Monthly Archives: February 2010

2. SLP Collaboration

School speech therapists were obliged to accept collaboration with IDEA 1997. At that juncture, they had to support “progress in the general curriculum,” resetting standards for speech and language disability along legal lines. Here is an overview from 2002:

“Contemporary standards-based reforms emphasize that every student must work toward the expectations set for each academic content area. As the mandates of the Individuals with Disabilities Education Act (IDEA, 1997) become fully implemented (ASHA, 1996; ASHA, 1999; Mead, 1999), more school speech-language pathologists (SLPs) will assess students’ abilities to meet curricular demands, design curriculum-based goals and objectives for students, and provide interventions designed to help students meet curricular requirements. This will apply whether the least restrictive environment for therapy is a classroom or a pullout setting” (Goliath).

QUESTIONS

It’s been 13 years since the general education requirement was set forth explicitly. Still, a good many questions come up:

What data do we have on school SLP collaboration? What percentage of the nation’s school SLPs routinely use collaboration as an intervention? In contrast, how much pull out is used? Are school SLPs setting up collaborative programs on their own, or are they waiting for school administrators to take the lead? Are SLPs trained in collaboration in the university clinic? What research is going on as to effectiveness? Does collaboration produce good results compared to direct intervention? Are annual IEP goals being met through collaboration? What communication goals are being achieved through collaboration? Does collaboration invalidate standard methods of asssessment? Is pull out still seen as the essential service delivery model, or has there been a change in outlook to move out of the therapy room? Are collaborative speech and language methods being replicated on a large scale? Is collaboration a part of the university preservice curriculum? Do state agencies vary in their requirements for SLP collaboration? Are university clinical supervisors teaching it on and off campus? Are SLPs involved in reducing special education over-identification through collaboration? Are they involved in RTI efforts and preschool programs designed to reduce the numbers of at-risk children placed in special education? Do school SLPs collaborate with each other? How do SLPs collaborate for LD prevention, when reading programs are entailed? How is collaboration being used from preschool to high school? Is collaboration saving time and reducing load demands? Is collaboration taking SLPs into general education programs? Are administrators freeing up time for collaboration? Are children receiving services through collaboration dismissed earlier?

BOUTIQUE SPEECH PATHOLOGY

Girl Scouts Marching on Main Street.

The impression one gains since 1980 is that we have created “boutique speech pathology.” Publications, commercial catalogs, and workshop experts throw out “exciting possibilities” on a “try- this-and-try-that” basis, as though we are trying to accessorize best practice. “This year try a blue shirt and a pink tie! You’ll like it!” Scope of practice is expanding like an overlarge wardrobe.

At the same time SLPs are admonished in the most serious tones to “follow evidence-based practice,” forsaking fads and invalid methods, and adhering to IDEA standards. The schizophrenia is obvious, and confusing.

SLP COLLABORATION

Here is what we have to confront:

Collaboration is now best practice, and not just another technique.

4. SLP Misidentification

We wonder who puts the so many children in special education? Who are the key decision-makers? SLPs play a key role.

IDEA 2004 regulations address the thorny problem of decisions to place learning disabled children, a category that by all sources has run wild over the last 35 years.

“The determination of whether a child suspected of having a specific learning disability is a child with a disability as defined in 34 CFR 300.8, must be made by the child’s parents and a team of qualified professionals…”

The decision to place is a team decision approved by the child’s parents. Final responsibility rests with the parents. It is unclear where responsibility resides when it comes to indefinitely large IEP teams. However, the team under IDEA regulations must include:

1. “The child’s regular teacher; or if the child does not have a regular teacher, a regular classroom teacher qualified to teach a child of his or her age; or for a child of less than school age, an individual qualified by the State educational agency (SEA) to teach a child of his or her age…”

We see the importance of the educational perspective in the composition of the IEP team. This can include the teacher who made the referral for services.

2. “At least one person qualified to conduct individual diagnostic examinations of children, such as a school psychologist, speech-language pathologist, or remedial reading teacher.”

This requirement confirms that school psychologists and speech-language pathologist provide much of the critical diagnostic information used for SLD placements. Remedial reading teachers, one surmises, play a lesser role nationwide.

Weight of opinion is not addressed by the IDEA regulations. Parents, psychologists, teachers and SLPs offer opinions carrying more weight than some of the other participants. Related services personnel add weight when their professional opinions fit the recommendation of LD eligibility.

Final determinations are still cast in the dim light of the group dynamics of the IEP team plus local customs (cf. Micro Level).

3. SLP Misidentification

SLPs evaluate speech and language behaviors as a basis for recommending SLI placement. “Unfortunately, non-native speakers of English, speakers of various dialects (whose language also varies within dialect), and bilingual or multilingual speakers are frequently classified as language delayed or disordered when, in fact, they are language different–although problems of underidentification also occur” (Medscape).

“Identification of speech and language impairments is further complicated by the fact that they often masquerade as other diagnostic conditions. For example, children with a diagnosis of attention-deficit/hyperactivity disorder (ADHD) may in fact have an underlying language disorder.”

SLI overlaps with SLD identification. “A significant portion of SLI pupils morph into SLD children. The underlying pathology for the two categories is the same, a genetically-based cognitive-linguistic processing disorder (Speech genes).” Language/processing problems are identified as articulation problems and this helps to mask LD problems (SSP).

SLI and SLD are both categories affected somewhat extremely by misidentification. Speech-language pathologists and school psychologists are the evaluators making the recommendations to IEP teams, and IEP teams tend to follow their lead.

SLPs can participate in RTI to reduce misidentifications:

“The purpose of implementing a response to intervention (RTI) program is to not only reduce the number of special education referrals and evaluations, but to also prevent inappropriate placement of students in special education. RTI yields major cost savings to the education system by preventing over-identification of speech and language impairments, reducing long-term costs of educating struggling learners and allowing special education resources to be allocated on the basis of highest need. In addition, IDEA 2004 permits school districts to use as much as 15% of special education monies to pay for qualifying early intervening services, including professional development for teachers” (SPG).

1. SLP Misidentification: Native Americans

“Over-identification of Native children as needing special education, including speech-language treatment, was a key concern identified in a recently completed study of Native American students in Washington state public schools” (Inglebret et al., Infusing Tribal Culture in Washington Schools, The ASHA Leader, 15, 24-25, 2010). In Washington state, there is an “achievement gap” between Native and non-Native children.

Overidentification of Native children was traced to a “lack of visibility of Native culture in the regular curriculum..,” resource distribution, personnel preparation, and misuse of standardized testing procedures.

Standard testing procedures rely on formats involving pictures and written words having limited Native content. “As a consequence, standardized testing procedures may be unfamiliar to a child and disconnected from daily life and may not, therefore, accurately reflect a child’s full potential.” Thus misevaluation leads to overidentification to say nothing about the problems of exiting Native children from speech and language services.

SLPs often do not have enough information to interpret cultural and linguistic differences: “For example, a boy who speaks White Mountain Apache may seem to be lisping to the ear of the referring teacher. A science approach is to point out that his native language contains a lateral stop fricative that sounds exactly like a lisp. Therefore, there is no diagnosis of disability. The boy simply has an accent carried over from his first language” (cf. 5. SLP Caseloads).

Universal Design for Special Education

“Universal Design Applied to Large Scale Assessments

National Center on Educational Outcomes
 

Sandra J. Thompson
Christopher J. Johnstone
Martha L. Thurlow

June 2002

Universal design is a concept that began in the field of architecture, but has been quickly expanding into environmental initiatives, recreation, the arts, health care, and now, education. Despite a slow but steady start in its application to instruction, the potential for dramatically affecting the design of large scale assessments is great. There is a tremendous push to expand national and state testing, and at the same time to require that assessment systems include all students – including those with disabilities and those with limited English proficiency—many of whom have not been included in these systems in the past. Rather than having to retrofit existing assessments to include these students (through the use of large numbers of accommodations or a variety of alternative assessments), new assessments can be designed and developed from the beginning to allow participation of the widest possible range of students, in a way that results in valid inferences about performance for all students who participate in the assessment.”

“Universal design is consistent with Response To Intervention approaches in the school setting.  It can be used to sidestep the artificial division between special education and general education.  Assessments can honor a gradation of abilities without categorization of any kind.  Low scores do not have to lead automatically to special education placement, allowing time for non-disabled children to be sorted out, helped and supported in the regular classroom.  Speech and language variations associated with language differences, dialects and slight delays can be programmed through collaborative efforts among general education teachers, special education teachers and related-services personnel.  Reading can continue to be the foundation of intervention without special education placement.  School speech therapists can promote oral language and language-based reading skills to contribute to the effort.  SLPs can move easily into the regular classroom and serve as general educators.  Dynamic assessment extends clinical assessment, consistent with a hybrid model of school speech and language as described in SSP.  This overall approach is different from inclusive education where children’s placements are forced on their performances for categorization purposes. 

How do we prepare school SLPs for this new age of non-categorizal thinking?  There is every indication that old academic training models are antiquated and the college professors must change the curriculum.  There is no reason to throw the baby out with the bath water but the language component needs expansion, updating and focus.  At this point reading appears to be nothing more than an item under language, when it represents an entire domain of learning.  A hybrid model of practice has far-reaching implications for basic theory and research.  The legal arena stemming from IDEA 2004 cannot be dropped into a course and covered in a single lecture.  Current school speech-language pathology is simply not nimble enough for Response to Intervention thinking.  University clinics have changed little since 1950.

On the other hand professional associations put out policy statements, trend information and continuing education materials that have no roots in academic curricula.  They are trying to invigorate change without coordination with SLPs in the schools and academic leaders.  Researchers are left out of the picture as they are engaged in scientific publication and trying to win tenure.

Some courses for school SLPs focus in on materials, methods and techniques as though there is no context for their applications.  The context entails questions about generalization of learning beyond the therapy room, and how reading techniques interface with speech and language methods.

The bridging point is full support for cognitive-linguistic theories of speech and language practice.  One-shot diagnostic prescriptive therapies based on conditioning paradigms have to be seriously questioned as to validity. 

The notion of “clinical population” has to be reworked and the notion of “struggling students” has to be integrated with current thinking.  Categories derived from clinical models can invite incorrect placement in special education.  This is evident when a standardized language test is given on language different pupils and a set cut off level is used for placement.   The discrepancy model  has been called into question.

The implications of  the clear problem of the overidentification and over-retention of at-risk children, particularly, non-disabled minority children, must be spelled out and addressed.  Perhaps it will help decision makers by saying it is an “opportunity” rather than a scandal.  One can make school SLP assessment exciting in that placement and retention decisions can be aligned with vital public policy and educational trends helping SLPs fit into the times.  Clarity and accuracy can be fun goals to reach.

Key is reducing special eligibility placement and dismissal rates while minimizing least restrictive environment.

http://education.umn.edu/NCEO/OnlinePubs/Synthesis44.html

Taking a Look at Speech Pathology Caseloads

Market in Paris.

In a series of useful posts in 2010, school SLPs provide an interesting window into the problems of managing big caseloads (Speaking of Speech). They show SLPs must depend on their directors of special education to help them with having too many pupils to deal with. Their appeals are heard and unheard. They search for “external solutions” (cf. About Us). Strategic Eligibility Management (SES) shifts the focus to Internal solutions, centering around one’s job description as presented. It does not set aside caseload standards and workload analysis. It does not set aside advocacy for size controls. It does focus on managing misidentification of at-risk children, pre-intervention programs, and efficient intake/dismissal procedures.

It is unfortunate that advocated workload policies place the locus of control in the hands of educational administrators.

One post is invaluable in showing how persistence is important:

Jan: “Yes, I agree w/ Fran in urging you to do a workload break down w/ help from ASHA’s info. Our grp of SLPs were also successful (over 2 yrs) in getting our director of SPED to consider this view. We are fortunate that she sees ASHA guidelines as very important. Now at meetings she’ll ask, “What is ASHA’s position on this?” I love it!

She has worked thru a workload approach for all SPED staff. She tries to keep our numbers around 40-45 (60 is limit in IL)….but we all know that students numbers do not present the entire picture. One student may consult, one may have 30 mins, one may have 120! I inherited a student from another dist w/ 120 minutes per week of S/L TX. Thank goodness he is doing great here and Mom is amenable to more time IN class with good lang peers than more time pull-out w/ me! Anyhow, that’s our next challenge-to rate students based on severity, etc.”

Here’s the other side of the coin, when the external approaches break down:

Al: “Those of you living in states with caseload limits of 60 are lucky. I live in Ohio and the limit is 80. Why even have one if it is going to be 80? I am lucky that my caseload is around 60 and usually is, however at 60 students in K-12 I am totally overwhelmed. With the caseload limit being as high as it is, I can’t imagine my administrators getting me any help (considering I am 20 under the caseload limit).

I was offered a job before my current one where the caseload was around 80 with mostly students with cognitive disabilities and multi-handicapped diagnoses. I tried explaining to the school administrator that this would be an impossibility but he just didn’t get it. I found out that they went on to hire a new grad. for the position. Yikes.”

It is interesting to see how little the level of discourse has changed in the last several years. The discourse is frozen and repetitive. Here is a small part of an interview conducted in 2005 with Kathleen Whitmire, Ph.D., Director of School Services, ASHA (KathleenWhitmire2):

“Beck: … OK then, moving to the topic of the day…what can you tell me about the rather large “SLP caseloads” in the schools? Many of the SLPs I speak with tell me that is a terrifically significant issue for them.

Whitmire: You’re exactly right. ASHA has collected data from surveys and focus groups for many years on this topic, and ASHA members who work in the schools have consistently indicated that caseload is one of their greatest concerns…”

The issue that SLPs might be a part of the problem if they are not dismissing children promptly or being more critical about which children are placed in special education does not surface in current open conversations.

Speaking of Speech: [http://members4.boardhost.com/monthlyquestion/msg/1264864781.html]

John M. Panagos

Professional Organizations and Over-identification

In prior posts we suggested that the over-placement of American children in special education is not a “hot topic” drawing enthusiastic interest of professional and governmental bodies. From the time of the enactment of IDEA in 2004, gradually there is less and less discussion of special education over-identification.

Let’s consider the roles played by professional organizations in advocating for reduction of over-identification.

“A professional association (also called a professional body, professional organization, or professional society) is a non-profit organization seeking to further a particular profession, the interests of individuals engaged in that profession, and the public interest” (Wikipedia).

On the one-hand we have special education personnel represented by various organizations. They advocate for the status and welfare of their members. On the other-hand we can consider the public interest entails “Free and Appropriate Public Education” for all at-risk school children. When children are misplaced in special education, their civil rights are violated.

“Such bodies generally strive to achieve a balance between these two often conflicting mandates. Though professional bodies often act to protect the public by maintaining and enforcing standards of training and ethics in their profession, they often also act like a cartel or a labor union (trade union) for the members of the profession, though this description is commonly rejected by the body concerned.”

For special education professionals to reduce misidentification, thereby protecting the welfare of school children, they must accept responsibility for programs to certify that members of their association s are well prepared to manage special education eligibility appropriately according to IDEA 2004 and U. S. civil rights codes.

2. Dismissal / Exits

Strategic Eligibility Management (cf. 4. SLP Caseloads) or SEM is a system designed to regulate special education enrollments to prevent misidentification and work overload. As a principled system, it centers around the flow of eligibility determinations from the time of identification to that of disqualification. Practitioners can develop and improve skills to manage their caseloads or instructional lists.

“The approach taken to SEM is three fold:

1. Reduce the number of children enrolled in special education.

2. Support least restrictive environment.

3. Dismiss children who no longer belong in special education.”

SEM requires the development of background and perspective on national public policy trends in special education transcending any one discipline. There must be an appreciation of the biases operating to place and retain at-risk children. Trends arising from IDEA 2004 and subsequent regulations should be understood as they apply directly to daily eligibility decision-making. Waiting for full agency support is not a good idea.

It can be argued that dismissal procedures are the most important area of practitioner skill. Once a learning disability teacher or an occupational therapist understands the difficulties of exiting children from special education, he or she will be motivated to work back into the chains of decisions leading up to dismissal determinations. It is better to avoid misidentification in the first place.

1. Dismissal / Exits

We start off on the problem of exiting children from special education with an eye towards speech-language pathology. Whereas IDEA 2004 and its derivative regulations give some attention to misidentification of at-risk children at the point of placement, there is virtually no national spotlight on the neglected topic of helping at-risk children GET OUT of special education. Where children have been “misidentified” initially they continue to be “re-misidentified” every time they have an annual IEP meeting. In many schools, no one seems to care.

Advocates for children exiting special education are few and far between. A provocative essay was written by Linda Schrock Taylor in 2002. Here are some excerpts:

“Every year, thousands of our children disappear into the vagueness of special placements, never to be released from the labels and stigma; never to escape and again be seen as ‘normal.’ Many teachers must notice this engulfing, this entrapment, of our children; some teachers must surely strive to defeat this grave and senseless closure on potential; but the problem is rarely mentioned or discussed” (Linda Schrock Taylor).

“A few months ago, the superintendent of our district stopped to ask how things were going. I said that it had been a good year; that I had just released three students from special education – a 7th grader, a 9th grader, and an 11th grader – and hoped to release more in the Fall. His surprise and shock were clearly evident. Mr. S. said, “Linda, these things never happen! – well almost never! I recently asked a fellow superintendent if he ever heard of any kids getting OUT of special education, and that fellow said that it is very, very rare for that to happen.”

“The majority of those enrolled in special education classes should only remain in special placement for a limited time – just long enough for problems to be corrected and delays remedied. I have a sign on my classroom door, “THIS IS A STEPPING STONE, NOT A RESTING PLACE.”

Taylor writes parents should be vigilant about remedial progress and ask this critical question: “When do you expect to complete the remediation, remove the label from my child, and remove my child from special education placement?”

IDEA 2004 and Disproportionality

In May of 2002, The Alliance for Excellent Education announced the beginning of plans to re-authorize IDEA. One heading said, “MINORITY OVER-IDENTIFICATION: IDEA Reauthorization Underway on Capitol Hill.” At the same time President George W. Bush “created a special Commission on Excellence in Special Education,” partly to study the problem over over-identification.

Alliance reported: “The reauthorization bill will undoubtedly attempt to reform a system in which race often plays a role in whether a child is labeled learning disabled. Currently, African-American students account for 16 percent of the U.S. student population, but represent 32 percent of the student in programs for mild mental retardation.” Congress wanted to reduce the number of special education pupils.

“In a recent editorial for The Detroit News, Matt Ladner directs Washington, D.C., to “thoroughly investigate every possible cause of this over-identification problem, from perverse financial incentives to outright racial bias.” He points to medical research that demonstrates a “strong link between ineffective reading instruction and later learning disabilities.” Referring to a 2001 Progressive Policy Institute/Fordham Foundation collection of studies on special education, Ladner writes that a team of medical doctors estimated that “nearly 2 million children have learning disabilities that could have been prevented with proper, rigorous and early reading instruction.”

For the renewal, Congress published a summary report in 2003, which covered testimony before the Committee on Health, Education, Labor and Pensions (naspon). The body wanted a “performance-driven” instead of a “compliance-driven” model, and to strengthen FAPE protections by “reducing misidentification of students.” The Commission on Excellence in Special Education was critical of the high emphasis on school paperwork and compliance without regard for over-identification.

Also:

“During the last reauthorization of IDEA, Congress took important steps to decouple funding from the identification of students with disabilities to eliminate incentives for States to increase grants by over identifying students for special education services.”

We must all be the keepers of the light: “Don’t needlessly place children in special education!”