. The World Federal Definitions Health Organization, in an effort to describe what may The Individuals with Disabilities Education Act happen in association with a health condition, defines (IDEA) includes speech-language pathology as both a impairment, disability, and handicap and differentiates related service and as special education. As related ser- outcome measures for each. See Table 1. vices, speech-language pathology is recognized as “developmental, corrective, and other supportive ser- Guidelines • Roles and Responsibilities of the School-Based Speech-Language Pathologist 1999 / III - 253

Table 1. World Health Organization (WHO) classifications.

IMPAIRMENT DISABILITY HANDICAP

Definitions Abnormality of structure or Functional consequences Social consequences of an function at the organ level of an impairment impairment or disability

Examples Speech, language, cogni- Communication problems Isolation, joblessness, de- tive, or hearing impair- in context of daily life pendency, role changes ments activities

Outcome Measures Traditional instrumental Functional status mea- Quality of life scales, and behavioral diagnostic sures handicap inventories, measures wellness measures

Source: International classification of impairments, disabilities, and handicaps. (World Health Organization, 1980)

School-based speech-language pathologists focus correction teachers” (Darley, 1961). In the 1950s, on all three aspects of a student’s communication speech-language pathologists who worked in a school needs: impairment, disability, and handicap. The setting, formerly referred to as “speech correctionists,” school-based speech-language pathologist (a) pre- “speech specialists,” or “speech teachers,” worked vents, corrects, ameliorates, or alleviates articulation, primarily with elementary school children who had fluency, voice and language impairments; (b) reduces mild to moderate speech impairments in the areas of communication and swallowing disabilities (the func- articulation, fluency, and voice. Later, with increased tional consequences of the impairment); and (c) less- knowledge about language development, the “speech ens the handicap (the social consequences of the therapist” developed skills in identifying and impairment or disability).5 remediating language disorders, thereby expanding Ultimately, the school-based speech-language the range of the profession (Van Hattum, 1982). Stu- pathologist’s purpose in addressing communication dents were typically treated in large groups, contrib- and related disorders is to effect functional and mea- uting to caseload sizes that in most situations surable change(s) in a student’s communication sta- significantly exceeded those of today. The speech-lan- tus so that the student may participate as fully as guage pathologist often employed a medical/clinical possible in all aspects of life—educational, social, and approach to treating students with communication vocational (ASHA, 1997e). impairments. With this approach the student’s problems were diagnosed, developmental tasks were pre- History scribed, clinical materials were used for treatment, and The roles and responsibilities of school-based the individual was treated until the pathology was speech-language pathologists have changed over the “corrected.” All of this was most often conducted by years in response to legislative, regulatory, societal, pulling students out of the classroom to receive ser- and professional influences. vices within a separate therapy resource room. The emphasis was on correcting the specific speech or lan- Traditional Role guage impairment. School-based speech-language programs have a Legislative Influences long history. Records indicate that in 1910 the Chicago public schools were the first schools to hire “speech Federal and state governments have been instrumental in obtaining rights for children with disabilities through the authorization of public laws. Practices defining speech-language pathologists’ roles and re- 5 The World Health Organization (1997) has drafted a revision of its classification of impairments, disabilities, and sponsibilities in schools today have been shaped in handicaps for field trials only. If finalized in current part by the laws and regulations, administrative poli- form, the dimensions will include impairments of struc- cies and procedures, and court rulings that govern the ture and impairments of function, activities (formerly provision of services to students with communication disabilities), and participation (formerly handicaps). disorders. Relevant federal laws are noted in Table 2. III - 254 / 1999 ASHA 2002 Desk Reference Volume 3 • Speech-Language Pathology

Table 2. Federal Statutes Relating to Education of Students With Disabilities

Year Name of Law Law # Highlights

1973 Section 504 of the Rehabili- PL 93-112 Civil rights law to prohibit discrimination on the basis tation Act of 1973 of disability in public or private programs and activities receiving federal financial assistance.

1975 Education for All Handi- PL 94-142 Mandates a free, appropriate education for all handicapped Children Act of 1975 capped students between the ages of 3 and 21. Provides (EHA) for Individualized Education Programs (IEPs), due process, protection in evaluation procedures, and education in the least-restrictive environment.

1986 Education for All Handi- PL 99-457 Extends protections of the EHA to infants and toddlers capped Children Act (birth to age 3) through the establishment of a formula Part H) grant program. An important component of early intervention is the comprehensive Individualized Family Service Plan (IFSP).

1990 Americans with Disabilities PL 101-336 A civil rights law to prohibit discrimination solely on Act (ADA) the basis of disability by mandating reasonable accommodations across all public and private settings, including private and public schools.

1990 Individuals with Disabilities PL 101-476 (Includes birth through 21). Expands the discretionary Education Act of 1990 programs, includes the additional categories of autism (IDEA) and traumatic brain injured as separate disability categories. Adds the statutory definitions of assistive technology device and service. Expands transition requirements.

1993 Goals 2000: Educate America PL 103-85 Describes inclusion of children with disabilities in Act of 1993 school reform effort. Develops eight National Education Goals. Ensures that students with disabilities are educated to the maximum extent possible.

1994 Improving America’s Schools PL 103-382 Provides for professional development and lists Act (IASA) competencies for all persons providing services, including related services and special education.

1997 Individuals with Disabilities PL 105-17 Encourages participation of students with disabilities Education Act Amendments in the general education curriculum and state- and of 1997 district-wide assessments. Encourages parental involvement in the IEP team placement decisions. Assures that communication and assistive technology needs of students are considered. Encourages use of voluntary mediation rather than attorneys and no cessation of services for disciplinary reasons if related Source: U.S. Congress to student’s disability. Guidelines • Roles and Responsibilities of the School-Based Speech-Language Pathologist 1999 / III - 255

As can be seen in Table 2, legislative changes have limited-English-proficient population is the fastest influenced many aspects of speech-language pro- growing population in America [Section 601 (7A-F)]. grams. Before the Education for All Handicapped The move toward pluralism—in which numerous dis- Children Act of 1975 (EHA) and its focus on provid- tinct ethnic, religious, or cultural groups co-exist—has ing services in the least-restrictive environment, “one produced students who are culturally and linguisti- million of the children with disabilities were excluded cally more diverse. Hence, speech-language patholo- entirely from the public school system and did not go gists need to address such professional issues as through the educational process with their peers” [Sec- nonbiased assessment and eligibility and intervention tion 601c (2C)]. Others with disabilities were in the considerations related to a diverse population. public schools, but their disabilities were undetected; The nature and complexity of disorders have in- this prevented them from having a successful educa- tensified. Speech-language pathologists within general tional experience. With the lack of adequate services education settings provide services for more students within the school system, families had to find services who are medically fragile and/or multihandicapped. outside the public school system, often far from home The emphasis on least-restrictive environment only and at their own expense [Section 601c (2D-E)]. EHA partially explains the increase. Medical advancements assured free, appropriate public education for all stu- are saving more lives, yet many who survive are physi- dents. It also increased accountability and documen- cally or medically challenged. Additionally, with tation, which consequently has directly affected health care reform, many students are released earlier school-based speech-language pathologists. from hospitals or rehabilitation centers and enter public Other legislation followed. With the enactment of schools requiring intensive speech-language services. EHA-Part H in 1986, services were expanded to include Such other societal influences as an aging population infants and toddlers and more categories of disabili- and squeezed budgets have often translated to fiscal ties. IDEA, in 1990, further broadened the range of the cutbacks to K–12 and postsecondary education pro- profession with the addition of more discretionary grams (ASHA, 1997h). These fiscal constraints have programs. In 1993, Goals 2000: Educate America Act made it more challenging to provide effective service. established eight national education goals (see Appen- Professional Influences dix C) and reinforced the notion that school reform legislation was relevant to speech-language pathology School-based speech-language pathologists pos- services (see Appendix D and ASHA, 1994i). sess a high degree of clinical competence by virtue of their professional study and experience. The field of Goals 2000, Improving America’s Schools Act speech-language pathology has developed a widened (IASA), and recent IDEA amendments all underscore scope of practice. Research and efficacy studies have the importance of postsecondary initial preparation been conducted and published to help determine best and continuing professional development to ensure a practices relating to speech-language pathology in all high quality of education for students with disabili- settings and within schools in particular. Advanced ties. And most recently, the IDEA amendments of 1997 technology has increased the scope and capabilities require that the IEP include information regarding the of speech-language pathologists. impact of the student’s disability in terms of the general education curriculum. Personnel shortages and changes in state licen- sure or department of education certification have af- In addition to federal legislative mandates, speech- fected the roles and responsibilities of school-based language pathologists must also be familiar with and speech-language pathologists in many states. The roles follow existing state regulations and guidelines and of the speech-language pathologist may vary depend- local policies and procedures in carrying out their roles ing upon the composition or severity of the caseload, and responsibilities. state or district mandates, and staffing needs. Societal Influences Current Model External factors other than legislative changes have influenced the roles of the school-based speech- Although the mission of the school-based language pathologist. America’s racial and ethnic pro- speech-language pathologist—to improve the com- file is rapidly changing, with an attendant shift in munication abilities of students—has remained con- student demographics. By the turn of the millennium, stant, the manner in which the school-based nearly one of every three Americans will be African speech-language pathologist addresses prevention, American, Hispanic, Asian American or American assessment, evaluation, eligibility determination, Indian. As a group, minorities constitute an ever-larger caseload management, and intervention has changed percentage of public school students. In addition, the and will continue to evolve. III - 256 / 1999 ASHA 2002 Desk Reference Volume 3 • Speech-Language Pathology

Today’s school-based speech-language patholo- conference time is needed during the school week to gists serve students who have complex communica- serve the student, educators, and parents appropri- tion disorders, many of which require intensive, ately.7 (See Caseload Management.) long-term interventions. Many school speech and lan- Currently, the school-based speech-language pa- guage caseloads consist of students with a wide range thologist is expected to fulfill a variety of roles (see of disabilities and diverse education needs. According Table 3 in Section II). The roles and responsibilities will to the Twentieth Annual Report to Congress on the Imple- vary in accordance with the work setting (e.g., home, mentation of IDEA, students with speech or language community, preschool, elementary or secondary impairments are the second largest category of stu- school), with the types of communication impairments dents served (20.2%) after specific learning disabilities and disorders exhibited by children in these settings, (51.2%) (U.S. Department of Education, 1998). Speech- and with the speech-language pathologist’s experi- language pathologists also provide services to stu- ence, knowledge, skills, and proficiency. The level of dents with related disability categories—including experience, knowledge, skills, and proficiency may be mental retardation; emotional disturbance; multiple expanded through additional training, such as disabilities; hearing, orthopedic, visual, or other health mentoring, teaming, peer coaching, co-teaching, or impairments; autism; deaf-blindness; and traumatic through continuing education (CE) opportunities brain injury. (workshops, seminars, institutes, and course work). Several education reform initiatives have influ- School-based speech-language pathologists enced and shaped the policies that we have today. The keep current with best practices in assessment and regular education initiative (REI) proposed that as intervention. When providing services for students many children as possible be served in the regular with impairments, disabilities, and/or handicaps, classroom by “encouraging a partnership with regu- speech-language pathologists work with students lar education” (Will, 1986, p. 20). Full-inclusion advo- with speech, language, hearing, and swallowing or cates went a step further and supported complete related impairments; promote the development and inclusion of students with special needs in the regu- improvement of functional communication skills for lar education classroom. Legislative mandates and students with communication and swallowing dis- general changes in philosophy have dictated that abilities; and provide support in the general educa- special education be provided in the least restrictive tional environment for students with communication environment (LRE). Careful consideration of LRE and handicaps to facilitate their successful participation, meaningful curriculum modifications based on the socialization, and learning. School-based speech-lan- students’ needs have led to expanded service-delivery guage pathologists’ roles and responsibilities have models. Now, in addition to taking students out of the evolved. They now include preparing students for aca- classroom for services, the speech-language patholo- demic success and the communication demands of the gist has an array of direct and indirect service-deliv- work force in the 21st century as well as alleviating ery options available to help students with handicapping conditions of speech and language dis- communication disorders (see Table 6). To integrate orders (ASHA, 1994i). speech and language goals with educational (academic, social/emotional, or vocational) objectives, di- In the future, research and outcomes data most rect intervention may take place in a variety of settings, certainly will alter assessment and intervention including the general education or special education techniques, influence models and theories of practice, classroom, the speech-language treatment room, the and further expand ASHA’s Scope of Practice (1996c) resource room, the home, or community facility (ASHA, and Preferred Practice Patterns for the Profession 1996b). Indirect service is also provided for profes- (1997e). sional staff, parents, and families.6 Contemporary speech-language pathologists not only provide assessment and intervention for students identified as having communication disorders, they 6According to the results of the ASHA Schools Survey, 80% also may recommend environmental modifications or of the speech-language pathologist’s time is spent in strategies for communication behaviors of children providing direct intervention and diagnostics. The re- who have not been identified as being eligible for spe- maining 20% is spent on such activities as meetings, cial education or related services (see Prevention). paperwork, training, and travel between schools (ASHA, 1995c). With the expanding consulting role, it is essential 7ASHA’s recommended maximum caseload size is 40 stu- for school-based speech-language pathologists to have dents regardless of the type or number of service deliv- a manageable caseload size. Adequate planning and ery models selected (ASHA, 1993b). Guidelines • Roles and Responsibilities of the School-Based Speech-Language Pathologist 1999 / III - 257

II. Roles and Responsibilities ing, and social relationships (ASHA, 1994i; Cazden, 1988; Nelson, 1989). This section describes specific roles and responsibilities of school-based speech-language patholo- Although intervention for students with commu- gists. Table 3 on the following page provides an outline nication disorders is still the primary role, this empha- of the various core roles and related responsibilities sis on prevention suggests an expanding role for the discussed in this section. Note that specific responsi- school-based speech-language pathologist that goes bilities may be shared by other members of teams8 beyond identification and intervention for children working together to meet the education and commu- with speech and language disorders (ASHA, 1991c; nication needs of students with disabilities and their Butler, 1996; Connecticut State Department of Educa- families. (Additional roles and opportunities are dis- tion, 1993; Kavanaugh, 1991). Prevention requires in- cussed in Section III). creased efforts to avoid or minimize the onset or development of communication disorders and their Prevention causes (ASHA, 1997d, 1997e). The causes are often The concept of prevention has broadened in scope characterized as biological, environmental, or multi- in speech-language pathology in the last 20 years. Pre- factorial. In the latter case, the environment interacts vention now includes more than speech improvement with genetic predisposition. This terminology and and language stimulation; it encompasses providing primary, secondary, and tertiary prevention are de- information on general health maintenance, environ- fined in ASHA’s Prevention of Communication Dis- mental hazards, and prenatal factors, in addition to orders Tutorial (1991c) and discussed below. early identification and intervention. Primary Prevention: The elimination or inhibition of The school-based speech-language pathologist the onset and development of a communication disorder by has an important role to play on the education team in altering susceptibility or reducing exposure for susceptible addressing prevention of communication disorders. persons. For the school-based provider, this may include con- The emphasis of primary prevention is on elimi- sultation regarding the acquisition of proficient lan- nating or reducing biological and environmental risk guage and communication skills by students in factors through disseminating prevention information general education preschool and early intervention to parents, families, education personnel, health care classrooms. The school-based speech-language and social service professionals, organizations, and pathologist’s active involvement in general education policy-making groups. Students who do not qualify for support will promote increased awareness that com- services under IDEA may benefit from the services of munication skills are the basis of most teaching, learn- the school-based speech-language pathologist who provides primary prevention services. Primary prevention activities may range from in- 8 IDEA encourages team evaluations and decision making. dividual conferences to school-wide presentations or School-based teams may be multidisciplinary, interdis- community in-services. They may include educating ciplinary, or transdisciplinary in philosophy, depending and collaborating with parents, families, educators, upon the setting, members, and the purpose of the team. Krumm, Aussant, Barcomb, Low, Lunday, and administrators, and the community regarding: Schmiedge (1997) define each of these types of teams as • classroom strategies that will enhance commu- follows: nication for all students Multidisciplinary: One person heads the team, but each • injury/accident prevention (e.g., wearing seat member communicates regarding his or her own disci- belts or bicycle helmets) pline. Knowledge of skills of other professions is minimal, and team members assume that the other • fluency-enhancing strategies professionals know the right thing to do. Evaluation • prevention of vocal abuse overlap is minimal. • students’ lifestyle choices affecting their com- Interdisciplinary: Team members communicate freely munication skills and that of their offspring across disciplines. Team members have substantial knowledge of other team areas regarding testing and Secondary Prevention: Early detection and treatment test results. Some redundancy of testing occurs. of communication disorders. Early detection and treatment Transdisciplinary: Several professionals support and con- may lead to elimination of the disorder or retardation of the sult with one implementor. Team is holistic and expands disorder’s progress, thereby preventing further complica- focus to parents and community. (This model is consis- tions. tent with early intervention program philosophy.) For consistency, “interdisciplinary” will be used through- Tertiary Prevention: Reduction of a disability by at- out this document. tempting to restore effective functioning. The major ap- III - 258 / 1999 ASHA 2002 Desk Reference Volume 3 • Speech-Language Pathology

Table 3. Core Roles and Responsibilities of School-Based Speech-Language Pathologists

Core Roles Responsibilities

Intervention Assistance Team / Child Study Team

PREVENTION In-Service Training Consultation

IDENTIFICATION Prereferral Interventions Screening: Hearing, Speech, and Language Referral and Consent for Evaluation

Interdisciplinary Team

ASSESSMENT Assessment Plan (Data Collection) Assessment Methods Student History Nonstandardized Assessment Standardized Assessment

EVALUATION Strengths/Needs/Emerging Abilities (Interpretation) Disorder/Delay/Difference Severity Rating Educational Relevance: Academic, Social-Emotional, and Vocational Factors Evaluation Results and Team Recommendations Specific Evaluation Considerations Age Attention Central Auditory Processing Cognitive Factors Cultural and/or Linguistic Diversity/Limited English Proficiency Hearing Loss and Deafness Neurologic, Orthopedic, and Other Health Factors Social-Emotional Factors

IEP Team

ELIGIBILITY Federal Mandates, State Regulations/Guidelines, and Local Policies/Procedures DETERMINATION Presence of Disorder Educational Relevance Other Factors

IEP/IFSP Federal Mandates, State Regulations/Guidelines, and Local Policies/Procedures DEVELOPMENT IEP Team, Factors, Components, Caseload Size

CASELOAD Coordination of Program MANAGEMENT Service-Delivery Options Scheduling Students for Intervention Caseload Size Guidelines • Roles and Responsibilities of the School-Based Speech-Language Pathologist 1999 / III - 259

Core Roles Responsibilities

Education Teams

INTERVENTION For Communication Disorders General Intervention Methods Scope of Intervention Communication Language Speech: Articulation/Phonology, Fluency, Voice/Resonance Swallowing

INTERVENTION For Communication Variations Cultural and/or Linguistic Diversity Limited English Proficiency Students Requiring Technology Support

COUNSELING Goal Setting and Purpose Referral

IEP Team

RE-EVALUATION Triennial Annual Ongoing

TRANSITION Between Levels (Birth to 3, Preschool, Elementary, Secondary) Secondary to Postsecondary Education or Employment More-Restrictive to Less-Restrictive Settings

DISMISSAL Federal Mandates, State Regulations/Guidelines, and Local Policies/Procedures Presence of Disorder Educational Relevance Other Factors

Speech-Language Pathologist

SUPERVISION Clinical Fellows Support Personnel University Practicum Students Volunteers

DOCUMENTATION Federal Mandates, State Regulations/Guidelines, and Local Policies/Procedures AND Progress Reports ACCOUNTABILITY Third-Party Documentation Treatment Outcome Measures Performance Appraisal Risk Management III - 260 / 1999 ASHA 2002 Desk Reference Volume 3 • Speech-Language Pathology proach is rehabilitation of the disabled individual who has A core prereferral team may consist of any combi- realized some residual problems as a result of the disorder. nation of the following: an administrator; the student’s Early screening, assessment, and treatment of an teacher; one or more other regular education teachers; impairment—traditionally considered special educa- a curriculum specialist; and student or pupil service tion or related services—may actually prevent further personnel, as appropriate, such as the school psy- disability or handicapping conditions. Such second- chologist, social worker, counselor, or nurse. Parents/ ary and tertiary prevention activities are included in families may also participate on prereferral teams. The the following sections on Identification, Assessment, composition of a prereferral team varies considerably and Intervention. among districts and states. Some teams are limited to general education staff; others include special educa- Identification tion and related service staff. One or more special edu- A core role of the speech-language pathologist is cation or related service providers may be added as to participate as a member of a team in identifying stu- necessary for specific student concerns. The speech- dents who may be in need of assessments to determine language pathologist may consult regarding perceived possible eligibility for special education or related ser- communication needs of students who may benefit vices. These assessments assist in determining the from classroom accommodations or special education presence of disabilities and eligibility/ineligibility for services. During the prereferral phase, it may be the special education and related services under IDEA. It responsibility of the speech-language pathologist, as is necessary for the speech-language pathologist to a team participant, to provide one or more of the fol- examine the identification and assessment/evaluation lowing services as appropriate for specific students: process through the prism of legal and ethical codes, • review pertinent school records policies, procedures, and guidelines specific to the • collect and review data to substantiate the out- state or local education agency. comes of attempted classroom modifications The basic phases of the identification process are and interventions prereferral, screening, and referral when indicated. • observe the student in the classroom Prereferral • collaborate with parents, teachers, and other Although not always required, the prereferral pro- professionals to provide strategies, resources, cess is a recommended option in many districts as a and additional recommendations for teacher first step in deciding whether a student is in need of interventions in the classrooms referral for a special education and related services • demonstrate intervention strategies, proce- evaluation or simply needs assistance or modification dures, and techniques within the general education environment. Many • provide follow-up consultation or participate schools establish educational problem-solving teams, in processing a formal referral for assessment often referred to as a Child Study Team, Intervention • gather additional data Assistance Team, or Student Success Team. These teams are defined as school-based problem-solving Screening groups whose purpose is to assist teachers with inter- Screening is the process of identifying candi- vention strategies for addressing the learning needs dates for formal evaluation. Any procedure that and interests of students before a formal referral for an separates those students in need of further evaluation evaluation (Ohio Department of Education, 1991). This from those not needing evaluation fulfills the pur- process is consistent with IDEA. The emphasis is on pose of screening. Screening may be accomplished classroom modifications and supports that, when suc- by using published or informal screening measures cessful, actually prevent the need for special education administered by the speech-language pathologist. In intervention. Team members collaborate to determine some states, trained support personnel may conduct if accommodations or modifications have been success- screening under the direction of the speech-language ful. An effective method is using dynamic assessment pathologist, who then interprets the measures. Non- to gauge a student’s potential to learn independently standardized checklists, questionnaires, interviews, or when given a mediated learning experience (see the observations interpreted by the speech-language pa- Assessment Methods and Intervention sections). Some thologist may also be considered screening measures. schools have more than one team. The first-level team Individual or mass speech/language screenings may is responsible for the prereferral process and documen- be mandatory in some regions and optional in others. tation of general education intervention implemented If and when it is the responsibility of the school-based in the classroom; a second-level team is responsible for speech-language pathologist to conduct the screen- the assessment and identification process, when rec- ings, the speech-language pathologist: ommended. Guidelines • Roles and Responsibilities of the School-Based Speech-Language Pathologist 1999 / III - 261

• selects screening measures meeting standards Within this document, a distinction is made between for technical adequacy the role of assessment and the role of evaluation. As- • administers and/or interprets a speech/lan- sessment “refers to data collection and the gathering of guage screening evidence”; evaluation “implies bringing meaning to that data through interpretation, analysis and reflec- • administers and/or interprets a hearing screen- tion” (Routman, 1994, p. 302). ing in accordance with state and local policy, procedures and staffing patterns (ASHA, 1997e) A responsibility of the school-based speech- language pathologist is to select assessment measures Referral that: When accommodations and interventions have • are free of cultural and linguistic bias been attempted but have not been successful, a referral for assessment may be initiated by any individual, • are appropriate for the student’s age including a parent, teacher, or other service provider. • match the stated purpose of the assessment tool The referral is a request for assessment of a student to the reported needs of the student with suspected special education needs. The assess- • describe differences when compared to peers ment focuses on all areas related to a suspected dis- • describe the student’s specific communication ability that may result in eligibility for special abilities and difficulties education and/or related services. The written referral includes a brief description of any previously at- • elicit optimal evidence of the student’s commu- tempted supplementary aids and services, program nication competence modifications and supports to the general education • describe real communication tasks (see Appen- environment, a statement regarding the effectiveness dix E) of those modifications, and a rationale for the assess- Assessment Plan ment. A comprehensive assessment plan is developed If a speech-language pathologist is a member or within local or state mandated time lines. It documents case manager of a team, in accordance with local poli- the areas of speech and language to be assessed, the cies, it may be the responsibility of the speech-language reason for the assessment, and the personnel conduct- pathologist to: ing the assessment. If an initial screening was com- • review referrals pleted, the results are used to identify the specific areas • participate in the development of the assessment of speech and language to be addressed. The student’s plan dominant language and level of language proficiency are specified in the assessment plan. Parents may par- • obtain the results of current hearing/vision ticipate in the development of the assessment plan. The screenings and monitor follow-up when appro- written assessment plan is provided to parents in their priate dominant language or native language, whenever • initiate referrals for additional assessment to possible, as per IDEA [Section 612(a)(6)(B)]. (See spe- other service providers cific evaluation considerations below.) • serve as liaison to appropriate nonpublic Assessment Methods school agencies and/or providers The foundation of a quality individualized assess- • communicate with general education class- ment is to establish a complete student history. That room teacher(s) and parent(s) regarding the information will direct subsequent assessment selec- status of the referral tion. The assessment data should reflect multiple per- • schedule referral meetings spectives. No single assessment measure can • obtain written parent/guardian consent for provide sufficient data to create an accurate and com- evaluation in accordance with federal man- prehensive communication profile (Haney, 1992; dates, state regulations and guidelines, and IDEA [Section 612(a)(6)(B)]). Conducting both local policy and procedures nonstandardized and standardized assessments en- • complete and distribute the paperwork to pro- ables the speech-language pathologist to view the stu- cess the referral dent in settings with and without contextual support. Combining standardized (norm-referenced) with Assessment nonstandardized (descriptive) assessment using A core role of the school-based speech-language multiple methods will assure the collection of data pathologist is to conduct a thorough and balanced that can furnish information about the student’s speech, language, or communication assessment. functional communication abilities and needs. Ex- III - 262 / 1999 ASHA 2002 Desk Reference Volume 3 • Speech-Language Pathology amples of descriptive assessment methods are check- Student history. The speech-language pathologist lists and developmental scales, curriculum-based collects relevant and accurate information through assessment, dynamic assessment data, and portfolios record review, observation, and parent, teacher, or stu- of authentic assessment data9 (e.g., student classroom dent interviews. Information regarding the student’s work samples, speech and language samples, and ob- medical and family history, communication develop- servations of the student in various natural contexts). ment, social-emotional development, academic A descriptive assessment allows focus on language achievement from previous education placements, during actual communication activities within natu- language dominance, community/family language ral contexts. codes and social-behavioral functioning are especially During assessment data collection, it is the respon- valuable when completing a student case history. sibility of the speech-language pathologist to gather Checklists and developmental scales. These tools information, select appropriate assessment methods, are used to obtain a large amount of information in an and conduct a balanced assessment. organized or categorized form to note the presence or This balanced assessment may include: absence of specific communication behavior. They may be completed either by the speech-language patholo- • gathering information from parent(s), family, gist or by others for the speech-language pathologist. student, teachers, other service-provider professionals and paraprofessionals Curriculum-based assessment. Curriculum-based assessment (CBA) refers to the “use of curriculum con- • compiling a student history from interviews texts and content for measuring a student’s language and thorough record review intervention needs and progress” (Nelson, 1998). • collecting student-centered, contextualized, Nelson suggests that CBA may extend the assessment performance-based, descriptive, and functional beyond the identification of a student as communica- information tion-impaired by including activities/skills that may • selecting and administering reliable and valid assess the acquisition of effective oral and written com- standardized assessment instruments that munication abilities. meet psychometric standards for test specific- An example of a curriculum-based measure that ity and sensitivity may be used by the speech-language pathologist is an Examples of each follow. information reading inventory that could be analyzed Parent/staff/student interviews. Parents are an collaboratively by the speech-language pathologist essential source of information—especially for stu- and the classroom teacher. dents who are very young or who have severe disabili- Dynamic assessment. Dynamic assessment is de- ties. Parents provide insight regarding communication fined as a “term used to identify a number of distinct skills in various settings outside the school and pro- approaches that are characterized by guided learning vide additional information about functional and de- for the purpose of determining a learner’s potential for velopmental communication levels. change” (Palincsar, Brown, & Campione, 1994). Dy- Classroom teachers, instructional assistants, and namic assessment is concerned with how well a stu- other school professionals are a primary source of in- dent can perform after being given assistance. The formation regarding a student’s functional communi- response the student makes to assistance helps to de- cation skills among peers within the classroom and termine future effective instruction (see Intervention). school environment. They also provide specific infor- Portfolio assessment. Portfolio assessment can be mation regarding listening, speaking, reading, writing, defined as a collection of such products as student spelling/invented spelling, and the relationship be- work samples, language samples, dictations, writing tween the student’s communication skills and the cur- samples, journal entries, and video/audio recordings riculum. Various teacher/staff checklists provide and transcriptions. A portfolio approach requires de- information specific to disability areas or communica- cisions regarding: tion functions. • what samples are included Student interviews are appropriate in many cases, • how many samples are included depending on the student’s age or cognitive level. The • student reflections on his or her work over time speech-language pathologist may gain insight into personal attitudes of the student related to communi- • analysis of the underlying processes repre- cation difficulties and motivation to change. sented by the samples as either learned or not learned

9Authentic refers to real-life activities and situations. Guidelines • Roles and Responsibilities of the School-Based Speech-Language Pathologist 1999 / III - 263

Observation/anecdotal records. The observation • identify strengths, needs, and emerging abili- of real-life communication behavior and the applica- ties tion of the resulting data describe language develop- • establish the presence of a disorder, delay, ment and function in a variety of natural contexts. or difference—including determining the The speech-language pathologist can also use the an- student’s communication abilities within the ecdotal records and observations conducted by other context of home and/or community individuals to complete various checklists, surveys, • determine a severity rating (when required by and developmental scales. state regulations and guidelines or local policy Standardized assessment information. When ap- and procedures) propriately selected for validity and reliability, stan- • define the relationship between the student’s dardized tests yield important information regarding level of speech, language, and communication language and speech abilities and are part of the abilities and any adverse effect on educational comprehensive assessment. They are norm-referenced performance and used to compare a specific student’s performance with that of peers. Statistical scores are valid • determine if the communication disability is only for students who match the norming population affected by additional factors influencing the described in the test manual. results of the communication assessment Although all areas of speech, language, and • summarize evaluation results and make recom- communication are interrelated, broad spectrum, mendations norm-referenced tests may be used to measure such The speech-language pathologist’s responsibili- skills of language comprehension and production as ties in specific areas are described below: syntax, semantics, morphology, phonology, pragmat- Communication Strengths and Needs ics, discourse organization, and following directions. Additional tests may be administered to assess such A careful analysis of the assessment data reveals specific areas as auditory abilities and auditory pro- the student’s strengths, needs, and emerging abilities. cessing of language. Tests are used to assess articula- These may include differences between receptive and tion, phonology, fluency, and voice/resonance; and expressive oral and written language skills. Analysis instrumental and noninstrumental protocols are used may also reveal differences in the components of lan- to assess swallowing function. guage form (phonologic, morphologic, and syntactic systems), content (semantic system), or function/use of The assessment data are compiled, records are language in communication (pragmatic system). reviewed, and observations and interviews are noted. Strengths, needs, and emerging abilities are also The best means to valid, nonbiased testing may be a identified within specific speech areas including ar- speech-language pathologist with a solid knowledge ticulation/phonology, fluency, and voice or resonance. base in speech and language development, delay, The student’s preferred communication modality is difference, and disorders who understands the value also considered. Identifying communication strengths and the inherent obstacles of standardized and and needs as prognostic indicators assists in deter- nonstandardized assessments and who possesses mining the probable potential for remediation and cre- the skills to analyze data generated through all ates a direct link from assessment to planning and assessment methods. conducting intervention. These strengths and needs are Evaluation considered within the broader context of classroom, Once the comprehensive assessment has been home, and community. completed, the results are interpreted. It is the inter- Disorder, Delay, or Difference pretation that gives value to the assessment data, Research on the sequence and process of normal hence the term evaluation (Routman, 1994). Consider- language and speech development provides the frame- ation is given to the nature and severity of a student’s work for determining whether the student exhibits a disorder and its effect on academic and social perfor- communication disorder, delay, or difference (see Ap- mance. Clinical judgment is used when evaluating pendix F, Developmental Milestones). Although the assessment information. Informed decisions are made distinction among disorder, delay, and difference is about eligibility and subsequent intervention strate- not always easily determined, the following ASHA gies. definitions are provided to clarify the terms. It is the responsibility of the speech-language A communication disorder is an impairment in the pathologist, as part of a team, to assist in interpreting ability to send, receive, process, and comprehend ver- data that will: III - 264 / 1999 ASHA 2002 Desk Reference Volume 3 • Speech-Language Pathology bal, nonverbal, and graphic symbol systems. A com- A speech, language, or hearing disorder may se- munication disorder may be evident in the process of verely limit a student’s potential vocational or career hearing, language, or speech; may be developmental choices regardless of the student’s other competencies. or acquired; and may range in severity from mild to (See Appendix H for examples of signs and effects of profound. A communication disorder may result in a communication disorders and Appendix I for an ex- primary disability or may be secondary to other abili- ample of a chart to document educational relevance.) ties (ASHA, 1993a, p. 40). Evaluate Results and Make Recommendations A communication delay exists when the rate of Many factors affect a child’s learning. Some of acquisition of language or speech skills is slower than these include quality of instruction; emotional status; expected according to developmental norms; however, home environment/support; family attitudes toward the sequence of development is following a predicted school services; composition of the classroom; charac- order (Nicolosi, 1989). For eligibility purposes, deter- teristics of the teacher; educational history; and the mination of the level of delay that is considered sig- student’s planning, attention, and simultaneous and nificant is specified in state regulations and guidelines sequential processing abilities. The student’s commu- or local policies and procedures. nication competence is evaluated in the context of the A communication difference is a “variation of a student’s history and educational environment. All symbol system used by a group of individuals that aspects of the assessment and evaluation are docu- reflects and is determined by shared regional, social, mented within the evaluation report. The speech and or cultural/ethnic factors. A regional, social, cultural, language information may be written in a self- or ethnic variation of a symbol system is not consid- contained communication report or may be included ered a disorder of speech or language” (ASHA, 1993a, in a unified team report. The report interprets, sum- p. 41). marizes, and integrates all relevant information that Severity Rating has been gathered, and describes the student’s present level of functioning in all speech, language, and hear- A severity rating scale provides a consistent ing areas and the relationship to academic, social- method of describing overall communication function- emotional, and/or vocational performance. ing. Many states have developed and published severity rating scales to help substantiate eligibility or The evaluation report serves as the basis for the dismissal criteria. Some states use the determined se- team’s discussion of alternatives and recommenda- verity rating as a “best practice” guide to assist in de- tions. It includes the following information: termining a recommended amount of intervention per • student history information from record review week. An example of a matrix based on severity was and parent, teacher, and/or student interview developed by the Illinois State Board of Education (see • date(s) of assessment(s) Appendix G). Obviously, the needs of the student and • relevant behaviors noted during observation clinical judgment affect the amount of service that the student receives. Consult state regulations and guide- • assessment information from all disciplines lines or local policies and procedures for severity rat- • observation/impressions in a variety of com- ing information. munication settings Educational Relevance • results of previous interventions Education takes place through the process of com- • descriptive assessment results munication. The ability to participate in active and • standardized assessment results and docu- interactive communication with peers and adults in mentation of any variations from standard the educational setting is essential for a student to administration access education (Michigan Speech-Language-Hear- • discussion of student’s strengths, needs, and ing Association, 1995). In order for a communication emerging abilities disorder to be considered a disability within a school- • disorder/delay/difference determination, in- based setting, it must exert an adverse effect on educa- cluding the student’s communication abilities tional performance. The speech-language pathologist within the context of home and community and team determine what effect the disorder has on the student’s ability to participate in the educational pro- • severity rating (when applicable) cess. The educational process includes preacademic/ • educational relevance, including academic, academic, social-emotional, and vocational perfor- social-emotional, and vocational areas mance. • interpretation/integration of all assessment data Guidelines • Roles and Responsibilities of the School-Based Speech-Language Pathologist 1999 / III - 265

• evaluation results and recommendations for 1993; Nelson, 1998; Work, Cline, Ehren, Keiser, & strategies, accommodations, and modifications Wujeck, 1993). Specific Evaluation Considerations Attention When interpreting the assessment data, consider- Attentional behaviors and activity levels differ ation is given to the effect of specific factors influenc- across ages, genders, and cultural background (ASHA, ing the results of the communication evaluation. 1997e). The student’s ability to focus and attend dur- Numerous relevant factors follow in alphabetical or- ing the assessment is considered when evaluating the der. results of the assessment. The effectiveness of modifications used during an assessment are documented. Age Information about the type and extent of variation from Chronological age and developmental level are standard test conditions is included in the evaluation considered during assessment and evaluation. School- report. This information is used by the team to evalu- based speech-language pathologists assess individu- ate the effects of variances on validity and reliability als from birth through age 21. The validity of of the reported information. standardized tests varies among instruments and Speech-language pathologists and audiologists across age levels. Careful observation and use of are increasingly involved with students with attention nonstandardized procedures assure a balanced as- deficit hyperactivity disorders (ADHD). These profes- sessment whether the assessment is conducted with sionals are often among the first to assist in the evalu- infants and toddlers, preschool and/or elementary ation of students and youth suspected of having ADHD school children, or secondary school adolescents. because of its co-occurrence with language learning Dynamic and authentic assessment data for all age disabilities and central auditory processing disorders levels provide information on the student’s functional (ASHA, 1997f). abilities or needs and potential to learn. Attention deficit hyperactivity disorder is a Speech-language pathologists involved in infant/ syndrome characterized by serious and persistent toddler and preschool assessment should have an difficulties in terms of inattention and hyperactivity- understanding of the health issues and effects of hos- impulsivity. According to the Diagnostic and Statistical pital stay on the child and the family, have access to a Manual (DSM-IV) of the American Psychiatric Associa- complete medical history, communicate with medical tion (1994), to confirm a diagnosis of ADHD, at least personnel, and should interview an affected child’s six characteristics within either category “must have family as part of a family-based assessment so that a persisted for 6 months to a degree that is maladaptive detailed developmental history can be obtained. and inconsistent with developmental level” (p. 84).10 School-based speech-language pathologists charged with responsibility for early identification and pre- An inattentive student may not exhibit hyperac- school students need to be sensitive to the wide varia- tive or impulsive characteristics and, therefore, may be tion in family systems and interactive styles overlooked in the classroom. That student may be at surrounding successful communication and language higher risk for educational failure than the student development, as well as have knowledge of all aspects with hyperactive and/or impulsive tendencies be- of “normal” development. With respect to assessment cause the student’s needs are not apparent. and evaluation, speech-language pathologists assume Some professionals assert that hyperactive/impul- the ongoing monitoring of a child’s communication, sivity behaviors may not be due to inattention but language, speech, and oral-motor development. Be- caused instead by poor inhibition or poor self-regula- cause young children change rapidly and families re- tion (Barkley, 1990; Westby, 1994). This may be related spond differently to their children at various periods to executive function, which is discussed further in in development, speech-language pathologists devise ASHA’s technical report on ADHD (1997f). systematic plans for periodic evaluation of progress A diagnosis of ADHD is made by medical profes- (ASHA, 1989b). sionals only after ruling out other factors related to Comprehensive evaluation of school-age children medical, emotional, or environmental variables that and adolescents includes assessment of the under- could cause similar symptoms. Therefore, physicians, standing and use of both oral and written language, psychologists, educators and speech-language pa- including pragmatic abilities (Damico, 1993; Nippold,

1993). Intervention strategies reflect the student’s 10 changing developmental stages and language needs/ The previous edition, DSM-III, made a distinction between undifferentiated attention deficit disorder (ADD) proficiencies throughout elementary and secondary and ADHD. DSM-IV uses ADHD with the two subcat- educational programs (Larson, McKinley, & Boley, egories noted above. III - 266 / 1999 ASHA 2002 Desk Reference Volume 3 • Speech-Language Pathology thologists conduct a comprehensive evaluation, which Cognitive-based impairments of communication are includes medical studies, psychological and educa- referred to as cognitive-communication impairments tional testing, speech-language assessment, neurologi- and are disorders that result from deficits in linguistic cal evaluation, and behavioral evaluations compiled and nonlinguistic cognitive processes. They may be by both the parent and teacher(s). The student’s per- associated with a variety of congenital and acquired formance should be assessed across multiple domains conditions (ASHA, 1988; 1991b). Speech-language in multiple settings by several persons. A differential pathologists are integral members of interdisciplinary diagnosis is difficult because of the complex interac- teams engaged in the identification, diagnosis, and tion existing between ADHD and cognitive, treatment of persons with cognitive-communication metacognitive, linguistic, social-emotional, and impairments (ASHA, 1987). sensori-integrative abilities. The role of the school speech-language patholo- Central Auditory Processing gist in evaluating the communication needs of stu- A central auditory processing disorder (CAPD) is dents with cognitive-communication impairments an observed deficiency in sound localization and lat- is delineated in the Guidelines for Speech Language Pro- eralization, auditory discrimination, auditory pattern grams (Connecticut State Department of Education, recognition, temporal aspects of audition, use of audi- 1993, pp. 90–91). Examples include: tory skills with competing acoustic signals, and use • collaborating with families, teachers, and oth- of auditory skills with any degradation of the acous- ers in locating and identifying children whose tic signal (ASHA, 1995a). CAPD may affect language communication development and behavior learning and language use as well as cognitive lan- may suggest the presence of cognitive impair- guage processing areas (e.g., attention, memory, prob- ments or whose communication impairments lem solving, and literacy). According to Chermak, “The accompany identified cognitive impairments behavioral profiles of students with CAPD, specific • collaborating with other professionals to inter- learning disabilities and ADHD often overlap, as pret the relationship between cognitive and might be expected given the complex interactions communication abilities among auditory processing, language skills, cognition, • assessing communication requirements and and learning” (1995, p. 208). CAPD may be evident in abilities in the environments in which the stu- combination with other disabilities, making differen- dent functions or will function (Cipani, 1989) tial diagnosis difficult. • assessing the need for assistive technology in The assessment of central auditory processing collaboration with audiologists including alter- disorders (CAPD) is a crossover area between the two native/augmentative communication systems professions of audiology and speech-language pathol- and amplification devices (Romski, Cevcik, & ogy and requires a cooperative effort among parents, Joyner, 1984; Flexer, Millin, & Brown, 1990, teachers, speech-language pathologists, audiologists Baker-Hawkins & Easterbrooks, 1994). and other professionals for a successful outcome. Speech-language pathologists contribute to the assess- Cultural and/or Linguistic Diversity ment process by formally evaluating receptive lan- The demographics of our society are changing guage and phonemic processing skills and by rapidly and dramatically. The number of students documenting observed auditory processing behaviors. with cultural and/or linguistic diversity is increasing This information is used by the audiologist to augment in school systems across the nation, especially in large the formal central auditory processing assessment bat- cities. In some states, over 40% of residents come from tery (Keith, 1995). ASHA has established preferred prac- culturally and linguistically diverse backgrounds tice patterns in CAPD assessment and treatment for (California Speech-Language-Hearing Association, both professions (ASHA, 1997d, 1997e). The current 1996). It has been estimated that in the near future one- developments in CAPD are described in Central Audi- third of the U.S. population will consist of racial and tory Processing: Current Status of Research and Implica- ethnic minorities [IDEA Section 601(7)(A-D)]. The tions for Clinical Practice (ASHA, 1995a). American Speech-Language-Hearing Association’s Cognitive Factors position paper on social dialects (ASHA, 1983) emphasizes the role of the speech-language pathologist in Cognition and language are intrinsically and re- distinguishing between dialects or differences and ciprocally related in both development and function. disorders. Additionally, the Office of Multicultural An impairment of language may disrupt one or more Affairs has developed a related reading list on this cognitive processes; similarly, an impairment of one topic (ASHA, 1997a). or more cognitive processes may disrupt language. Guidelines • Roles and Responsibilities of the School-Based Speech-Language Pathologist 1999 / III - 267

Responsibilities relating to assessment of students ated with the basic communication fluency achieved with culturally and linguistically diverse backgrounds by all normal native speakers of a language (social include: language). Cognitive academic linguistic proficiency • reviewing the student’s personal history, in- (CALP), on the other hand, relates to aspects of lan- cluding cultural, linguistic, and family back- guage proficiency strongly associated with literacy and ground academic achievement (Cummins, 1981). • assisting instructional staff in differentiating Approximately 200 languages are spoken in the between communication disorders and cultur- United States (Aleman, Bruno, & Dale, 1995). Within ally or linguistically based communication dif- each group of students whose first language is other ferences than English, there is also a continuum of proficiency in English (ASHA, 1985a). In evaluating speakers of • determining difference/disorder distinctions of languages other than English, some of whom may be a dialect-speaking student and recommending accustomed to more than two languages, the con- intervention only for those features or charac- tinuum is particularly relevant. The continuum of teristics that are disordered and not attributable English language learners includes speakers who fall to the dialect within the following designations: Limited English Proficiency • bilingual English proficient (proficient in L-1 School-based speech-language pathologists play and L-2) an important role in determining appropriate identifi- • limited English proficient (proficient in L-1, but cation, assessment, and academic placement of stu- not L-2) dents with limited English proficiencies (Adler, 1991; ASHA, 1998f). Prereferral interventions using • limited in both English and the primary lan- Interventinon Assistance Teams are used to address guage (limited in L-1 and L-2) student, teacher, curriculum, and instruction issues A further caution regarding bilingual evaluation (Garcia & Ortiz, 1988). The differing mores, cultural is that if a test was not normed on bilingual or limited- patterns, and—particularly—the linguistic behaviors English-proficient students, then the test norms may of these students require input from their family mem- not be used for a bilingual or limited-English-proficient bers and a culturally sensitive and competent team of student (Langdon & Saenz, 1996). Responsibilities professionals, which may include bilingual speech- related to bilingual assessment may include: language pathologists, teachers, English as a second • serving as a member of the interdisciplinary language (ESL) staff, interpreters/translators, and/or prereferral team when there is concern about a assistants (Cheng, 1991; Langdon, Siegel, Halog, & limited-English-proficient student’s classroom Sanchez-Boyce, 1994; Leung, 1996). Many speech- performance language pathologists are trained to distinguish stu- • seeking collaborative assistance from bilingual dents who have a communication disorder in their first speech-language pathologists, qualified inter- (also called home or native) language (L-1) from stu- preters, ESL staff, and families to augment the dents who may be in the process of second language speech-language pathologist’s knowledge base (L-2) acquisition. The speech-language pathologist (ASHA, 1998f) who has not had such training must seek consultation with knowledgeable individuals. • teaming with a trained interpreter/translator to gather additional background information, In order to effectively distinguish difference from conduct the assessment, and report the results disorder in bilingual children, it is important for of assessment to the family (Langdon et al., speech-language pathologists to understand the first 1994) as well as the second language acquisition process and to be familiar with current information available on • compiling a history including immigration morphologic, semantic, syntactic, pragmatic, and pho- background and relevant personal life history nological development of children from a non- such as a separation from family, trauma or English language background. Assessment includes exposure to war, the length of time the student measuring both social language and academic lan- has been engaged in learning English, and the guage abilities. Proficiency in social language may type of instruction and informal learning op- develop within the first 2 years of exposure to English; portunities (Cheng, 1991; Fradd, 1995) it may take an additional 5 years for academic language • gathering information regarding continued proficiency to develop. Basic interpersonal communi- language development in the native language cation skills (BICS) are the aspects of language associ- and current use of first and second language III - 268 / 1999 ASHA 2002 Desk Reference Volume 3 • Speech-Language Pathology

• providing a nonbiased assessment of commu- Kretschmer, 1982). Even students with mild, fluctuat- nication function in both the first (native/home ing, or unilateral hearing loss often exhibit significant language) and second language of the student academic delays and grade failure (Bess et al., 1998; (Note: IDEA Section 612(a)(6)(B) requires as- Connecticut Advisory School Health Council, 1988; sessment in “the child’s native language or Davis, Elfenbein, Schum, & Bentler, 1986; Gallaudet mode of communication unless it clearly is not University Center for Assessment and Demographic feasible to do so.”) Study, 1998; Joint Committee on Infant Hearing, 1994; • evaluating both social and academic language Oyler, Oyler, & Matkin, 1988). proficiency The Agency for Health Care Policy and Research Hearing Loss and Deafness reports that the most common etiology of temporary and fluctuating hearing loss in children from birth to In the United States, more than 1.2 million children 3 years of age is otitis media, which can be acute or under 18 years of age have either a congenital or an chronic and may occur with or without effusion (U. S. acquired hearing loss (Adams & Marano, 1995). The Department of Health and Human Services, 1994). Not ultimate academic and social outcomes for these stu- all children who experience otitis media have signifi- dents depend on the coordinated efforts of many indi- cant hearing loss or develop subsequent communica- viduals, including but not limited to, the student, tion and learning problems. However, the prevalence parents, classroom teachers, the audiologist, and the of otitis media (especially chronic otitis media) during speech-language pathologist. A teacher of the deaf and what is known to be a significant period in the acqui- hard of hearing, a speech-language pathologist, or an sition of communication skills places children exhib- audiologist often serves as the coordinator of services iting this illness at risk for delay or disorder of speech and liaison for the parents and student to the school and oral language that may adversely affect educa- system. The heterogeneous population of children tional performance (Friel-Patti, 1990; Roberts, 1997; with hearing loss or deafness encompasses a broad Roberts & Medley, 1995). range of functional communication styles and abilities and types of services ranging from students in regular In cooperation with audiologists who serve chil- education classes requiring support services to stu- dren in educational settings, the responsibilities of the dents attending a school for the deaf. The relationship school speech-language pathologist in assessing the that exists between a child’s and family’s choice of communication needs of children with hearing loss communication systems and his/her ability to develop may include: a language or languages in one or more communica- • collaborating with audiologists and promoting tion modalities varies among children (ASHA, 1998c). early detection of children with hearing loss When a student has a hearing loss, the methods • conducting hearing screenings for identifica- chosen for development of language skills are related tion of children who can participate in condi- to such factors as: tioned play or traditional audiometry and • age of onset of the hearing impairment referral of individuals with possible ear disorder or hearing loss to audiologists for follow- • type/severity of hearing loss up audiologic assessment (ASHA, 1998b) • availability and use of residual hearing • collaborating with health professionals and • presence of additional disabilities audiologists to integrate case history and • access to assistive technology (computer- audiologic information into speech-language assisted real-time captioning, hearing aids, FM assessments systems) and interpreters/translators (sign, • identifying the communication demands of the ASL, cued speech) various settings in which the child functions • level of acceptance, skills, and support by fam- (Creaghead, 1992; Palmer, 1997) ily, educators, and peers • daily trouble shooting and hearing aid and • acoustic environment of the classroom and assistive listening device maintenance in the other spaces used for instruction and extracur- educational setting ricular activities • collaborating with audiologists regarding lan- Numerous reports and studies document the guage assessment of students with suspected effects of hearing loss on speech, language, social- central auditory processing disorders emotional, and academic development (Baker- • monitoring speech and language development Hawkins & Easterbrooks, 1994, Kretschmer & and related educational performance of stu- Kretschmer, 1978, Maxon & Brackett, 1987, Quigley & dents with known histories of chronic otitis Guidelines • Roles and Responsibilities of the School-Based Speech-Language Pathologist 1999 / III - 269

media and students with unilateral hearing • assessing the need for assistive technology to loss promote communication development and in- • collaborating with other professionals to evalu- teraction (Connecticut State Department of ate language performance levels and identify Education, 1993) communication disorders, if present Social-Emotional Factors • providing aural rehabilitation and sign lan- Communication is an important tool in creating guage development (if competent to do so) (Con- a secure and safe school environment that fosters necticut State Department of Education, 1993; learning for all students. Speech, language, and listen- English, 1997) ing skills provide the communication foundation Neurological, Orthopedic, and Other Health Factors for the development and enhancement of confidence and self-esteem in learners. Giddon (1991) emphasizes The neurophysiological systems underlying the need for expanding the role of the school-based speech and language development are particularly speech-language pathologist in mental health issues vulnerable to organic insults that may produce paraly- and behavioral management as part of the team, sis, weakness, or discoordination. Students with con- specifically to assist with communication issues and genital or acquired neurological, orthopedic, or certain insights. health impairments (e.g., TBI) frequently exhibit communication impairments in one or more of the areas of Responsibilities when assessing a student with language, articulation/phonology, fluency, voice, dysfunctional social-emotional communication in- resonance, oral motor function, swallowing, or cogni- clude: tive communication. These deficits may range from • participating as a member of a team that mild to severe, with variations in severity over time. The assesses students at risk for communication- age of onset of the neurological or other physical related education problems impairment, as well as its locus and nature, will affect • collaborating with other professionals and the type of communication impairment that the families in an effort to differentiate difficult student exhibits. Although the primary basis of these behaviors that may be due to psychosocial disorders may be structural, environmental influences disorders from those related to communication on communication development can also be signifi- impairments (e.g., misunderstanding orally cant—the result of limitations on environmental inter- presented information and using aggression in action. The multidimensional nature of these the absence of appropriate communication) impairments requires the development of comprehensive interdisciplinary programs for evaluation and • assisting educators in identifying behavior service (Connecticut State Department of Education, patterns that may be related to language dys- 1993). function as well as identifying behavior that negatively affects communication (e.g., selective The responsibilities of the school speech-language mutism) pathologist in evaluating the communication needs of • assisting in assessment of communication de- students with neurological, orthopedic, other health mands and interactions within various envi- impairments, or multiple impairments include: ronments to determine factors that may • promoting early identification of children contribute to breakdowns in learning or inter- whose communication development and be- personal relations (Connecticut State Depart- havior may suggest the presence of neurologic, ment of Education, 1993) orthopedic, other health, or multiple impairments Eligibility Determination • collaborating with other professionals to inte- Comprehensive assessment (data collection) and grate medical history into speech-language as- evaluation (interpretation of that data) enable the sessment speech-language pathologist to identify students with • collaborating with other professionals in the significant educationally relevant communication assessment of prespeech skills in the areas of disorders. As part of the eligibility determination for motor development, respiration and feeding, special education and related services, the speech- and in assessing the effect of the impairment on language pathologist who has identified the student’s communication development and interactions speech-language needs and the team address the relationship between the student’s speech and lan- • assessing the communication requirements of guage disabilities and any adverse effect on the ability home, school, and vocational settings to learn the general curriculum, including academic, III - 270 / 1999 ASHA 2002 Desk Reference Volume 3 • Speech-Language Pathology social-emotional, or vocational areas. The team relies —“is qualified to provide, or supervise the pro- on the evaluation results to determine both a student’s vision of, specially designed instruction to meet need for service and the student’s eligibility for special the unique needs of children with disabilities education and related services on the basis of federal —“is knowledgeable about the general curricu- legislative mandates, state regulations and guidelines, lum and local policies and procedures. —“is knowledgeable about the availability of The definition of speech or language impairment resources of the local educational agency at the federal level appears in IDEA: “a communica- • “an individual who can interpret the instruction disorder, such as stuttering, impaired articulation, tional implications of evaluation results. . . a language impairment or a voice impairment that adversely affects a child’s educational performance” • “other individuals. . . who have knowledge or [Section 300.7 (b)(11)]. State codes may establish eligi- special expertise regarding the child, including bility criteria for each area of speech and language, for related services personnel as appropriate specific age groups (e.g., infants, preschoolers), and • “whenever appropriate, the child with a dis- considerations for culturally/linguistically different or ability” [Section 614(d)(1)(B) (i-vii)] economically disadvantaged students. Special factors in developing the IEP content in- School-based speech-language pathologists are clude: responsible for obtaining and following their state eli- • “in the case of a child whose behavior impedes gibility criteria. States may use different indicators for his or her learning or that of others, consider, classification of mild, moderate, severe, or profound. when appropriate, strategies including positive Differing state criteria may result in variations in eli- behavioral interventions and supports to ad- gibility decisions, recommended amount of service, dress that behavior and service delivery options. Local procedures may • “in the case of a child with limited English pro- further define severity levels and eligibility criteria. ficiency, consider the language needs of the For general eligibility and dismissal consider- child as such needs relate to the child’s IEP ations, school-based speech-language pathologists • “in the case of a child who is blind or visually may also refer to the ASHA technical reports, includ- impaired, provide for instruction in Braille and ing Issues in Determining Eligibility for Language In- the use of Braille unless the IEP team deter- tervention (1989c) and Admission/Discharge Criteria mines—after an evaluation of the child’s read- in Speech-Language Pathology (1994a). ing and writing skills, needs, and appropriate IEP/IFSP Development reading and writing media (including an evaluation of the child’s future needs for instruction An individualized education program (IEP) is in Braille)—that the use of Braille is not appro- developed for students (age 3 or older) who qualify for priate for the child speech and/or language services. The IDEA Amend- ments of 1997 added new requirements for the compo- • “consider the communication needs of the sition of the IEP team, detailed several special factors child; and in the case of a child who is deaf or for the development of the IEP, and expanded specific hard of hearing, consider the child’s language required components [Section 614]. and communication needs, opportunities for direct communications with peers and profes- The IEP document is developed by the total IEP sional personnel in the child’s language and team, including the speech-language pathologist as communication mode, academic level, and full appropriate. The IEP team includes: range of needs, including opportunities for di- • “the parents of a child with a disability rect instruction in the child’s language and • “at least one regular education teacher of such communication mode child (if the child is, or may be, participating in • “consider whether the child requires assistive the regular education environment) technology devices and services” [Section • “at least one special education teacher or, 614(d)(3)(B)(i-v)] where appropriate, at least one special educa- The IEP includes the components listed in Table 4. tion provider of such child • “a representative of the local educational agency who— Guidelines • Roles and Responsibilities of the School-Based Speech-Language Pathologist 1999 / III - 271

Table 4. Required Components of IEP.

Strengths The strengths of the child and the concerns of the parents for enhancing the education of their child

Evaluation results The results of the initial evaluation or the most recent evaluation

Present level of The effect of the student’s disability on the involvement and progress in the educational general education curriculum (or participation in appropriate preschool performance activities)

Annual goals and Measurable goals, benchmarks, or objectives related to meeting general short-term objectives education curriculum or other educational needs that result from the disability

Amount of special Projected beginning date, frequency, and duration of service education or related services

Supplementary aids Program modifications or support services necessary for the student to advance and services toward attaining annual goals, be involved and progress in the general education curriculum, participate in nonacademic activities, and be educated and participate in activities with other students with and without disabilities

Participation with Extent of participation with students without disabilities in the general students without education class and in extracurricular activities disabilities

Test modifications Modifications in the administration of state- or district-wide assessments of student achievement that are needed in order for the student to participate in the assessment (If exempt, the reason the test is not appropriate must be stated.)

Transition service At age 14, transition services that focus on a student’s courses of study. At age 16, transition services specify interagency responsibilities or needed community links

Notification of Documentation that the student has been informed of the rights that will transfer of rights transfer to the student upon reaching the age of majority under state law (must notify at least one year before the student reaches that age of majority)

Evaluation Measures of the student’s progress (e.g., criterion-referenced test, standardized procedures and test, student product, teacher observation, or peer evaluation) and how often the method of evaluation will take place (e.g., daily, weekly, monthly, each grading period/ measurement semester, or annually). Progress must be reported as often as progress is reported for general education students.

IEP team members Signatures of all members of the IEP team that developed the IEP

Source: Section 614d(3)(A)(i-ii), 614d (1)(A)(i-viii) III - 272 / 1999 ASHA 2002 Desk Reference Volume 3 • Speech-Language Pathology

The IEP is reviewed at least annually (or more • strengths, needs, and emerging abilities often to reflect program changes). The IEP must be in • need for peer modeling effect at the beginning of each school year. • communication needs as they relate to the gen- For each IDEA-eligible infant and toddler (under eral education curriculum 3 years of age), an Individualized Family Service Plan • need for intensive intervention (IFSP) is required. The IFSP must be developed at an IFSP meeting held within mandated time lines. Speech- • effort, attitude, motivation, and social skills language pathologists are responsible for being famil- • severity of the disorder(s) iar with the required procedures for the development • nature of the disorder(s) and review of the IFSP [Section 636]. Speech-language • age and developmental level of the student pathologists who work with infants and toddlers are involved in ensuring that the child’s communication The 18th Annual Report to Congress on the Imple- needs are addressed on transition to preschool ser- mentation of the Individuals with Disabilities Educa- vices under IDEA. tion Act stressed the importance of providing a full continuum of services for students with disabilities. Caseload Management The report specifies that there is no single special edu- The role of the school-based speech-language pa- cation setting that benefits all students. A range of thologist is to assist the team in selecting, planning, options, tailored to meet the individual needs of all and coordinating appropriate service delivery and students, continues to be the most effective approach various scheduling options throughout the duration (U. S. Department of Education, 1996). of services—not just for initial placement decisions. The Department of Education recommendation is If the speech-language pathologist serves as the consistent with ASHA’s position statement on inclu- case manager for any student identified as needing sive practices, which states that “an array of speech, special education and or related services, the respon- language, and hearing services should be available in sibilities of the speech-language pathologist may in- educational settings to support children and youths clude: with communication disorders” (1996b, p. 35). The inclusive practices philosophy emphasizes serving stu- • scheduling and coordinating both school-based dents “in the least restrictive environment that meets and community assessments their needs optimally” (p. 35). See Table 5 for an ex- • assuming a leadership role in developing the planation of service delivery options. During the IEP/IFSP course of intervention, a student might participate in • assisting families in identifying available ser- several service delivery models before dismissal. vice providers and advocacy organizations Scheduling Students for Intervention within the community An ongoing caseload management responsibility • coordinating, monitoring, and ensuring timely of the school-based speech-language pathologist is to delivery of special education and/or related determine the most effective use of time and services. services Intensity and duration of service for a student are based • scheduling and coordinating the re-evaluation on such factors as the: process • nature and severity of speech-language disor- • facilitating the development of transition plans ders • coordinating services or providing consultation • impact on educational performance for students in charter schools and private • student’s academic program schools (ASHA, 1989b) • student’s involvement in other special educa- Service Delivery Options tion programs Recommendations regarding the nature (direct or • additional support systems available indirect), type (individual or group), and location of • levels of service to be given service delivery (speech-language resource room, classroom, home, or community) are based on the need • provision for consultative service to provide a free, appropriate public education for each Additional considerations that affect the speech- student in the least-restrictive environment and con- language pathologist’s schedule include: sistent with the student’s individual needs as docu- • time for screening, testing, test interpretation, mented on the IEP. Considerations include: report writing, team meetings, case management, and conferences Guidelines • Roles and Responsibilities of the School-Based Speech-Language Pathologist 1999 / III - 273

• collaboration/consultation and planning time in determining caseload size, including roles and re- • master schedule (e.g., lunch, music, school- sponsibilities of the speech-language pathologist, age wide activities) and severity of students, and service delivery models. The following statement from that ASHA document • special schedule considerations (e.g., half-day provided recommendations for caseload size in 1993; kindergarten, block schedules) however, changes in student population and IDEA • number of schools served requirements should also be considered in determin- • travel between schools ing appropriate caseload size today. • availability of appropriate facility/location for “Caseload size must reflect a balance between services (U. S. Congress, 1990a) how many hours are available in the school day for • programming of AAC devices and planning for services to students, and how many hours are needed and training parents and educators in the use to complete paperwork, staffing, and other required of assistive technology activities. The recommended maximum caseload for appropriate services is 40 students, regardless of the • continuing education type or number of service delivery models selected. Caseload Size Special populations may dictate fewer students on the The Guidelines for Caseload Size and Speech- caseload. A recommended maximum caseload com- Language Service Delivery in the Schools (ASHA, posed entirely of preschoolers is 25. Other populations 1993b) delineate many considerations to be observed that may require additional time, and therefore fewer

Table 5. Service Delivery Options.

Service delivery is a dynamic concept and changes as the needs of the students change. No one service delivery model is to be used exclusively during intervention. For all service delivery models, it is essential that time be made available in the weekly schedule for collaboration/consultation with parents, general educators, special educators and other service providers.

Monitor: The speech-language pathologist sees the student for a specified amount of time per grading period to monitor or “check” on the student’s speech and language skills. Often this model immediately precedes dismissal.

Collaborative Consultation: The speech-language pathologist, regular and/or special education teacher(s), and parents/families work together to facilitate a student’s communication and learning in educational environments. This is an indirect model in which the speech- language pathologist does not provide direct service to the student.

Classroom-Based: This model is also known as integrated services, curriculum-based, transdisciplinary, interdisciplinary, or inclusive programming. There is an emphasis on the speech-language pathologist providing direct services to students within the classroom and other natural environments. Team teaching by the speech-language pathologist and the regular and/or special education teacher(s) is frequent with this model.

Pullout: Services are provided to students individually and/or in small groups within the speech-language resource room setting. Some speech-language pathologists may prefer to provide individual or small group services within the physical space of the classroom.

Self-Contained Program: The speech-language pathologist is the classroom teacher responsible for providing both academic/curriculum instruction and speech-language remediation.

Community-Based: Communication services are provided to students within the home or community setting. Goals and objectives focus primarily on functional communication skills.

Combination: The speech-language pathologist provides two or more service delivery options (e.g., provides individual or small group treatment on a pullout basis twice a week to develop skills or preteach concepts and also works with the student within the classroom). Sources: ASHA, 1993b, 1996b III - 274 / 1999 ASHA 2002 Desk Reference Volume 3 • Speech-Language Pathology students on the caseload, include students who are eligibility criteria established within federal mandates, technologically dependent, medically fragile, multilin- state guidelines, and local policies and procedures for gual or limited-English proficient. Some states limit the special education and related services. number of students in self-contained classrooms. Eight Students receive intervention when their ability to students without a support person, or 12 students with communicate effectively is impaired (or their diagno- a support person, are the recommendations for this sis indicates risk for impairment) and there is reason type of setting” (ASHA, 1993b). to believe that intervention will reduce the degree of Intervention for Students With impairment, disability, or handicap and lead to im- Communication Disorders proved communication behaviors (ASHA, 1997e). Established IEP goals and objectives are implemented Speech-language pathology services may be pro- for students who qualify for services under IDEA vided for students with speech, language, or commu- through direct and/or indirect services to facilitate the nication disorders as defined by the evaluation and achievement of the stated objective criteria. Interven-

Table 6. Methods for Effective Intervention.

Responsibilities Methods

Planning intervention Determine priority areas for intervention Determine content to meet goals and objectives Select appropriate materials Determine intervention methods based on student learning styles

Managing intervention Establish classroom management system Establish positive environment Use time productively Communicate realistic expectations Coordinate curricula and goals with other educational staff, parents/families Motivate students

Delivering intervention Present instruction Promote problem-solving and thinking skills Provide relevant practice of skills taught Provide opportunity for communication in the natural environment Keep students actively involved Provide feedback Prompt/cue as appropriate during guided learning

Evaluating intervention Monitor engaged time Monitor student understanding Make judgments about student performance Maintain records of student progress Inform students, parents, and teachers of progress Use treatment outcomes data to make decisions Determine effect on classroom performance Modify instruction

Based on the work of Algozzine, B., & Ysseldyke, J., 1997. Strategies and Tactics for Effective Teaching. Adapted with permission. Guidelines • Roles and Responsibilities of the School-Based Speech-Language Pathologist 1999 / III - 275 tion, aimed at achieving functional communication dent in communicating more effectively in the school outcomes, is provided through various methods and environment. techniques. Just as evaluation decisions are based on Scope of Intervention a thorough understanding of speech and language development and the processes of communication, so Speech-language pathology is a dynamic and con- too are intervention decisions. tinuously developing practice area. The scope of practice should not be regarded as all-inclusive; that is, it It is beyond the scope of this document to describe does not necessarily exclude new or emerging areas. specific techniques for intervention. Entire university courses and texts, professional institutes and semi- ASHA’s Scope of Practice in Speech-Language Pa- nars, professional literature and articles, ASHA Spe- thology includes treatment and intervention (i.e., pre- cial Interest Divisions, and Web sites are devoted to vention, restoration, amelioration, compensation) and intervention techniques for specific deficits and disor- follow-up services for disorders of: ders within each speech and language area. Commer- • “language (involving the parameters of phonol- cially published materials for remediation of speech, ogy, morphology, syntax, semantics, and prag- language, and communication disorders, when appro- matics; and including disorders of receptive priately selected to match student needs, are additional and expressive communication in oral, written, useful tools to help students meet their goals and ob- graphic, and manual modalities) jectives. It is the responsibility of the speech-language • “cognitive aspects of communication (includ- pathologist to keep current on intervention methods ing communication disability and other func- reflecting best practices in speech-language pathology. tional disabilities associated with cognitive General Intervention Methods impairment) Speech-language pathologists benefit from the lit- • “social aspects of communication (including erature produced by effective schools research. challenging behavior, ineffective social skills, Christenson and Ysseldyke (1989) identified 10 factors lack of communication opportunities) within the four components of effective teaching: plan- • “speech: articulation, fluency, voice (including ning, managing, delivering, and evaluating instruc- respiration, phonation, and resonance) tion. Algozzine and Ysseldyke (1997) expanded that • “oral, pharyngeal, cervical esophageal, and work by delineating numerous “effective” strategies related functions (e.g., dysphagia, including and specific tactics (activities) that teachers could disorders of swallowing and oral function for implement. These strategies are used for teacher train- feeding; orofacial myofunctional disorders)” ing, as well as by Intervention Assistance Teams. (ASHA, 1996c, p. 18)11 School-based speech-language pathologists rely Although the components of the Scope of Practice on principles of effective intervention when working are listed separately within this document for ease of with students who have disorders within all areas discussion, each component of communication is in- encompassed by ASHA’s Scope of Practice in Speech- terconnected with and greatly influences the other Language Pathology (1996c). Table 6 outlines respon- components. If there is a deficit in any one area of lan- sibilities for intervention that include planning, guage or speech, it may directly influence other areas. managing, delivering, and evaluating intervention. The responsibilities of the speech-language pa- These general methods facilitate effective intervention thologist in intervention for all communication disor- for students. ders within the Scope of Practice of Speech-Language During intervention, the speech-language patholo- Pathology include: gist communicates with parents, families, educators, • reviewing all assessment/evaluation informa- and other community professionals to reinforce IEP/ tion IFSP goals at home and in the classroom, facilitate gen- eralization of communication abilities, and monitor • comparing assessment data with knowledge of the student’s progress. Speech-language pathologists normal language, speech, and communication may also provide information concerning the charac- development teristics of the classroom environment conducive to • considering other factors that may have de- communication development. Classroom or indi- pressed communication ability, and addressing vidual accommodations or modifications may be suggested related to seating and positioning; time demands; pragmatic/social language; organizational or note-taking skills; assistive technology devices, sys- 11 The list of disorders has been reordered to follow the tems, or services; and materials that may assist the stu- text of this document. III - 276 / 1999 ASHA 2002 Desk Reference Volume 3 • Speech-Language Pathology

those through intervention, recommending ac- Communication. Communication is the process of commodations or modifications to the environ- exchanging ideas and information through verbal and ment, or referring to other health professionals nonverbal means. It is a complete process for both • selecting materials appropriate to age and de- speaker and listener. velopmental level According to ASHA, “A communication disorder • applying effective teaching principles (see is an impairment in the ability to receive, send, process, Table 6) and comprehend concepts or verbal, nonverbal, and graphic symbol systems. A communication disorder • collaborating with parents and education per- may be evident in the processes of hearing, language, sonnel and/or speech. A communication disorder may range • observing student responses during interven- in severity from mild to profound. It may be a develop- tion to determine progress mental or acquired disorder. Individuals may demon- Following are descriptions of the areas included strate one or any combination of speech/language in the scope of practice of school-based speech- disorders. A communication disorder may result in a language pathologists.

Table 7. Oral and Written Receptive and Expressive Language Factors.

Listening Speaking Reading Writing Receptive Expressive Receptive Expressive

Form Applies Uses words and Applies Uses words and phonological, sentences correctly graphophonemic, sentences correctly morphological, in discourse morphological, in writing and syntactic rules according to and syntactic rules according to for comprehension phonological, for comprehension spelling, of oral language morphological, of text morphological, and syntactic rules and syntactic rules

Content Comprehends the Selects words and Comprehends the Selects words and meaning of words uses oral language meaning of words uses written and spoken to convey meaning and text language to convey language Formulates meaning thoughts into oral Formulates language thoughts into Uses precise and written language descriptive Uses precise and vocabulary descriptive Uses literal and vocabulary figurative language Uses literal and figurative language

Function Follows directions Uses appropriate Understands mood, Follows rules of Understands social language for the tone, style, and discourse meanings social context context of text Uses various styles Takes turns in and genres of listener/speaker writing role

Cognitive Attention, long- and short-term memory, problem solving, and related components Communication Components Guidelines • Roles and Responsibilities of the School-Based Speech-Language Pathologist 1999 / III - 277

primary disability or it may be secondary to other dis- • determining the appropriateness of interven- abilities” (1993a, p. 40). A deficit in any of the follow- tion on the basis of potential for functional im- ing components of language or speech may interfere provement in a reasonable and generally with communication competence. predictable period of time Language. Language is a complex and dynamic • selecting or designing appropriate tasks, system of conventional symbols that is used in vari- stimuli, and methods—including such ad- ous modes for thought and communication. vances as the use of computers and augmenta- “Contemporary views of human language hold tive devices that: • implementing individual and group programs • Language evolves within specific historical, specifically designed to treat cognitive-commu- social, and cultural contexts. nication deficits • Language, as rule-governed behavior, is de- • training and counseling students, family mem- scribed by at least five parameters: phonology, bers, educators, and other professionals in morphology, syntax, semantics, and pragmat- adaptive strategies for managing cognitive- ics. communication disorders • Language learning and use are determined by • recognizing the effects of pharmacologic inter- the interaction of biological, cognitive, psycho- vention and neurodiagnostic procedures on social, and environmental factors. each student’s behavior and reporting behavioral changes to appropriate physicians • Effective use of language for communication requires a broad understanding of human in- • integrating behavior modification techniques as teraction including such associated factors as appropriate for the management of associated nonverbal cues, motivation, and sociocultural problems, such as self-abusive and combative roles”(ASHA, 1987, p. 54). behaviors and agitation • recommending prosthetic and augmentative Table 7 lists a few examples of communication cognitive-communication devices (ASHA, behaviors representative of each language domain and 1987) system. The table is not intended to be all-inclusive of the myriad communicative behaviors that reflect lan- Language and academic success. In addition to their guage knowledge and skills. traditional roles, school speech-language pathologists have a growing impact on students’ success from “A language disorder is impaired comprehension preschool through adolescence in such areas as en- and/or use of spoken, written, and/or other symbol hancing literacy development and developing social- systems. The disorder may involve the form of language emotional communication skills. Speech-language (phonology, morphology, syntax), the content of lan- pathologists working in school settings have increas- guage (semantics), and/or the function of language in ingly assumed the role of collaborating with classroom communication (pragmatics) in any combination” teachers to enhance academic success for all students (ASHA, 1993a, p. 40). Intervention is conducted to (ASHA, 1993d; Canady & Krantz, 1996). achieve improved, altered, augmented, or compensated language behaviors for listening, speaking, reading, Literacy development. Speech-language patholo- and writing (ASHA, 1996c). gists in the schools have become increasingly aware of the need for expanding their contributions in the Cognitive-Communication. Speech-language pa- areas of reading and writing skills. Butler (1996) em- thologists provide intervention for both congenital and phasizes the importance of recognizing the complex acquired cognitively based communication impair- interplay between spoken and written language and ments. The speech-language pathologist concerned the need to go beyond listening and speaking to read- with the management of students with cognitive com- ing and writing. Children’s reading and writing skills munication disorders assumes responsibility for thor- have been found to reflect their oral language compe- ough and flexible exploration of relations between tence (Achilles, Yates, & Freese, 1991; Adams, 1990; cognitive deficits and their communication conse- Canady & Krantz, 1996; Horowitz & Samuels, 1987; quences (ASHA, 1987). Olson, Torrance, & Hildyard, 1985), thereby linking Impairments of cognitive processes may contrib- oral language disorders with specific reading disabili- ute to deficits in the syntactic, semantic, phonologic, ties. Research demonstrates that language is continu- and/or pragmatic aspects of language. Speech- ous across both oral and written modalities. One of the language pathologists engage in interventions for obstacles “to skilled reading is a failure to transfer the cognitive communication impairments such as: comprehension skills of spoken language to reading III - 278 / 1999 ASHA 2002 Desk Reference Volume 3 • Speech-Language Pathology and to acquire new strategies that may be specifically • collaborate with classroom teachers and read- needed for reading” (National Research Council, 1998, ing professionals to enhance academic success p. 4). Silliman and Wilkinson (1994a) discuss this infor children who experience difficulty with tegration of communication processes as the pathway reading, writing, listening, and speaking to literacy (p. 27). Reading is a complex behavior re- Social-emotional communication skills. One of the quiring high-level linguistic (semantic and syntactic) major identified problems facing American schools is abilities as well as decoding skills. disruptive, violent, or unacceptable behavior that im- Research has also shown that explicit awareness pedes learning not only for the violating student but of the speech sound system (phonological awareness) for other students in the same classroom (ASHA, 1994i; is related to early reading development (Blachman, U.S. Congress, 1993). These students create a threat- 1994; Catts, 1993; Swank & Catts, 1994; Torgeson & ening environment for themselves, classmates, and the Wagner, 1994, Wagner & Torgeson, 1987). Speech- school staff. Language skills are an important ingre- language pathologists’ knowledge of specific interven- dient in establishing social relationships. Typically tion techniques for phonological deficits enables them developing children employ their language skills to to plan and support early intervention programs fo- share information, express feelings, direct behavior, cusing on training of phonological awareness in pre- and negotiate misunderstandings as they interact with school and primary grades (Catts, 1991; Gillam & van others. Classroom behavior management systems en- Kleeck, 1996). Training in oral and written language couraging students to communicate with their teach- assessment and remediation allows the speech- ers and peers are important. Students with speech and language pathologist to make valuable contributions language impairments, however, have been shown to in the intervention of the full range of reading and exhibit poorer social skills and fewer peer relation- writing disabilities (Catts & Kamhi, 1986, 1999; Kamhi ships than their normally developing peers (Fujiki, & Catts, 1991). Brinton, & Todd, 1997). It is also well documented that Thus, the speech-language pathologist’s goal is to students with a range of disabilities involving lan- establish an environment that allows for maximum guage deficits experience significant social difficulties practice and development of all language skills, (Antia & Kreimeyer, 1992; Aram, Ekelman, & Nation, whether through reading, writing, listening, or speak- 1984; Bryan, 1996; Guralnick, 1992). The speech- ing. language pathologist, as a team professional in the school setting, can contribute to solutions that may It is the speech-language pathologist’s responsi- result in positive change. bility regarding literacy to: The responsibilities specific to developing social- • collaborate with other school personnel to de- emotional communication skills are to: velop emergent literacy and language arts programs that incorporate activities appropriate to • provide information to the instructional staff the developmental communication levels of regarding the role of pragmatics and dynamics children of communication when dealing with social- emotional problems in the school • participate in the selection or modification of language arts and instructional strategies • assist in the training of educational staff on the curricula and materials for use in integrating effective use of verbal and nonverbal commu- instruction in reading, writing, listening, and nication in conflict resolution and discipline speaking • collaborate with educational staff and parents • provide information and training regarding to determine the communication intent of the the linguistic bases of reading and writing and child’s obvious and subtle behaviors, and to the development of environments and activities facilitate the use of socially appropriate commu- that foster the development of literacy skills nication • provide information and support for parents of • collaborate with the school staff, as a member at-risk children regarding the importance of lit- of a school peer mediation team, to enhance stu- eracy activities within the home environment dents’ self-esteem by increasing their skills as effective communicators • provide intervention by teaching phonemic, syntactic, morphemic, and semantic aspects of • demonstrate lessons, team teach, and model language in both oral and written modalities techniques to enhance pragmatic communication skills in the areas of problem solving, so- • assist in the development of students’ oral and cial communication, and coping skills written discourse skills Guidelines • Roles and Responsibilities of the School-Based Speech-Language Pathologist 1999 / III - 279

• provide consultative services that address de- Speech. Speech disorders may be impairments of velopment of vocabulary to enhance emotional articulation/phonology, fluency, or voice/resonance. expression and control. Impairment of any of these categories may have a nega- Central auditory processing disorders. The speech- tive effect on general communication and general edu- language pathologist is the professional who may be cational progress if the disorder is distracting enough most involved in the management of children with to interfere with the speaker’s message. Assessment central auditory processing disorders (CAPD), particu- that identifies specific areas of need assists interven- larly if recommendations involve direct therapeutic tion decisions. techniques that can best be handled in an individual Articulation/phonology. Accurate production of therapy situation or if the student exhibits a language- speech sounds relies on the interplay of phonemic, based CAPD that requires more traditional language phonological, and oral-motor systems. See Table 8 for intervention. The speech-language pathologist moni- representative aspects of each area. tors the student’s speech and language capabilities An articulation or phonological disorder is “the during the CAPD intervention process. atypical production of speech sounds characterized by Components of a comprehensive CAPD interven- substitutions, omissions, additions or distortions that tion program include: may interfere with intelligibility” (ASHA, 1993a, p. 40). • training and education of key individuals Children with phonological disorders exhibit error patterns in the application of phonological rules for • resources for implementing management sug- speech. Intervention is conducted to achieve improved, gestions altered, augmented or compensated speech (ASHA, • methods of data collection and research to docu- 1997e). ment program efficacy Orofacial-myofunctional treatment is conducted Intervention leads to improvement in listening, to improve or correct the student’s orofacial spoken language processing, and the overall commu- myofunctional patterns and related speech patterns. nication process. Intervention for students with CAPD Orofacial myofunctional intervention may include al- includes: teration of lingual and labial resting postures, muscle • auditory training or stimulation retraining exercises, and modification of processing • communication and/or educational strategies and swallowing solids, liquids, or saliva and may be conducted concurrently with speech-language inter- • metalinguistic and metacognitive skills and vention (ASHA 1991d, p 7; 1997e). strategies Fluency. There are numerous theories concerning • use of assistive listening devices as recom- the development of fluent speech. Ramig and Shames mended (1998) provide a historical review and summarize vari- • acoustic enhancement and environmental ous theories about the causation of stuttering. Interven- modification of the listening environment as tion approaches for reducing disfluency address one recommended or all of the affective, behavioral, and cognitive com- • collaboration with professionals and families ponents represented in Table 9. to increase the likelihood of successfully imple- “A fluency disorder is an interruption in the flow menting intervention strategies of speaking characterized by atypical rate, rhythm, and • family counseling regarding their role in the repetitions in sounds, syllables, words, and phrases. management process (Bellis, 1997) This may be accompanied by excessive tension,

Table 8. Articulation/Phonology Components.

Phonemic Phonological Oral-Motor

Speech sounds. The rules for the sound system Oral motor range, strength, and Categorized by vowels and of the language, including the set mobility. Planning, sequencing, by consonant manner, place, of phonemes with allowable and co-articulation of speech and voicing. combination and pattern movements. modifications. III - 280 / 1999 ASHA 2002 Desk Reference Volume 3 • Speech-Language Pathology struggle behavior, and secondary mannerisms” tion, coordination of respiration and laryngeal valving (ASHA, 1993a, p. 40). Stuttering may be viewed as a to allow for functional oral communication (Andrews, syndrome characterized by abnormal disfluencies ac- 1991; ASHA, 1997e). companied by observable affective, behavioral, and All students with voice disorders must be exam- cognitive patterns (Cooper & Cooper, 1998). ined by a physician, preferably in a specialty appro- ASHA’s Preferred Practice Patterns for the Profession priate to the presenting complaint. The examination of Speech-Language Pathology (1997e) contains informa- may occur before or after the voice evaluation by the tion regarding the roles of the school-based speech- speech-language pathologist (ASHA, 1997e). language pathologist in the assessment of students Students affected by resonance and airflow defi- who stutter. ASHA’s Guidelines for Practice in Stutter- cits are treated to achieve functional communication. ing Treatment (1995b) provide additional information Structural deficits related to these deficits include con- concerning the assessment and treatment of stuttering. genital palatal insufficiency and/or velopharyngeal Responsibilities for students with fluency disorders insufficiency or incompetence.12 Other resonance and include planning and implementing intervention to: airflow deficits include neuromuscular disorders, • reduce the frequency of stuttering faulty learning, or sound specific velopharyngeal incompetence. • reduce severity, duration, and abnormality of stuttering behaviors The responsibilities related to intervention for • reduce defensive behaviors voice and resonance disorders include: • remove or reduce factors that create, exacerbate, • giving information and guidance to students, or maintain stuttering behaviors teachers and other professionals, and families about the nature of voice disorders, alaryngeal • reduce emotional reactions to specific stimuli speech, and/or laryngeal disorders affecting when they increase stuttering behavior respiration • transfer and maintain these and other fluency producing processes (ASHA, 1995b)

Voice and resonance. Physical, functional, and emo- 12Velopharyngeal describes structures or disorders between tional factors are integrated to produce vocal compe- the soft palate and the back wall of the nasopharynx. tence (see Table 10). An adequate voice is one that is When the structures in this area close, it is known as appropriate for the student’s age and sex and does not velopharyngeal closure. This closure takes place during create vocal abuse. speech and swallowing so that the oropharynx is sepa- rated from the nasopharynx by the raising of the soft “A voice disorder is characterized by the abnor- palate and the moving inward of the walls of the phar- mal production and/or absence of vocal quality, pitch, ynx. A failure of this closure is known as velopharyngeal loudness, resonance, or duration, which is inappro- incompetence. If the soft palate or vellum fails to reach priate for an individual’s age and/or sex” (ASHA, the back wall of the pharynx because of damage or 1993a, p. 40). Intervention for students with voice dis- because it is too short to reach the wall, it is known as orders is conducted to achieve improved voice produc- velopharyngeal insufficiency (Morris, 1993).

Table 9. Fluency Factors.

Affective Behavioral Cognitive

Feelings about speaking Respiration Language/linguistic competencies

Self-esteem Articulation Accuracy of perceptions

Feelings in response to Phonation Attitudes about speaking environmental and situational influences

Feeling of fluency control Rate of speaking Attitudes regarding fluency

Concomitant factors Guidelines • Roles and Responsibilities of the School-Based Speech-Language Pathologist 1999 / III - 281

Table 10. Voice/Resonance Factors.

Physical Functional Emotional

Respiration: lungs, diaphragm Loudness/intensity, sustained Confidence phonation

Phonation: larynx, vocal folds Pitch, onset of phonation Self-esteem

Resonance: velopharyngeal, Resonance and airflow Stress oral, and nasal resonance structures

• providing appropriate voice care and conser- vention with communication function intervention vation guidelines, including strategies that pro- (ASHA, 1990b). mote healthy laryngeal tissues and voice Intervention for swallowing disorders may production and reduce laryngeal trauma or include: strain • providing information and guidance to stu- • discussing goals, procedures, respective re- dents, families, and caretakers about the nature sponsibilities and the likely outcome of inter- of swallowing and swallowing disorders vention • consulting and collaborating with medical pro- • instructing in the proper use of respiratory, viders throughout planning and intervention phonatory, and resonatory processes to achieve • training caregivers and educational staff on improved voice production safe eating and swallowing techniques Swallowing. Safe swallowing and eating are • instructing families, caregivers, and educators essential activities of daily living and are needed to on the social-emotional relationship between ensure effective communication. As noted in Table 11, feeding/swallowing and educational success. a combination of physical, functional, and health factors are considered when determining if interven- Intervention for Students With tion is appropriate. Communication Variations “Swallowing function treatment is conducted to Cultural and/or Linguistic Diversity improve the student’s oral, pharyngeal, and laryngeal “Our nation’s need for multicultural infusion neuromotor function and control and coordination of is gaining importance as its population continues respiratory function with swallowing activities” to diversify” (Cheng, 1996). America’s educators are (ASHA, 1997e, p. 63). The school-based speech- developing alternative strategies to supplement tradi- language pathologist may facilitate the student’s tional instructional methods for meeting the needs of ability to efficiently chew and swallow more safely culturally and linguistically diverse students (ASHA, and more efficiently. School-based speech-language 1983; 1985a). ASHA recognizes the role of the speech- pathologists may integrate swallowing function inter- language pathologist as a resource or consultant to the

Table 11. Swallowing Factors.

Physical Functional Health

Oral, pharyngeal, esophageal Safe and efficient eating Pulmonary complications function

Respiratory function Developmental skills for eating Nutritional implications

Gastrointestinal consideration Pleasure of eating, social Modified diet interaction III - 282 / 1999 ASHA 2002 Desk Reference Volume 3 • Speech-Language Pathology classroom teacher. The speech-language pathologist 1985a; 1989a; 1998f; see also the Office of Multicultural who has a thorough knowledge of the linguistic rules Affairs related reading list [ASHA, 1998a]). of a student’s dialect can assist the classroom teacher Responsibilities relating to intervention for in taking the child’s dialect into account in instruction students with a primary language other than English (Cole, 1983). include: “Communication difference/dialect is a variation • assisting the classroom teacher in taking the of a symbol system used by a group of individuals that student’s language skills into account for in- reflects and is determined by shared regional, social, struction or cultural/ethnic factors. A regional, social, or cul- • assisting the classroom teacher in understand- tural/ethnic variation of a symbol system should not ing communication style differences in limited- be considered a disorder of speech or language” English-proficient populations (ASHA, 1993a, p. 41). Responsibilities relating to students with social dialects include: • helping students who are eligible for services develop a command of the structure, meaning, • consultation with preschool and elementary and use of English teachers and the student’s family in efforts to bridge the gap between home and school lan- • assisting parents with appropriate modeling guage for students with social dialect variants and use of language stimulation activities • collaboration with other school personnel to • referring students for additional services or develop a school environment in which cultural programs, as appropriate and linguistic diversity are respected and ad- Students Requiring Technology Support dressed within the curriculum The school-based speech-language pathologist • consultation with school instructional staff to recommends support services to classroom teachers promote an understanding of social dialects as in the form of assistive technology and classroom serving communication and social solidarity adaptations that will improve communication functions opportunities for students and allow them to more • consultation with classroom teachers to pro- fully participate in classroom discourse. “Augmenta- mote an understanding of specific dialects as tive and alternative communication systems attempt rule-governed linguistic systems with distinct to compensate and facilitate, temporarily or perma- phonological and grammatical features as well nently, for the impairment and disability patterns of as semantic and pragmatic variants individuals with severe expressive and/or language • collaboration with the education staff to assure comprehension disorders. Augmentative/alternative that instructional approaches, materials, and communication may be required for individuals dem- activities are appropriate for the child’s cultural onstrating impairments in gestural, spoken, and/or and linguistic differences written modalities” (ASHA, 1993a, p. 41). Augmenta- tive and alternative communication systems, as well • providing in-services to education staff as computer technology, may improve school perfor- regarding language difference versus language mance. The speech-language pathologist often teams disorders (Also see the Office of Multicultural with allied professionals, such as occupational thera- Affairs related reading list [ASHA, 1997a].) pists and physical therapists, to evaluate and imple- Limited English Proficiency ment adaptations for specific needs of students with Recommendations for classroom and curriculum physical limitations. modifications vary depending on the student’s profi- Responsibilities related to assistive technology ciency on the continuum from nonfluent to fluent for intervention and services include: both English and the native language. It is important • providing input on the effect of physical orga- for the speech-language pathologist to understand the nization of the classroom in fostering commu- bilingual as well as the monolingual language acqui- nication development and interaction sition process. It is also important for the school-based • monitoring the technology needs of the student speech-language pathologist to be familiar with cur- given curriculum expectations rent norms for the morphological, semantic, syntactic, pragmatic, and phonological development of children • recommending and selecting augmentative or from limited-English proficient backgrounds. Consul- assistive technology devices or services to pro- tation with a bilingual speech-language pathologist mote communication and participation in the and other professionals (e.g., ESL instructors, inter- regular classroom of the technology device or preter/translators, etc.) is recommended (ASHA, services (ASHA, 1997e, 1998d). Guidelines • Roles and Responsibilities of the School-Based Speech-Language Pathologist 1999 / III - 283

Counseling service at least once every 3 years to determine if there is a need for re-evaluation regardless of whether the Counseling facilitates recovery from or adjustment students are served in a direct or an indirect interven- to a communication disorder. The purposes of coun- tion model. A student may be re-evaluated more fre- seling may be to provide information and support, re- quently to ensure that the goals and objectives of the fer to other professionals, and/or help develop current program and setting meet the needs of the stu- problem-solving strategies to enhance the intervention dent. This more frequent re-evaluation may be initiated process. Requests for information and support as well at teacher or parent request [Sections 614(a)(2)(A), as strategies for achieving goals should be determined 614(a)(4)(A)]. in collaboration with students and families. Informed parental consent is required before con- Counseling may be considered an intervention ducting a re-evaluation, except when the local educa- technique; however, it is a particular type of intervention agency (LEA) can demonstrate that it has taken tion appropriate in dealing with all language, speech, reasonable measures to obtain consent and the parent and communication disorders. Counseling may be has not responded [Section 614 (c)(3)]. appropriate for parents, families, and/or students, depending on the age of the student. The process of Re-evaluation may include: counseling improves two-way communication. Im- • re-evaluations conducted as required by IDEA13 proved communication affects the ability to make de- (This comprehensive evaluation includes as- cisions regarding cause/effect (etiology), appropriate sessment results as well as consideration of all intervention, and transfer and maintenance (carryover) pertinent information: classroom-based assess- (Johnston & Umberger, 1996). Johnston and Umburger ments, observations, and information provided also list three methods of counseling: by the parent.) • interpersonal communication • annual reviews conducted to evaluate and re- • indirect counseling vise the IEP to ensure that goals and objectives • direct counseling reflect the student needs. (Progress is documented, outcomes are reviewed, and goals are Counseling for students and families includes: affirmed or revised.) • assessment of counseling needs • ongoing/periodic evaluation of student re- • assessment of family goals and needs sponses observed and documented during in- • provision of information tervention (e.g., dynamic assessment and observing improvements with scaffolding14) • strategies to modify behavior or environment relating to speech and language Revisions to the intervention plan and to the IEP • development of coping mechanism and systems are made when necessary. for emotional support Re-evaluation leads to: • development and coordination of self-help and • continuation or modification of the current spe- support groups relating to speech and language cial education program or related service It is the responsibility of the speech-language pa- • referral to additional special education pro- thologist to: grams or appropriate related service agencies • develop open and honest communication • dismissal • collaborate with students and families to determine and meet counseling/information support needs • determine when it would be appropriate to pro- 13 If the IEP Team determines that no additional data are vide direct or indirect counseling relating to needed to determine whether the student continues to speech and language issues be a student with a disability, the LEA may notify the parent of that determination and the reasons for it and • refer students or families with counseling issues the right of the parents to an assessment to determine to licensed and certified professionals when ap- whether the student continues to be a student with a propriate disability. Unless the parent requests such an assess- Re-Evaluation ment, a reevaluation is not required [Section 614(c)(4)]. 14 The concepts of dynamic assessment and scaffolding are Re-evaluation needs are addressed by the IEP team addressed in Wallach and Butler (1994) by several au- for all students eligible for special education or related thors: Nelson; Palincsar et al.; Silliman and Wilkinson; and van Kleeck III - 284 / 1999 ASHA 2002 Desk Reference Volume 3 • Speech-Language Pathology

Transition • progress with previous services (Florida State Department of Education, 1995) Speech-language pathologists participate on planning teams to assist students in successful transition. A local education agency shall evaluate a stu- Transition may entail a change: from special educa- dent with a disability before determining the student tion to general education; between such levels as early is no longer a student with a disability [Section 614 intervention (infant and toddler), preschool, elemen- (c)(5)]. An IEP review team convenes to review all tary, and secondary school programs; or from high standardized and nonstandardized assessment school to post-secondary destinations including em- information, and a formal meeting is scheduled if ployment, vocational training, military, community dismissal is indicated. college, or 4-year college. Dismissal occurs when a student no longer needs Students who have been in self-contained, special- special education or related services to take advantage ized classes require encouragement and support dur- of educational opportunities. Reasons for dismissal ing transition to a less-restrictive environment. For and the interdisciplinary team’s recommendation for transition to be successful, it is important to commu- dismissal are documented. State regulations and nicate with parents, teachers, and other professionals guidelines vary as to when dismissal is appropriate. in order to integrate speech and/or language goals into The Illinois State Board of Education (1993) specifies the home, classroom, other programs, and the commu- that students must meet one of three exit criteria: nity. Progress and outcomes are documented in each • The need for specialized services to address the setting. adverse effect(s) on educational performance is The school-based speech-language pathologist is no longer present. a member of the team that supports a student’s effec- • The disability no longer has an adverse effect tive transition. Both “sending” and “receiving” on the student’s educational performance. speech-language pathologists are involved in the IEP • The disability no longer exists. development process as well as in program planning at the time of transition. Numerous states and some districts have developed dismissal standards for each language and The school-based speech-language pathologist speech disorder based on a matrix of severity ratings prepares students for the anticipated communication to be used as general guidelines for assisting speech- demands of vocational or post-secondary settings. language pathologists with dismissal decisions (see Promoting transition readiness at each level enhances Appendices J and K). the student’s and parent’s level of comfort, confidence, and success in the new environment (see further [Sec- The speech-language pathologist considers the tion 614(d)]). federal mandates, state regulations and guidelines, and local education agency dismissal criteria. ASHA’s Dismissal Report on Admission/Dismissal Criteria (1994a) is The discussion of dismissal actually begins dur- also available to assist with dismissal decisions. ing the eligibility staffing meeting when prognostic Supervision indicators and guidelines for dismissal are discussed with the parent.15 Although the prognosis may change The speech-language pathologist may, given his/ over time, consideration should be given to: her position, provide supervision to speech-language pathologists, and/or support personnel, when super- • potential to benefit from intervention visory requirements have been met. The term clinical • medical factors supervision refers to the tasks and skills of clinical • psychosocial factors teaching related to the interaction between the speech- • attendance language pathologist and the client. Clinical supervision in speech-language pathology is a distinct area • parent involvement of expertise and practice requiring specific competen- • teacher involvement cies (ASHA, 1985b, 1989d). Supervisors are often role • other disabling conditions models for the beginning professional or support per- • student motivation sonnel. Clinical supervision within the school setting relates to supervision of:

15 • colleagues who are completing their clinical . According to ASHA’s Code of Ethics, “Individuals shall fellowship requirement for ASHA’s certificate not guarantee the results of any treatment or procedure, directly or by implication; however, they may make a of clinical competence (CCC; ASHA, 1994b; reasonable statement of prognosis” (ASHA, 1994d, p. 1). 1997b; 1997g) Guidelines • Roles and Responsibilities of the School-Based Speech-Language Pathologist 1999 / III - 285

• speech-language pathology assistants in accor- of a supervisor (e.g., knowledge of the law, budgets, dance with ASHA’s Code of Ethics (1994d); the ethics and performance appraisals). These competen- Guidelines for the Training, Credentialing, Use and cies may be obtained through continuing education op- Supervision of Speech-Language Pathology Assis- portunities, additional coursework, and other programs tants (ASHA, 1996a); and state regulations and in the supervisory process. The administrator/ supervi- guidelines for the use of support personnel sor may be the person who supervises and conducts the • university practicum students according to performance appraisal of the speech-language patholo- specific university guidelines, state regulations gist. (See performance appraisal below). and guidelines, and ASHA (1994h) Documentation and Accountability • school-approved volunteers who assist with Documentation and accountability are required clerical and materials management within the for each of the core roles of the school speech-language speech-language program pathologist (see Table 12). Documentation is needed An administrator/supervisor of a school program for the student; family; federal, state, and local require- should have the expertise and competencies required ments; and third-party insurance payers.

Table 12. Core Roles and Required Documentation.

Core Roles Examples of Documentation

Prevention Team meetings, schedules, plans, regular education classroom program

Identification Observation notes, anecdotal records, cumulative file, medical history, teacher checklists, referral form

Assessment/ Standardized test protocols, nonstandardized interview and observation notes, Evaluation portfolios, assignment reports, parent input

Eligibility Federal, state or local education agency (SEA, LEA) eligibility criteria Determination Severity ratings and interdisciplinary team report (when applicable)

IEP/IFSP Individualized education program (IEP) Development Individualized family service plan (IFSP) Parent, teacher and other professional input

Caseload IEP/IFSP, schedule, attendance records, progress reports Management

Intervention Standardized and descriptive assessment information, treatment outcomes measures, third-party documentation, goals and objectives, benchmarks, lesson plans, treatment notes, progress reports

Counseling Assessment data, anecdotal records, progress notes, release of information forms, record of referrals

Re-evaluation Federal, SEA, or LEA documentation

Transition Federal, SEA, or LEA documentation

Dismissal Federal, SEA, or LEA dismissal criteria Severity ratings and interdisciplinary team report (when applicable)

Supervision Performance appraisals, observation notes III - 286 / 1999 ASHA 2002 Desk Reference Volume 3 • Speech-Language Pathology

Clear and comprehensive records are necessary to • following billing and supervision procedures justify the need for intervention, to document the effec- • being familiar with health insurance and man- tiveness of that intervention, and for legal purposes. aged care Professionals in all positions and settings must be • being familiar with professional liability issues concerned with documentation. ASHA requires that (ASHA, 1991e; 1991f; 1994e; 1994g) “accurate and complete records [be] maintained for each client and [be] protected with respect to confiden- Treatment Outcomes Measures tiality” (ASHA, 1992b, p. 64; see also ASHA, 1994c; Treatment outcomes measures document evidence 1994f). of the effectiveness of intervention on communication Federal, State, Local Compliance and Procedural abilities. They are typically based on skills that may Safeguards be observed and recorded, and are not dependent on the treatment approach or method of service delivery. It is the role of the speech-language pathologist to Within the school setting, outcomes may reflect adhere to federal mandates, state regulations and performance that relates to the student’s educational guidelines, and local education agency policies and functioning within the classroom and with peers procedures related to parent/guardian notification, during a school day. ASHA is developing a National compliance documentation, and procedural safe- Outcomes Measurement System (NOMS) for speech- guards [Section 615(a-d)]. language pathology in pre-K and K–12 educational Progress Reports/Report Cards settings (ASHA, 1998g, 1999). Additional components Parents must be informed of their child’s progress of NOMS are being developed in health care settings “at least as often as nondisabled children’s progress” and audiology. [Section 614(d-A)viii]. The progress report includes: Responsibilities relating to collecting treatment • the student’s progress toward the annual goals outcomes data are to: • the extent that progress is sufficient to enable • collect and record data for eligibility, caseload the child to achieve the goals by the end of the planning and management, and dismissal pur- year poses Third-Party Documentation • collect and record data that reflect functional skills and performances Speech-language pathology services are a covered benefit under many private medical insurance plans • use functional communication measures or as well as the Medicaid program. State and local edu- functional status measures that reflect commu- cation agencies are authorized to use whatever federal, nication/educational change and consumer state, local, and private funding sources, including satisfaction family insurance, are available to pay for services in- • integrate functionally based goals or bench- cluded on a student’s IEP. School districts may seek marks into intervention programs Medicaid payment for speech-language pathology • use data collected to promote changes in service services provided to Medicaid-eligible students. Agree- delivery (ASHA, 1997c, 1998g) ments governing payment and procedures must be es- Performance Appraisal tablished between the applicable school district and the state Medicaid agency. Documentation is an important task of the supervisor in schools. Supervisors are responsible for conduct- Speech-language pathologists providing services ing performance appraisals of those being supervised. under Medicaid or other third-party insurance com- Performance appraisal is the practice of evaluating job- panies are responsible for: related behaviors. Professional performance appraisal is • investigating and understanding the state’s an important factor in facilitating a growth process that Medicaid policies and procedures should continue throughout an individual’s profes- • meeting minimum qualified personnel stan- sional career (ASHA, 1993c; Dellegrotto, 1991). Perfor- dards as defined by federal and state regula- mance appraisal is conducted to: tions • assist the person being supervised in the devel- • being aware of the parent’s right to informed opment of skills as outlined in the core roles consent • assist the person being supervised in the de- • providing the parent with sufficient informa- scription and measurement of his/her progress tion about third-party reimbursement processes and achievement • documenting treatment sessions Guidelines • Roles and Responsibilities of the School-Based Speech-Language Pathologist 1999 / III - 287

• assist the person being supervised in develop- Community and Professional Partnerships ing skills of self-evaluation School-based speech-language pathologists estab- • evaluate skills with the person being supervised lish community and professional partnerships beyond for purposes of grade assignment, completion the school setting to meet student and program needs. of the clinical fellowship requirements, and/or These partnerships include cooperation with audiolo- professional advancement (ASHA, 1985b) gists, community-based speech-language patholo- Risk Management gists, health care providers, the media and community, parents and parent groups, preschools, professional School speech-language pathologists must be organizations, and universities. The partnerships in- knowledgeable about risk management procedures in volve frequent, extensive, and open communication. relation to chronic communicable disease prevention Speech-language pathologists often coordinate alli- and management. Speech-language pathologists ances and seek ongoing input from participating part- should follow safety and health precautions that: ners. Cooperative partnerships enhance the quality of • ensure the safety of the patient/client and cli- services provided for students with communication nician and adhere to universal health precau- disorders and contribute to the success of school-based tions (e.g., prevention of bodily injury and speech and language programs. transmission of infectious disease) Audiologists • ensure decontamination, cleaning, disinfec- tion, and sterilization of multiple-use equip- The role of speech-language pathologists in pro- ment before reuse according to facility-specific viding services to students with hearing loss, deafness, infection control policies and procedures and and/or central auditory processing disorders is according to manufacturer’s instructions unique, and special considerations apply. Many stu- (ASHA, 1990a, 1991a, 1994f, 1997e) dents with hearing loss and/or central auditory processing disorders served by speech-language pathologists may benefit from hearing aids, cochlear III. Additional Roles and Opportunities implants, an assistive listening device or system, This section describes additional roles and oppor- environmental modification, large area amplification tunities for school-based speech-language patholo- systems, and/or instructional modification. In addi- gists. Table 13 provides an outline for those roles. tion to communication with audiologists from education settings, a close association with community-based audiologists is essential in providing services for students receiving their care.

Table 13. Additional Roles & Opportunities for School-Based Speech-Language Pathologists.

Additional Roles Opportunities

Community and Audiologists Professional Community-based speech-language pathologists Partnerships Health care providers Media/community Parents/parent groups Preschool personnel Professional organizations Universities

Professional Specialization Leadership Mentor Opportunities Research Schoolwide participation

Advocacy Students Programs Facilities III - 288 / 1999 ASHA 2002 Desk Reference Volume 3 • Speech-Language Pathology

Speech-language pathologists collaborate with Health Care Providers audiologists to: Speech-language pathologists collaborate with • provide or review hearing screenings and moni- health care providers and agencies to: tor the audiologic findings of students, includ- • prevent communication impairments through ing those on the speech-language pathologist’s preschool interdisciplinary screening programs caseload and early awareness initiatives • make referrals for audiologic evaluations • coordinate diagnostic and intervention • collaborate with audiologists to promote im- programs for children whose communication proved acoustic environments and accessibil- development or swallowing is affected by ity of classrooms and other school settings that health-related conditions and disorders facilitate communication and prevent noise- • consult with professionals serving on diagnos- induced hearing losses tic and treatment recommendation teams or • assist the audiologist in monitoring hearing clinics developed for specific physiologically aids, cochlear implants, group/classroom am- based conditions or disorders (e.g., cleft palate plification (FM auditory trainers), and assistive or cerebral palsy) listening devices or sound field systems in or- Media/Community der to maximize acoustic accessibility of students with hearing loss or other auditory Speech-language pathologists work with the me- disorders dia and the community to: • assist the audiologist and educators of students • initiate public awareness programs via with hearing loss in providing consultation promotional announcements, public radio with other education staff to develop instruc- and television presentations, school Internet tional modifications and/or to encourage use communications, and in the print media of technology, interpreters, and other accommo- • collaborate with other speech, language, audi- dations to meet the needs of students with hear- ology, and hearing professionals in cooperative ing loss or deafness public information projects such as Better Hear- • share pertinent information with education ing and Speech Month, health or career fairs, staff regarding language levels and communi- and departmental open houses and visitation cation needs as related to the student’s hearing programs loss • establish communications with community • facilitate an understanding by nondisabled service groups, nonprofit charity organizations, peers of the nature of hearing loss and deafness allied agencies, and the business community and the communication styles or modes of stu- for the purpose of informing, educating, and dents with hearing loss and deafness seeking grants for communication disorders programs in the schools Community-Based Speech-Language Pathologists • create and distribute public information bro- School-based speech-language pathologists estab- chures that describe speech-language pathol- lish communication links with area speech-language ogy programs in the schools and the referral pathology private practitioners and with employees of procedures for those programs diagnostic and treatment facilities that provide communication disorders services to preschool and school- Parents/Parent Groups age children to: Speech-language pathologists develop partner- • coordinate services for mutual clients, assuring ships with parents, families, and parent support opportunities for optimal benefits for the stu- groups to: dents and their families • provide information on the prevention of • form alliances for mutual referral resources communication disorders • share professional information and expertise • promote communication development and lit- among colleagues eracy skills of infants and young children • facilitate transition of services from community • provide information and recommendations for to public school speech-language programs positive speech and language development and home intervention strategies • advocate for the communication needs of students Guidelines • Roles and Responsibilities of the School-Based Speech-Language Pathologist 1999 / III - 289

• gain information about how the school speech- • provide practicum experiences in the school language program can best meet the needs of setting students and families • serve as adjunct faculty members Preschool Personnel • lecture to promote understanding of the scope Alliances with personnel from preschool child of practice and the roles and responsibilities of care centers, nursery schools and Head Start programs the speech-language pathologist within the are promoted by the speech-language pathologist at school setting sites that provide services to early childhood students. • recruit upcoming graduates by encouraging The partnership is established to: university students to consider school-based • consult with professional and paraprofes- career options sional staff members to facilitate educational • provide input for university program directors success and social communication skills and faculty regarding knowledge and skills • collaborate with families and preschool center needed to be an effective school-based speech- staff members to enhance the communication language pathologist skills of young children before school entry • form alliances with university diagnostic and • monitor the progress of children identified as treatment clinics for mutual referral resources at risk for and/or exhibiting communication and supplemental treatment options for stu- impairments who are enrolled at the commu- dents nity preschool sites • encourage regular and continuing education • establish procedures for appropriate referrals course work offerings and professional devel- to school-based speech-language pathologists opment opportunities that focus on the needs for children exhibiting communication prob- of the school-based speech-language patholo- lems gist • facilitate appropriate transition to public school • develop cooperative research projects relating programs to school-age populations Professional Organizations Professional Leadership Opportunities Speech-language pathologists are actively in- School-based speech-language pathologists have volved in national, state, and local professional multiple professional opportunities beyond core organizations to: roles and responsibilities. These opportunities allow • promote professional growth through attend- speech-language pathologists to assume leadership ing and presenting at national, state, and local roles, to develop initiatives, and to use their personal continuing education programs, workshops, attributes and professional expertise to provide posi- and conferences tive and significant contributions to students, educa- • read, author, or edit articles for professional tors, families, and the community. The decision to journals and other publications participate in these professional activities is made by each individual, after considering professional respon- • participate on committees, boards, councils, sibilities, time constraints, personal interests and ex- and task forces to advocate for the profession pertise. and for students with communication disorders Specialization • volunteer for leadership roles at the local, Speech-language pathologists who have acquired state, and national levels specialized training in a particular area can serve as specialists or mentors to other school-based providers. • participate in ASHA Special Interest Divisions Some school districts have designated specialists or other professional groups to network with within their speech-language departments to meet the colleagues regarding specific areas of profes- needs of various individuals, especially those with sional interest or expertise, thereby enriching lower-incidence disabilities. The need for specialists growth opportunities and participatory contri- depends on the school’s unique population of students butions (see Appendix B). with communication disorders as well as the exper- Universities tise of the speech-language pathologist(s) on staff. Speech-language pathologists may collaborate Examples of specialty positions and their related with universities to: duties follow. The list is not meant to be all-inclusive. III - 290 / 1999 ASHA 2002 Desk Reference Volume 3 • Speech-Language Pathology

• Assistive Technology Specialist: provides as- Mentor sessments for students, support to parents and Mentoring can be a critical element in building a classroom teachers, and technical assistance to career and attaining job satisfaction. It is effectively staff responsible for students identified as re- used in many organizations as a way to develop a new quiring alternative communication systems; professional’s knowledge of values, beliefs, and prac- recommends assistive devices that will enable tices. It can help in learning to apply clinical judgment students to communicate and participate in in a variety of scenarios. This translates into a more regular classrooms productive, efficient, and effective professional and • Autism Specialist: provides technical assistance has been reported to contribute to successful retention to staff responsible for students identified as and career satisfaction, better decision making, and autistic or exhibiting behaviors characteristic of greater perceived competence (Horgam & Simeon, the syndrome; provides assistance to speech- 1991; Huffman, 1994). language pathologists, classroom teachers, The speech-language pathologist has the oppor- parents, students, and administrators tunity to: • Bilingual Specialist: provides evaluations for • serve as a mentor to newly practicing school- bilingual students (e.g., English/ Spanish); as- based speech-language pathologists sists in scheduling a bilingual interpreter/ translator for parent communication and/or • provide assessment information and/or tech- assessment purposes; assists school-based nical assistance in specific disorder areas or speech-language pathologists regarding pro- service delivery options gramming for these students, or may provide • encourage advocacy efforts or provide advice direct intervention on administrative issues (ASHA, 1992a) • Cleft Palate Specialist: works with a team of Research medical and dental specialists; provides evalu- Speech-language pathologists collect treatment ation and management of velopharyngeal func- outcomes data in the school-based setting. School- tion related to hypernasality and nasal air flow based speech-language pathologists provide data to disorders; provides in-services to schools re- administrators, parents, and teachers on the outcomes lated to cleft lip/palate, craniofacial anomalies of services to students with communication disabili- and related disorders of velopharyngeal dys- ties. The general education environment offers the function, consults regarding management of opportunity to participate in research that can ad- maladaptive/compensatory articulation habits vance the professions (ASHA, 1997c; O’Toole, related to disorders of velopharyngeal dysfunc- Logemann, & Baum, 1998). tion and other resonance disorders The speech-language pathologist may: • Diagnostic Specialist: provides comprehensive evaluations for students referred for, or enrolled • promote opportunities for university faculty in, specialized language programs; assists and students to develop research projects with speech-language pathologists with difficult-to- school populations test students • assist in obtaining cooperation from school • Fluency Specialist: provides technical assis- administration, staff, and parents to implement tance to speech-language pathologists, teach- research initiatives ers, and parents or provides direct services to • seek funding for research opportunities students with fluency disorders • conduct research or collaborate with education • Resource Specialist: provides guidance for staff on research projects newly hired speech-language pathologists to • participate in treatment outcomes projects assist in the transition from academia to prac- Schoolwide Participation Opportunities tice or provides support for speech-language pathologists who transferred to a new level or The role of the school-based speech-language pa- setting thologist as an integral member of the total school staff is realized by active participation in school activities • Voice Specialist: provides assessments and/or and committees. Many opportunities exist for the technical assistance for students with sus- speech-language pathologist in the schools to make pected or confirmed voice disorders positive contributions as a cooperative, visible team player. Guidelines • Roles and Responsibilities of the School-Based Speech-Language Pathologist 1999 / III - 291

Recognizing that each school situation is unique, paperwork, consultations with parents and the speech-language pathologist may have the oppor- teachers, interdisciplinary meetings, and regu- tunity and may choose to become involved in larly scheduled direct and indirect services for schoolwide initiatives that will benefit the communi- students on the caseload (ASHA, 1993b) cation skills of all students in the school. Initiatives • an array of services to address differences in may include: type and severity of disorders • participating with professional colleagues in • adequate staffing levels to maintain manageable the development and revision of curricula to caseloads and for the financial resources nec- promote greater emphasis on communication essary to provide a sufficient number of quali- skills within the general education environment fied personnel • participating in district- and schoolwide pro- • professional development opportunities to fessional activities, such as committees and maintain a high-quality program through councils designated for curriculum develop- access to in-service training, professional ment, problem solving, conflict mediation and conferences, site visits to observe other speech- violence prevention teams, professional devel- language pathologists and students, and a opment, parent support and volunteer groups, professional library of current journals, books, recruitment, community relations, and hand- and videotapes book/guidelines development • adequate facilities for student evaluation and • participating in school events, projects, and intervention that meet federal, state, and local meetings, such as student performances, assem- safety and instructional standards (ASHA, blies, field trips, literacy and reading projects, 1992b; U.S. Congress, 1990a) and prekindergarten orientation programs • proper work conditions (e.g., lighting, natural • volunteering for leadership roles within the and artificial ventilation, acoustical treatment, school district and community relating to edu- heating/air conditioning) cational and communication enhancement • financial resources for appropriate equipment, goals with students materials, and diagnostic instruments to pro- • representing speech-language pathologists in vide services for students of varying ages, abili- contract negotiations regarding salary scale, ties, and disorders positive working conditions, and program de- • availability of computer hardware and software velopment necessary for instruction, assessment, records, Advocacy reports, and program management The school-based speech-language pathologist is • policies and procedures consistent with the a strong advocate for students enrolled in the speech- school’s mission and goals language program and works cooperatively to achieve • the communication needs of students in the the program goals and objectives. A student’s achieve- total school environment ment is enhanced when speech-language pathologists Advocacy training materials, including the and school administrators cooperatively team for ef- M-Power Box: The Power of One (School Version), are fective planning, coordination, and implementation of available from ASHA for school-based speech- speech-language programs as part of the total educa- language pathologists (ASHA, 1998e). tion system. School-based speech-language pathologists communicate with local, state, and federal policymakers as well as regulatory and legislative IV. Summary bodies about issues important to students with com- The roles and responsibilities specific to school- munication disorders. based speech-language pathologists have been shaped To assure quality service conditions for their stu- by national and state legislation and regulations; so- dents, school-based speech-language pathologists cietal factors; and by the scope, standards, and ethics advocate for: of the profession. These ASHA guidelines were developed to clarify the speech-language pathologist’s roles • adequate administrative support to carry out and responsibilities within the school setting. Speech- their roles and responsibilities language pathologists, school and district administra- • sufficient time within the workday and week for tors, lobbyists, and legislators may use these planning, diagnostics, observations, report guidelines to develop, modify, and/or describe high- writing, supervisory responsibilities, required quality, school-based speech-language programs. III - 292 / 1999 ASHA 2002 Desk Reference Volume 3 • Speech-Language Pathology

Students with communication disorders, their Aleman, S. R., Bruno, A., & Dale, C. V. (1995). English as the families, and the community benefit from the speech- official language of the United States: An overview. (Con- language pathologist’s professional expertise in the gressional Research Service Report for Congress). Wash- field of speech, language, and communication. The ington, DC 95-1054EPW. speech-language pathologist is an essential member Algozzine, B., & Ysseldyke, J. E. (1997). Strategies and tac- of the interdisciplinary, IEP, and education teams. tics for effective instruction (2nd ed.). Longmont, CO: Sopris West. (Eric Document Reproduction Service No. The core roles of the school-based speech-language ED 386889) pathologist are prevention, identification, assessment, American Psychiatric Association. (1994). Diagnostic and evaluation, eligibility determination, IEP/IFSP devel- statistical manual of mental disorders (4th ed.). Washing- opment, caseload management, intervention, counsel- ton, DC: Author. ing, re-evaluation, transition, and dismissal for American Speech-Language-Hearing Association. (1983, students with language, articulation/phonology, flu- September). Social dialects and their implications. Posi- ency, voice/resonance, or swallowing disorders. tion paper. Asha, 25, 23–27. Documentation/accountability and supervision are American Speech-Language-Hearing Association. (1985a, also considered core roles. Specific responsibilities for June). Clinical management of communicatively handi- each of these core roles are further delineated within capped minority language populations. Asha, 27, 29–32. these guidelines. American Speech-Language-Hearing Association. (1985b, Evolving roles for the school-based speech- June). Clinical supervision in speech-language pathology and audiology. Asha, 27, 57–60. language pathologist are discussed. The speech- language pathologist’s knowledge of normal versus American Speech-Language-Hearing Association. (1987). The role of speech-language pathologists in the habili- disordered communication is valuable in (a) distin- tation and rehabilitation of cognitively impaired indi- guishing language differences from disorders for viduals. Asha, 29(Suppl. 6), 53–55. bilingual students; (b) promoting understanding of American Speech-Language-Hearing Association. (1988, social dialects for students from culturally and lin- March). The role of speech language pathologists in the guistically diverse populations; and (c) evaluating identification, diagnosis, and treatment of individuals students with cognitive, sensory, neurological, ortho- with cognitive communicative impairments (Position pedic, or other health impairments who may also have Statement). Asha 30, 79. communication disorders. The speech-language American Speech-Language-Hearing Association. (1989a, pathologist’s knowledge is an asset to the education March). Bilingual speech-language pathologists and team when creating teaching strategies to enhance audiologists. Asha, 31, 93. literacy or social and behavioral communication American Speech-Language-Hearing Association. (1989b, skills for all students. May). Communication-based services for infants, toddlers, and their families. Asha, 31, 32–34, 94. Involvement in additional professional opportu- American Speech-Language-Hearing Association. (1989c, nities are increasingly important to the integrity of March). Issues in determining eligibility for language school-based speech-language pathology programs. intervention. Asha, 31, 113–118. These opportunities include community and profes- American Speech-Language-Hearing Association. (1989d, sional partnerships, leadership initiatives, and advo- March). Preparation models for the supervisory process cacy efforts. in speech-language pathology and audiology. Asha, 31, 97–106. 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American Speech-Language-Hearing Association. (1998a). Blachman, B. A. (1994). Early literacy acquisition: The role Bilingualism, LEP (limited English proficiency), and ESL of phonological awareness. In G. Wallach & K. Butler (English as a second language). Rockville, MD: ASHA Of- (Eds.). Language learning disabilities in school age children fice of Multicultural Affairs. and adolescents: Some principles and applications (pp. 253- American Speech-Language-Hearing Association. (1998b). 274). Needham Heights: MA: Allyn & Bacon. Guidelines for audiologic screening. Rockville, MD: Author. Bryan, T. (1996). A review of studies on learning disabled American Speech-Language-Hearing Association. (1998c). children’s communication competence. In R.L. Hearing loss: Terminology and classification (position Schiefelbusch (Ed.), Language competence assessment and statement and technical report). ASHA Desk Reference intervention (pp. 227–259). San Diego, CA: College Hill. (Vol. 4, pp. 16a–16b). 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Appendix A: ASHA Code of Ethics see the ASHA Desk Reference, volume 1, and the ASHA Web page

Appendix B: ASHA School-Related Resources

American Speech-Language-Hearing Association 10801 Rockville Pike, Rockville, MD 20852 301-897-5700 ACCESS ASHA Action Center Toll Free Numbers: Answer Line (IVR) 1-888-321-ASHA Consumers 1-800-638-8255 Members 1-800-498-2071 Product Sales 1-888-498-6699 Voice Mail (Long Distance) 1-800-274-2376 Fax-on-Demand 703-531-0866

• ASHA Web site — http://www.asha.or g

• ASHA School Services

• ASHA Special Interest Divisions (SIDs) 1. Language Learning and Education 2. Neurophysiology and Neurogenic Speech and Language Disorders 3. Voice and Voice Disorders 4. Fluency and Fluency Disorders 5. Speech Science and Orofacial Disorders 6. Hearing and Hearing Disorders: Research and Diagnostics 7. Aural Rehabilitation and Its Instrumentation 8. Hearing Conservation and Occupational Audiology 9. Hearing and Hearing Disorders in Childhood 10. Issues in Higher Education 11. Administration and Supervision 12. Augmentative and Alternative Communication 13. Swallowing and Swallowing Disorders (Dysphagia) 14. Communication Disorders and Sciences in Culturally and Linguistically Diverse Populations 15. Gerontology 16. School-Based Issues Note: Some Special Interest Divisions have listservs.

• State Speech-Language-Hearing Associations

• School Allied and Related Professional Organizations (ARPOs) * Council of Language, Speech and Hearing Consultants in State Education Agencies * Public School Caucus * Council of School Supervisors and Administrators Contact ASHA for further information on the above resources, other related professional contacts or resources such as position papers, guidelines, technical reports and relevant papers. Guidelines • Roles and Responsibilities of the School-Based Speech-Language Pathologist 1999 / III - 301

Appendix C: Goals 2000: Education America Act: National Education Goals

GOAL 1: “By the year 2000, all children in America will start school ready to learn. GOAL 2: “By the year 2000, the high school graduation rate will increase to at least 90 percent. GOAL 3: “By the year 2000, all children will leave grade 4, 8, and 12 having demonstrated competency over challenging subject matter including English, Mathematics, Science, Foreign Languages, Civics and Government, Economics, Arts, History, and Geography, and every school in America will ensure that all students learn to use their minds well, so that they may be prepared for responsible citizenship, further learning, and productive employment in our nation’s modern economy. GOAL 4: “By the year 2000, the nation’s teaching force will have access to programs for the continued improvement of their professional skills and the opportunity to acquire the knowledge and skills needed to instruct and prepare all American students for the next century. GOAL 5: “By the year 2000, United States students will be first in the world in Mathematics and Science Achievement. GOAl 6: “By the year 2000, every adult American will be literate and will possess the knowledge and skills necessary to compete in a global economy and exercise the rights and responsibilities of citizenship. GOAL 7: “By the year 2000, every school in the United States will be free of drugs, violence, and the unauthorized presence of firearms and alcohol and will offer a disciplined environment conducive to learning. GOAL 8: “By the year 2000, every school will promote partnerships that will increase parental involvement and participation in promoting the social, emotional, and academic growth of children.” Source: National Education Goals Panel. (1996). The National Education Goals Report. Washington, DC.

Appendix D: School Reform Issues Related to Speech-Language Pathology Analysis of recent and proposed changes in education policies and practices at national, state, and local levels: 1. Language and communication skills are the foundation of all learning. 2. Effective communication and language skills are fundamental for achievement of the eight national education goals. 3. Speech-language pathologists and audiologists are uniquely trained to enhance students’ language skills. Such professionals provide a valuable contribution to learning, in general, and school reform initiatives, more specifically. 4. Improved outcomes for consumers should be fundamental in school reform initiatives. 5. The rights and protections of individuals with disabilities must be maintained as education policies and practices change. 6. Providing initial preparation and continuing education to speech-language pathology and audiology professionals affects the quality of education that students with communication disorders receive. 7. The availability of qualified service providers affects each school district’s ability to meet the communication needs of its students. 8. Service delivery for students with communication disorders is undergoing significant change. 9. Technology will play an increasingly dominant role in education, affecting learners of all types, ages, and needs. 10. The effectiveness of school reform initiatives will depend on the availability and efficient use of resources. Source: American Speech-Language-Hearing Association. (1997). Trends and issues in school reform and their effects on speech- language pathologists, audiologists, and students with communication disorders. ASHA Desk Reference (Vol. 4, 310–310i). III - 302 / 1999 ASHA 2002 Desk Reference Volume 3 • Speech-Language Pathology

Appendix E: Advantages and Disadvantages of Types of Assessments

Advantages Disadvantages

Norm-referenced Designed for diagnosis Not designed for identifying specific language tests Allow comparison with age or intervention objectives grade peer group on an Norm group is representative of objective standard national samples, but may not be Facilitate comparisons across representative enough of the several domains to assess student’s background discrepancies and broad strengths/weaknesses

Criterion- Test for regularities in Not designed for use in making referenced performances against a set of criteria program placement or eligibility tests Useful for designing interventions, decisions interfacing with curriculum objectives, and describing where a student is along a continuum of skills

Checklists Easy to administer and practical Not designed to evaluate peer- Can give a broad evaluation in or age-group level areas judged important Address crucial academic skills on which referral is often based

Structured Permit guided evaluations of Can be time consuming observations communication in context Presence of observer may alter Can focus on several aspects behavior, especially in teens at once Occur on-site; are based on reality

Source: Ohio Department of Education (1991). Ohio handbook for the identification, evaluation, and placement of children with language problems. Columbus, OH: Author. Reprinted by permission.

Note. Other types of assessments are described in the assessment section of this Guidelines document. Guidelines • Roles and Responsibilities of the School-Based Speech-Language Pathologist 1999 / III - 303

Appendix F: Developmental Milestones for Speech and Language

Age Language and Speech Behaviors

1 year recognizes his or her name understands simple instructions initiates familiar words, gestures, and sounds uses “mama,” “dada,” and other common nouns

1 ½ years uses 10 to 20 words, including names recognizes pictures of familiar persons and objects combines two words, such as “all gone” uses words to make wants known, such as “more,” “up” points and gestures to call attention to an event and to show wants follows simple commands imitates simple actions hums, may sing simple tunes distinguishes print from nonprint

2 years understands simple questions and commands identifies body parts carries on conversation with self and dolls asks “what” and “where” has sentence length of two to three words refers to self by name names pictures uses two-word negative phrases, such as “no want” forms some plurals by adding “s” has about a 300-word vocabulary asks for food and drink stays with one activity for 6 to 7 minutes knows how to interact with books (right side up, page turning from left to right)

2 ½ years has about a 450-word vocabulary gives first name uses past tense and plurals; combines some nouns and verbs understands simple time concepts, such as “last night,” “tomorrow” refers to self as “me” rather than name tries to get adult attention with “watch me” likes to hear same story repeated uses “no” or “not” in speech answers “where” questions uses short sentences, such as “me do it” holds up fingers to tell age talks to other children and adults plays with sounds of language III - 304 / 1999 ASHA 2002 Desk Reference Volume 3 • Speech-Language Pathology

3 years matches primary colors; names one color knows night and day begins to understand prepositional phrases such as “put the block under the chair” practices by talking to self knows last name, sex, street name, and several nursery rhymes tells a story or relays an idea has sentence length of three to four words has vocabulary of nearly 1,000 words consistently uses m, n, ng, p, f, h, and w draws circle and vertical line sings songs stays with one activity for 8 to 9 minutes asks “what” questions

4 years points to red, blue, yellow, and green identifies crosses, triangles, circles, and squares knows “next month,” “next year,” and “noon” has sentence length of four to five words asks “who” and “why” begins to use complex sentences correctly uses m, n, ng, p, f, h, w, y, k, b, d, and g stays with activity for 11 to 12 minutes plays with language (e.g., word substitutions)

5 years defines objects by their use and tells what they are made of knows address identifies penny, nickel, and dime has sentence length of five to six words has vocabulary of about 2,000 words uses speech sounds correctly, with the possible exceptions being y, th, j, s/z, zh, and r knows common opposites understands “same” and “different” counts 10 objects uses future, present, and past tenses stays with one activity for 12 to 13 minutes questions for information identifies left and right hand on self uses all types of sentences shows interest and appreciation for print

6–7 years identifies most sounds phonetically forms most sound-letter associations segments sounds into smallest grammatical units begins to use semantic and syntactic cues in writing and reading Guidelines • Roles and Responsibilities of the School-Based Speech-Language Pathologist 1999 / III - 305

begins to write simple sentences with vocabulary and spelling appropriate for age; uses these sentences in brief reports and creative short stories understands time and space concepts, such as before/after, second/third comprehends mathematical concepts, such as “few,” “many,” “all,” and “except”

8, 9, 10, 11 years by second grade, accurately follows oral directions for action and thereby acquires new knowledge substitutes words in oral reading, sentence recall, and repetition; copying and writing dictation are minimal comprehends reading materials required for various subjects, including story problems and simple sentences by fourth grade, easily classifies words and identifies relationships, such as “cause and effect”; defines words (sentence context); introduces self appropriately; asks for assistance exchanges small talk with friends initiates telephone calls and takes messages gives directions for games; summarizes a television show or conversation begins to write effectively for a variety of purposes understands verbal humor

11, 12, 13, 14 years displays social and interpersonal communication appropriate for age forms appropriate peer relationships begins to define words at an adult level and talks about complex processes from an abstract point of view; uses figurative language; organizes materials demonstrates good study skills follows lectures and outlines content through note taking paraphrases and asks questions appropriate to content

Adolescence and interprets emotions, attitudes, and intentions communicated by others’ facial young adult expressions and body language takes role of other person effectively is aware of social space zones displays appropriate reactions to expressions of love, affection, and approval compares, contrasts, interprets, and analyzes new and abstract information communicates effectively and develops competence in oral and written modalities

Source: Ohio Statewide Language Task Force. (1990). Developmental milestones: Language behaviors. In Ohio Handbook for the Identification, Evaluation and Placement of Children with Language Problems (1991). Columbus: Ohio Department of Education. Reprinted by permission.

Editor’s Note. These milestones are variable due to individual differences and variance in the amount of exposure to oral and written communication. III - 306 / 1999 ASHA 2002 Desk Reference Volume 3 • Speech-Language Pathology

Appendix G: Example of a Severity/Intervention Matrix

Clinical judgment may necessitate modification of these guidelines.

Mild—1 service delivery unit Moderate—2 service delivery units Minimum of 15–30 minutes per week Minimum of 31–60 minutes per week

Severity of Impairment minimally affects the Impairment interferes with the individual’s Disorder individual’s ability to communicate ability to communicate in school learning in school learning and/or other social and/or other social situations as noted by situations as noted by at least one other at least one other familiar listener. familiar listener, such as teacher, parent, sibling, peer.

Articulation/ Intelligible over 80% of the time in Intelligible 50–80% of the time in Phonology connected speech. connected speech. No more than 2 speech sound errors Substitutions and distortions and some outside developmental guidelines. omissions may be present. There is Student may be stimulable for error limited stimulability for the error sounds. phonemes.

Language The student demonstrates a deficit in The student demonstrates a deficit in receptive, expressive, or pragmatic receptive, expressive or pragmatic language as measured by two or more language as measured by two or more diagnostic procedures/standardized diagnostic procedures/standardized tests. Performance falls from 1 to 1.5 tests. Performance falls from 1.5 to 2.5 standard deviations below the mean standard deviations below the mean standard score. standard score.

Fluency 2–4% atypical disfluencies within a 5–8% atypical disfluencies within a speech sample of at least 100 words. speech sample of at least 100 words. No tension to minimal tension. Noticeable tension and/or secondary characteristics are present. Rate and/or Prosody: Rate and/or Prosody: Minimal interference with Limits communication. communication.

Voice Voice difference including hoarseness, Voice difference is of concern to parent, nasality, denasality, pitch, or intensity teacher, student, or physician. Voice is inappropriate for the student’s age is not appropriate for age and sex of the of minimal concern to parent, teacher, student. student, or physician. Medical referral may be indicated. Medical referral may be indicated. Guidelines • Roles and Responsibilities of the School-Based Speech-Language Pathologist 1999 / III - 307

Appendix G: Example of a Severity/Intervention Matrix (cont.)

Severe—3 service delivery units Profound—5 service delivery units Minimum of 61–90 minutes per week Minimum of 91+ minutes per week

Impairment limits the individual’s ability to Impairment prevents the individual from communicate appropriately and respond communicating appropriately in school in school learning and/or social and/or social situations. situations. Environmental and/or student concern is evident and documented.

Intelligible 20–49% of the time in connected Speech is unintelligible without gestures speech. Deviations may range from and cues and/or knowledge of the context. extensive substitutions and many omissions Usually there are additional pathological to extensive omissions. A limited number or physiological problems, such as of phoneme classes are evidenced in a neuromotor deficits or structural deviations. speech-language sample. Consonant sequencing is generally lacking. Augmentative communication systems Augmentative communication systems may be warranted. may be warranted.

The student demonstrates a deficit in The student demonstrates a deficit in receptive, expressive or pragmatic language receptive, expressive or pragmatic language as measured by two or more diagnostic that prevents appropriate communication procedures/standardized tests (if in school and/or social situations. standardized tests can be administered). Performance is greater than 2.5 standard deviations below the mean standard score. Augmentative communication systems Augmentative communication systems may may be warranted. be warranted.

9–12% atypical disfluencies within a More than 12% atypical disfluencies within speech sample of at least 100 words. a speech sample of at least 100 words. Excessive tension and/or secondary Excessive tension and/or secondary characteristics are present. characteristics are present. Rate and/or Prosody: Rate and/or Prosody: Interferes with communication. Prevents communication.

Voice difference is of concern to parent, Speech is largely unintelligible due to teacher, student or physician. Voice is aphonia or severe hypernasality. Extreme distinctly abnormal for age and sex of effort is apparent in production of speech. the student. Medical referral is indicated. Medical referral is indicated.

Notes. By the age of 7 years, the student’s phonetic inventory is completed and stabilized (Hodson, 1991). Adverse impact on the student’s educational performance must be documented. If the collaborative consultation model of intervention is indicated at the meeting, the student receives one additional service delivery unit. Source: Illinois State Board of Education. (1993). Speech-language impairment: A technical assistance manual. Springfield: Au- thor. Reprinted by permission. Editor’s Note. The state or district matrix may be used as a general guideline, but the amount of service per week is determined by the IEP team to meet the individual needs of the students. III - 308 / 1999 ASHA 2002 Desk Reference Volume 3 • Speech-Language Pathology

Appendix H: Signs and Effects of Communication Disorders

Type of Disorder Signs Effects

Social Learning

Language Student may show Student may be Student may fail to impaired comprehen- excluded from play understand instruction. sion and poor verbal and group activities. This may have the expression. Student may withdraw same result as missing from group situations. school altogether. “Learning problems” may result.

Articulation/ Abnormal production of Student may be ridiculed Student may have Sound Sequencing speech sounds; “speech or given“cartoon decoding or compre- impairment”; speech character”nickname; hension problems with sounds not typical for may be ignored or respect to specific student’s chronological excluded from group words. age. activities.

Fluency Abnormal flow of verbal Student may be ridiculed Student may do poorly expression, characterized by others. Student may on reports, oral by impaired rate or begin to avoid speaking assignments, and rhythm and perhaps in group settings. reading. Student may “struggle behavior.” withdraw from group learning activities.

Voice Abnormal vocal quality, Student may be Student’s self- pitch, loudness, ridiculed, ignored, or confidence may suffer. resonance, and excluded from play or This may lead to duration may be group activities. withdrawal from evidenced. Child’s voice participation in class, does not sound “right.” and grades may fall.

Hearing Student may give Student may appear to Student may fail to evidence of not be isolated. Student follow directions or fail hearing speech. may not participate in to get information group activities as a from instruction. matter of course.

School Meeting Kit (ASHA, 1989). Document out of print. Permission granted to reproduce. Guidelines • Roles and Responsibilities of the School-Based Speech-Language Pathologist 1999 / III - 309 e educational (p. 20). Tallahassee: Florida Depart- ______Comments: ___ Other: ___ No vocational impact reported. student about communicationabout student ___ Unable to answer/ask questions Social Impact Vocational Impact ______s: Job-related skills/competencies student cannot No social impact reported. Communication problem interferes with demonstrate due to communication problems: terminating verbal interactions. supervisor’s comments. __ Student has difficulty maintaining and__ coworker’s to response Inappropriate ___ Comments: ______Other: Appendix I: Example of an Educational Relevance Chart A resource manual for the development and evaluation of special programs exceptional students ______

process in one or more of the following areas:

______County, Florida. (1995). In •• Academic — ability to benefit from the curriculum • Social — ability to interact with peers and adults Academic Impact Vocational — ability to participate in vocational activities No academic impact reported. ___ . Example only; state and local procedures may vary. Academic areas affected by communicationproblems: Social areas affected by communication (Applicable for secondary students) problem __ Reading __ Math __ Language Arts __ Other: __ Academics below grade level.activities.language-based with Difficulty __ __ Difficulty comprehending information problem.orally.information conveying Difficulty __ __ Other:______Student demonstrates embarrassment ___ Peers tease communication problem. peers. ___ ability to be understood by adults and/ororal understand/follow to Inability ___ in a coherent/concise manner. directions. ment of Education. Adapted with permission by Lee County and Florida Department Impact documented by:documented Impact Comments: presented orally. and/or frustration regarding ______***** ______***** ***** ______does /does not demonstrate a communication disorder that negatively impacts the ability to benefit from th Source: Lee (Name of student) Note III - 310 / 1999 ASHA 2002 Desk Reference Volume 3 • Speech-Language Pathology

Appendix J: Example of Entry/Exit Criteria for Caseload Selections Worksheet

Student’s Name: ______Date:______Speech-Language Pathologist: ______Section I. The student HAS/DOES NOT HAVE a communication disorder. The disorder is in articulation/___ language/___ voice/___ fluency/___. (Circle and indicate severity.) Factors preventing designation of a communication disorder are: ______Section II. The communication disorder DOES/DOES NOT impact educational performance and IS/IS NOT an educational disability. ____ The problem affects social/emotional development or adjustment in the school setting. ____ The problem affects participation in the school program. ____ The problem affects academic achievement (i.e., the acquisition of skills basic to learning: reading, writing, math, etc.). ____ The problem interferes with effective communication (opinions from others who interact with the student must be sought). Section III. The student SHOULD/SHOULD NOT be considered for speech/language intervention.

Entry/continuation: Recommendation is based on Exit/dismissal: Recommendation is based on existence of all of the following as determined by the existence of one or more of the following as determined speech-language pathologist: by the speech-language pathologist: ___ Student has a communication disorder that is ___ Student has met terminal goals and objectives amenable to intervention. in deficit areas. OR ___ Student’s cognitive/developmental level ___ Student’s communication disorder is related appears sufficient to acquire targeted skill(s) to a medical/physical or emotional problem based on information available at this time. and is not considered amenable to ___ Student’s deficit areas require the intervention intervention at this time. (direct or indirect) of a speech-language ____ Student’s cognitive/developmental level does pathologist. not appear to be sufficient to acquire ___ Student does not demonstrate adequate targeted skill(s) at this time. compensatory skills for deficit areas. ____ Student’s deficit areas can be managed through classroom modifications or by another service provider. ____ Student has developed compensatory skills that are functional in the deficit areas. ____ Student does not have regular school and/or therapy attendance pattern. ____ Student does not demonstrate motivation to participate. ____ Student does not have the attentional and behavioral skills appropriate for intervention (adaptations and other models of intervention have been tried). ____ Student has made little or no measurable progress in ___ months or ___ years of consistent intervention. Guidelines • Roles and Responsibilities of the School-Based Speech-Language Pathologist 1999 / III - 311 ___ the rmal limits rcent of the clear, the rate e performance is imal duration, or ge. iate report of the Admission, a is met: The modal pitch is optimal, Date ______onger benefiting from speech-language intervention. no adverse effect on time under varying conditions age, sex, and speaking situationsopt an at is __ The student demonstrates fluency __ Speech-Language Pathologist ______Appendix K: Example of a Dismissal Criteria Chart of remediation. or __ The student’s language skills areremediatedin adequate judged educational performance and areas of content, structure, minimal or no listener and usage, or auditory processing of use. as determined by informal measures. speaker reaction. __ The student with a disability that precludes normal expressive language is eligible for dismissal when he/she can communicate by using an augmentative communication system. ______Review, Dismissal meeting.) Student Name ___ Speech-language problem no longer interferes with the student’s educational performance including social, emotional, academic, or vocational functioning. developmental factors, the student’s speech-languag within the expected language performance ran Specific Dismissal Criteria Phonology __ The student maintains apercent75 of minimum correct production of error __The student scores less than 2.0 expected language performancethebelow deviations standard Language that is within normal limits for laryngeal tone is behaviors. compensatory appropriate achieved has student The ___ Fluency Voice The student is eligible for dismissal when reevaluation documents that one or more of the general specific criteri General Dismissal Criteria ___ Speech-language problem no longer exists. ___ Student is no l School Comments ______phonemes on TALK probes administered at 8 and 16 week intervals range on appropriate standard-areasevaluate that tests ized or exhibits some transitory minimalis There dysfluencies. nasality is within no pe 80 of minimum a Speech-language problem is no longer a disability. ___ Given current medical, neurological, physical, emotional, or Source: Howard County Public Schools, Ellicott City, Maryland, (1997). Reprinted by permission. Note: Example only. State and local dismissal criteria vary. Follow state regulations policies procedures. SLP 11 White Copy: Student FolderStudent Copy: White 11 SLP Yellow Copy: Speech-Language Pathologist Pink Parent (Attach to the appropr