29. The History of School Speech Pathology

Root Causes

A perfect storm of elements hit school SLPs after 1975. By 1980 special education teachers and related services specialists howled. Everything was happening all at once — more difficult children coming into schools, a new classification system, placement evaluations, direct supervision, curriculum connections, eligibility meetings, formal goals, paperwork and so forth. Extra work made all tasks more difficult.  Psychologists shared that concern:

“A significant percent of people working in schools do not appear to understand the implication of casually asking their school psychologist, “Can’t you just test or counsel one or two or five more children?” The addition of another assessment, counseling /or consultation case may dramatically increase that school psychologist’s list of responsibilities, as well as the rest of the multidisciplinary team’s responsibilities, in much broader ways than is readily apparent.”

Feinberg, Ted, Karen L. Nuijens, Karen L., & Canter, Andrea (2005).  Workload vs. Caseload: There’s More to School Psychology Than Numbers, NASP CommuniquО, Vol. 33, #6.

What were the root causes of the problems 1980 SLPs faced?

Inadequate Academic Preparation

Academic institutions and professional organizations did not prepare SLP graduates for approaching changes in American schools.   School speech pathology was not a high priority.  Training centered around the dated medical model:

” ….the origins of the medical model continue to plague the SLP today. Many SLPs educated in the 1970s, 1980s and 1990s have difficulty making the shift. This is not surprising when the clinical model continues to be used at the university level with little emphasis on inclusion, collaboration and consultation.” 

Means, J. (2006). The impact of IDEA 04 and NCLB on related services. How do we meet the challenges? Forum on Public Policy Online; A journal of the Oxford Round Table, Fall 2006 edition. http://www.forumonpublicpolicy.com/archive06/means.pdf

Shallow Interpretation

SLP graduates did not understand the profound historical and cultural changes taking place. Nor did professors and ASHA administrators.   ASHA administrators were locked into growing the organization.   SLPs saw education change as a grand inconvenience.  When  you are freshly trained you assume you have the right tools.   IDEA was viewed as negotiable, with enough complaining about scope of practice and caseload numbers.  Today collaboration is still viewed as a “creative option for service delivery.” Scope of practice is a nefarious burden.   

ASHA sought to coax SLPs into new practice patterns when IDEA already required them. Straight talk was missing.  SLPs did not see they were given an opportunity for job security and greater visibility in schools. IDEA elevated SLPs nationally but they remained wedded to traditional service delivery.   Anxiety, denial, anger and rigidity are predictable responses when one is a part of a paradigm shift one does not understand.

Protectionism

School speech pathology was a major ASHA revenue source.  Like all professional organizations, it strove to protect employment opportunities, which, in turn, supported dues collections and the general budget.  Revenue from school members helped support the entire organization.

The first response to EHA 1975 was to determine whether placement criteria might reduce school caseloads and the need for SLPs.  Nothing happened. In fact, caseloads went up because more children stayed longer in special education, and more children were receiving special education.  Employment became more secure as a result of IDEA mandates.  The fears were unwarranted and helped push the analysis in the wrong direction.

Then SLPs lobbied states to set caseload limits but the results were unimpressive.  States like Ohio retained high caseloads, where some clinicians had 100 or more children to work with.

Next, the focus shifted to workload analysis, an approach which sustained the protectionist outlook.   Administrators were not easily persuaded by claims SLPs worked too hard (though they did worked too hard).  Current economic factors make this strategy even less convincing.

Protectionism diverted attention away from long-term planning and analytical problem solving.

Information Gap

In 1970 the national office after almost 50 years established a one-person office for school affairs.  It launched a modest publication and reached out to school clinicians for information and advice.  It was the case and still is that a paucity of field data were available on what school SLPs actually do in their jobs.  Therefore, when EHA 1975 pushed into the conversation, there was  no information available, scattered academic papers and books notwithstanding.

Two information problems existed.

First, academics did “hard research” for tenure and were not encouraged to do field studies using “soft data.”  A good academic career could not be sustained by school surveys.

Second, SLP graduates were not required to do research as a graduation requirement.  Graduates lacked the research skills to evaluate IDEA’s impact on practice.

ASHA administrators and leaders were flying blind.  It was widely assumed that the CCC curriculum could be easily adapted to any situation.  This was not true for IDEA content. Information was badly needed.

Continuing Education Shortfall

Continuing education programs were offered with the expectation SLPs could pick up in-depth knowledge of IDEA requirements and implement the requirements within the framework of traditional practice guidelines.  Presenters typically did not understand the long-term implications of IDEA.  The temptation was to see IDEA as another “hot topic” in the array of hot topics.  Moreover, only a tiny percentage of school SLPs at any one time could attend the programs offered here and there around the country. Continuing education was not available everywhere, and it cost money.  Dissemination of content was sporadic, including that which was published on paper.  SLPs were being self-taught, gleaning information coming from state departments of education, other school personnel, in-service programs and local SLP organizations.

At the same time concerns over information gaps  were not finding their way back to the academic centers.  Graduates going into school practice were not getting the information they needed.  In the 1970s it was difficult even to add elementary language courses to the curriculum.  Means (above) pointed out the medical model continued to dominate thinking to the extent that school issues were ignored:   “…the clinical model continues to be used at the university level with little emphasis on inclusion, collaboration and consultation.”  The burden of knowledge generation for IDEA applications fell exclusively on continuing education outlets.

Delayed Response

IDEA issues were condensed into the signature issue of workload and that issue lead to protracted conversation.  In 2005, Dr. Kathleen Whitmire, ASHA’s Director of School Services, was interviewed about caseloads:

“Beck:   And frankly, developments in caseloads and workloads may have even greater importance than meets the eye, as so many SLPs work in the schools. 

Whitmire: Yes, that’s correct. We have about 56 thousand ASHA SLPs working in the schools, so that’s a significant number of professionals providing needed services to students. Also, we know that large caseloads impede student success, limit service delivery options, increase burnout, and are a significant factor in attrition. So rethinking caseload as workload is a critical component in student success, quality of services, and recruitment and retention of qualified personnel.”

http://www.speechpathology.com/interviews/interview-with-kathleen-whitmire-ph-1387

The segment is quite significant in unintended meaning.  Thirty years after EHA 1975 the issue is presented as though it is a current problem.  The viewpoint could easily fit the circumstances of 1990, for example.  One who reads back finds the caseload issue dragged on and on and on.  In fact, one whole generation of school SLPs is retiring without seeing a solution to the workload problem.  More accurately, without seeing a solution to the IDEA impact problem.

Elsewhere Dr. Whitmire remarked:   “For over twenty years, there has been debate about the determination of the “adverse affect” of a communication disorder upon a child’s educational performance.”

(http://www.mnsu.edu/comdis/isad5/papers/whitmire.html, 2002).

Comment

The caseload problem has been a symptom and not a cause.

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