TECHNICAL ASSISTANCE AND BEST PRACTICES MANUAL Speech-Language Pathology in the Schools

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1 I. Definition and Overview Central Consolidated School District No. 22 TECHNICAL ASSISTANCE AND BEST PRACTICES MANUAL Speech-Language Pathology in the Schools Speech and/or language impairments are those disorders that adversely affect a student s educational performance by interfering with or limiting the student s ability to communicate in terms of reception, integration, formulation or expression of information, thoughts or feelings when compared to their peers within the linguistic environment. Speech and language impairments may have etiologies of a functional and/or organic nature. Dysfluency exists when the child exhibits abnormal disruptions in the normal, rhythmic flow of speech that are markedly noticeable and are not readily controllable. Articulation Impairment involves the impaired reception, processing or production of phonemes (speech sounds). Production errors may be classified into appropriate phonological processes or individual sound omissions, substitutions, additions, or distortions. Voice Impairment is an abnormality in pitch, resonance, loudness or quality for age and/or sex. Language Impairment is an impairment in the ability to comprehend, process or produce language in terms of form, content or use. Areas involved include expressive language, receptive language, integrative language, vocabulary and pragmatics, and their impact on reading, writing, and other communicative modes. Research on the sequence and process of normal language and speech development provides the framework for determining whether the student exhibits a communication disorder, delay, or difference. Although the distinction among disorder, delay, and difference is not always easily determined, the following American Speech-Language-Hearing Association (ASHA) definitions are provided to clarify the terms. A communication disorder is an impairment in the ability to send, receive, process, and/or comprehend verbal, nonverbal, and/or graphic symbol systems. A communication disorder may be evident in the process of hearing, language, or speech; may be developmental or acquired; and may range in severity from mild to profound. A communication disorder may result in a primary disability or it may be secondary to other abilities (ASHA, 1993a, p. 40). A communication delay exists when the rate of acquisition of language or speech skills is slower than expected according to developmental norms; however, the sequence of development is following a predicted order (Nicolosi, 1989). For eligibility purposes, determination of the level of delay that is considered significant is specified in state regulations and guidelines or local policies and procedures. 1

2 A communication difference is a variation of a symbol system used by a group of individuals that reflects and is determined by shared regional, social, or cultural/ethnic factors. A regional, social, cultural, or ethnic variation of a symbol system is not considered a disorder of speech or language (ASHA, 1993a, p. 41). Limited English Proficiency is not, in itself, a qualification for speech/language intervention services, although a student with Limited English Proficiency may also have a qualifying speech-language impairment. Speech-language pathologists (SLPs) are professionally trained to prevent, screen, identify, assess, diagnose, refer, provide intervention for, and counsel persons with, or who are at risk for, articulation, fluency, voice, language, communication, swallowing, and related disabilities. In addition to engaging in activities to reduce or prevent communication disabilities, SLPs also counsel and educate families or professionals about these disorders and their management (ASHA, 1996c). In the Central Consolidated School District (CCSD), speech-language services are provided to students who have communication impairments that adversely affect educational performance. The linkage between the speech and/or language impairment and educational performance will be made by the SLP based on current evaluations/performance reports and recommendations by the multidisciplinary team and will be documented on the IEP. II. Assessment It is necessary to exercise caution when using standardized tests that have been normed on populations different from that of the student being tested. SLPs recognize cultural differences, and the interpretation of test results is modified according to this knowledge. When possible, the establishment of local norms is encouraged so that appropriate normative comparisons may be made. Dialects reflect basic behavioral differences between groups of individuals within a society and should be considered natural cultural manifestations of group differences. Dialectal variations of English may be present in any or all components of the language system (phonology, morphology, syntax, semantics and pragmatics) and do not constitute a language disorder. It is important that SLPs be able to distinguish between dialectal differences and communication disorders. It is the role of the SLP to treat only those features or characteristics that are true errors and not attributable to the dialect. (See Comparison of Navajo and English Adapted from Young, RW. English as a Second Language for Navajos: An Overview of Certain Cultural and Linguistic Factors. Navajo Area Office; Division of Education, Bureau of Indian Affairs; In Battle, Dolores E., Communication Disorders in Multicultural Populations, Andover Medical Publishers, 1993, p ) A core role of the school-based SLP is to conduct a thorough and balanced communication assessment. SLPs should select assessment measures that: 1) consider cultural and linguistic differences, 2) are appropriate for the student s age, 3) match the stated purpose of the assessment tool to the reported needs of the student, 4) describe differences when compared to peers, 2

3 5) describe the student s specific communication abilities and difficulties, 6) elicit optimal evidence of the student s communication competence, and 7) describe real communication tasks. Within CCSD many students are not represented by the normative samples used for traditional norm referenced tests. For these students, although standardized tests should be administered, they should be treated as criterion-referenced tests with professional judgement being used in interpretation of test results. Evaluation of school aged children should include a speech/language assessment that attempts to address all facets of the suspected disability. They must include, but are not limited to the following: 1. Language Disorders Vocabulary/ Concepts Auditory processing Grammar/Sentence structure Linguistic organization/word retrieval Language sample 2. Articulation Disorders Oral peripheral examination Standardized articulation test Speech sample 3. Voice Disorders Oral peripheral examination Analysis of voice samples, perceptual and/or technological Laryngeal examination report with written approval form from an otolaryngologist or other physician for a child to receive voice therapy 4. Fluency Formal fluency test Observation in setting other than therapeutic Background history from parent Evaluation must include observations of classroom structure and curriculum as well as individual student strengths and weaknesses when compared to peers within their linguistic environment. To insure that assessment considers the educational effects of an impairment, the student s teacher is a required partner in assessing eligibility. It must be remembered that the educational needs of a child with a disabling condition include non-academic, (socialemotional and vocational areas) as well as academic areas, and that the term educational performance as used in IDEA (Individuals with Disabilities Education Act) means more than academic standards as determined by standardized measures. 3

4 The child s teacher should present information regarding the child s speech and language functioning level within the classroom. Teacher classroom observation, student portfolio and other assessment instruments can be used to structure the information collection process from teachers. Important considerations should include: 1) the child s ability to process information (academic and social information) and, 2) the child s ability to express information, noting the quality and frequency of speech and language production. The second necessary element is the opportunity for parental input. This is especially critical for the preschool child. Parents are able to provide valuable information regarding the child s communicative behavior in various settings and the SLP should listen to parental concerns to gain clues about the level of development at which the child functions. Both teacher input and parent input can give the SLP essential information regarding the child s communicative performance. The SLP should analyze this information and compare it with the standardized testing and observations obtained. III. Placement Considerations The definition of speech or language impairment at the federal level appears in IDEA: a communication disorder, such as stuttering, impaired articulation, a language impairment or a voice impairment that adversely affects a child s educational performance. As part of the eligibility determination for special education and related services, the team must address the relationship between the student s speech and language disabilities and any adverse effect on the student s ability to learn the general curriculum, including academic, social-emotional, or vocational areas. Because of the cultural/linguistic diversity of this population, standardized norms and cut off scores are not appropriate for determining eligibility. Professional judgement and consultation with other professionals experienced in working with this population must be considered. The following are appropriate questions to be considered in determining eligibility and placement: 1) Does the student s speech or language differ significantly from that of his/her peers? 2) What is the nature or etiology of the speech-language impairment? 3) What is the degree of the deficit(s)? 4) What are the strengths and weaknesses of the student s communication system(s)? 5) What is the impact of the speech-language impairment(s) on the student s educational performance? 6) Do the student s communication skills meet his/her needs in current learning environments? 7) Would providing speech/language therapy to this student significantly change his/her ability to communicate? 4

5 IV. Speech Language Assessment of Pre-school Aged Children Evaluation of pre-school aged children should be completed from a variety of sources including attempts at standardized testing, caretaker observation and report, SLP observation, and developmental/medical history. Evaluation procedures must result in a description of the speech and language characteristics manifested by the student and the effect of the student s speech and language deficits on his/her educational performance. For pre-school children, the effect of the deficit in the home environment is considered because the home is the child s primary educational setting. Delays or deviancies in communication skill development that significantly interfere with the child s ability to engage in interactions in the home have an adverse effect on educational performance. Parent/home communication checklists can be used to structure the information collection process from parents. SLPs charged with responsibility for early identification of preschool students need to be sensitive to the wide variation in family systems and interactive styles surrounding successful communication and language development, as well as have knowledge of all aspects of normal development. V. Intervention A range of speech, language and hearing services is available through CCSD Exceptional Programs to support students with communication disorders. CCSD supports serving the student in the least restrictive environment that meets their needs and will be determined through the IEP. Service delivery is a dynamic concept and changes as the needs of the student change. No one service delivery model is to be used exclusively during intervention. Service Delivery options include: 1) Monitor: The SLP 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. 2) Collaborative Consultation: The SLP, 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 SLP does not provide direct service to the student 3) Classroom Based: This model is also known as integrated services, curriculum-based, transdisciplinary, interdisciplinary, or inclusive programming There is an emphasis on the SLP providing direct services to students within the classroom and other natural environments. Team teaching by the SLP and the regular and/or special education teacher(s) is frequent with this model. 4) Pullout: Services are provided to students individually and/or in small groups within the speech-language resource room setting. Some SLPs may prefer to provide individual or small group services within the physical space of the classroom. 5

6 5) Community Based: Communication services are provided to students within the home or community setting. Goals and objectives focus primarily on functional communication skills. 6) Combination: The SLP provides two or more service delivery options (e.g., provides individual or small group treatment on a pull-out basis twice a week to develop skills or preteach concepts and also works with the student within the classroom). For all service delivery models, it is important that time be made available in the weekly schedule for collaboration/consultation with parents, general educators, special educators and other service providers. VI. Dismissal Considerations The discussion of dismissal actually begins during the eligibility-staffing meeting when prognostic indicators and guidelines should be discussed with the parent. Although the prognosis may change over time, consideration should be given to: 1) potential to benefit from intervention, 2) medical factors, 3) psychosocial factors, 4) attendance, 5) other disabling conditions, 6) student motivation, 7) progress with previous service. Dismissal occurs when a student no longer needs special education or related services to take advantage of educational opportunities. Reasons for dismissal and the IEP team s recommendation for dismissal should be documented through the IEP and the Written Notice of Action. A Multidisciplinary Team Evaluation Report and the Written Notice of Action are necessary to dismiss a student completely from Special Education. Exit criteria to be considered include: 1) the need for specialized services to address the adverse effects on educational performance is no longer present, 2) the disability no longer has an adverse effect on the student s educational performance, 3) the disability no longer exists. A student should be exited or discharged from a speech-language program when the student has made significant communicative progress such that the handicapping condition no longer adversely affects his/her educational progress. 6

7 VI. Bibliography American Speech-Language-Hearing Association. (1993a, March). Definitions of communication disorders and variations. Asha, 35(Suppl. 1 0), American Speech-Language-Hearing Association. (1996c, Spring). Scope of practice in speechlanguage pathology. Asha, 38(Suppl. 16), Nicolosi, L., Harryinan, E., & Kresheck, J. (1989). Terminology of communication disorders: Speech-language-hearing. Baltimore, MD: Williams & Wilkins. Battle, Dolores E., (1993) Communication Disorders in Multicultural Populations, Andover Medical Publishers. 7

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