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Roles and Responsibilities of Speech-Language Pathologists in Early Intervention: Guidelines [Guidelines]

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Roles and Responsibilities of Speech- Language Pathologists in Early Intervention: Guidelines Ad Hoc Committee on the Role of the Speech-Language Pathologist in Early Intervention Reference this material as: American Speech-Language-Hearing Association. (2008). Roles and Responsibilities of Speech-Language Pathologists in Early Intervention: Guidelines [Guidelines]. Available from www.asha.org/policy. Index terms: early intervention, newborns, infants and toddlers, developmental disorders doi:10.1044/policy.GL2008-00293 © Copyright 2008 American Speech-Language-Hearing Association. All rights reserved. Disclaimer: The American Speech-Language-Hearing Association disclaims any liability to any party for the accuracy, completeness, or availability of these documents, or for any damages arising out of the use of the documents and any information they contain. Roles and Responsibilities of Speech-Language Pathologists in Early Guidelines Intervention: Guidelines About This This guidelines document is an official statement of the American Speech- Document Language-Hearing Association (ASHA). It was developed by ASHA's Ad Hoc Committee on the Role of the Speech-Language Pathologist in Early Intervention. Members of the Committee were M. Jeanne Wilcox (chair), Melissa A. Cheslock, Elizabeth R. Crais, Trudi Norman-Murch, Rhea Paul, Froma P. Roth, Juliann J. Woods, and Diane R. Paul (ex officio). ASHA Vice Presidents for Professional Practices in Speech-Language Pathology Celia Hooper (2003–2005) and Brian B. Shulman (2006–2008) served as the monitoring officers. The ASHA Scope of Practice in Speech-Language Pathology (ASHA, 2007) states that the practice of speech-language pathology includes providing services for infants and toddlers with communication needs. The ASHA Preferred Practice Patterns (ASHA, 2004e) are statements that define universally applicable characteristics of practice. The guidelines within this document fulfill the need for more specific procedures and protocols for serving infants and toddlers. It is required that individuals who practice independently in this area hold the Certificate of Clinical Competence in Speech-Language Pathology and abide by the ASHA Code of Ethics (ASHA, 2003b), including Principle of Ethics II, Rule B, which states that “individuals shall engage in only those aspects of the profession that are within their competence, considering their level of education, training, and experience.” This document was disseminated for select and widespread peer review to speech-language pathologists, speech, language, and hearing scientists; and audiologists with expertise in early intervention, family members of young children, graduate students in communication sciences and disorders, and related professionals. This document was approved by the ASHA Board of Directors (BOD 4-2008) in February 2008. The guidelines will be reviewed and considered for revision on a regular basis (within no more than 5 years from the date of publication). Decisions about the need for revision will be based on new research, trends, and clinical practices related to early intervention in speech-language pathology. **** Executive Summary The development of communication skills is a dynamic process that is shaped by interdependent factors intrinsic to the child and in interaction with the environment. The reciprocal and dynamic interplay between biology, experience, and human development converge to influence developmental experiences. Most importantly, the course of development is alterable through provision of early intervention services. The early intervention practices described in the Roles and Responsibilities of Speech-Language Pathologists in Early Intervention: Guidelines include those based on both internal (e.g., policy, informed clinical opinion, integrative scholarly reviews) and external evidence (e.g., empirical data) from the literature. As the Committee evaluated available external evidence, variation was apparent both in strength of the research designs and implementation (e.g., randomized control vs. observation without controls). Many of the practices detailed in the guidelines have not yet been studied adequately; however, when considered in terms of internal and external evidence, the practices demonstrate promise and were therefore included in the guidelines document. 1 Roles and Responsibilities of Speech-Language Pathologists in Early Guidelines Intervention: Guidelines Speech-language pathologists (SLPs) will need to consider both the strengths and the limitations of current empirical studies when evaluating the preponderance and quality of evidence for practices presented here. The Committee recognized that there are few areas of early intervention practice in which clear, unequivocal answers emerge from empirical research that can be applied confidently to broad classes of infants and toddlers with disabilities. In recognition of this, no attempt was made in this document to prioritize specific assessments, interventions, or treatment programs. The goal was to present a range of assessment and intervention practices with some basis in either internal or external evidence, in an effort to provide a backdrop against which clinicians can evaluate newly emerging external and internal evidence in making service decisions for particular children and families. This document includes conclusions and recommendations derived from available empirical evidence that were formed by consensus of the ASHA Ad Hoc Committee on the Role of the Speech-Language Pathologist in Early Intervention through five face-to-face meetings and nine phone conferences between November 2004 and December 2007. However, SLPs recognize that in areas for which empirical evidence is lacking, extrapolations from evidence with other populations and applications of principles stemming from theoretical models, societal norms, and government mandates and regulations also are relevant for decision making. Recommended practices are expected to change as new evidence emerges. Within a collaborative context, SLPs should be able to articulate both the principles and the levels of evidence that undergird their service delivery practices. SLPs serve as an integral part of a team, including families, that is responsible for formulating and implementing service delivery plans that meet the unique communication needs of infants and toddlers. The recommended knowledge and skills needed by SLPs serving infants and toddlers are presented in a companion document (ASHA, 2008a). Further, a technical report providing background and a basis for understanding the communication characteristics and challenges of infants and toddlers with or at risk for communication disabilities also was developed by the committee to provide further information and guidance on the implementation of the roles and responsibilities outlined in the position statement (ASHA, 2008b). Guiding Principles Four guiding principles that reflect the current consensus on best practices for providing early and effective communication interventions for infants and toddlers (birth to age 3 years) serve as a foundation for the design and provision of services. Specifically, services are (a) family-centered and culturally responsive; (b) developmentally supportive and promote children's participation in their natural environments; (c) comprehensive, coordinated, and team-based; and (d) based on the highest quality internal and external evidence that is available. Services Are Family-Centered and Culturally Responsive An aim of all early intervention services and supports is responsivity to family concerns for each child's strengths, needs, and learning styles. An important component of individualizing services includes the ability to align services with each family's culture and unique situation, preferences, resources, and priorities. The term family-centered refers to a set of beliefs, values, principles, and practices that support and strengthen the family's capacity to enhance the child's development and learning. These practices are predicated on the belief that families provide a lifelong context for a child's development and growth. The family, rather 2 Roles and Responsibilities of Speech-Language Pathologists in Early Guidelines Intervention: Guidelines than the individual child, is the primary recipient of services to the extent desired by the family. Some families may choose for services to be focused on the family, whereas others may prefer a more child-centered approach. Family-centered services support the family's right to choose who is the recipient of the services. Components of family-centered practices include offering more active roles for families in the planning, implementing, interpreting, and decision making in service delivery. Family-centered practices can maximize time and other resources, create closer alignment between family and professional decisions and plans, and increase decision making by families. Services Are Developmentally Supportive and Promote Children's Participation in Their Natural Environments Effective early intervention services and supports are based on theoretical, empirical, and clinical models of child development which assume that the acquisition of communication occurs within a social and cultural framework, and which make use of commonly accepted theories about how individual children learn communication, speech, language, and emergent literacy skills. Early identification and intervention practices that are developmentally supportive are
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