1. Educational Speech Pathology

Trends in school practice are stretching generic university preservice models in speech-language pathology (speech therapy) to their limits!

Steppling, Quattlebaum and Brady have authored an important article (Toward a Discussion of Issues Associated With Speech-Language Pathologists’ Dismissal Practices in Public School Settings) that shows intellectual points where preservice clinical models do not accommodate school decision making. They focus in on dismissal for discussion (Dismissal).

A shift in federal law in 1997 changed the picture as to whether SLPs work in isolation or work to reinforce the general curriculum:

“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).

Prevention is an often-stated aim of SLP practice but the use of evidence-based programs in schools to reduce special education overidentification is not a feature of prevention.

Do preservice programs cover misidentification as an ethical question?

Take another example, generalization of intervention to “progress in the general curriculum.” Intervention models do not address such topics, and the interesting possibilities thereby arising.

When phonological intervention is set up, is there any concern for how it generalizes to classroom literacy? Or, how classroom literacy instruction generalizes to phonological intervention?

One-on-one direct intervention is emphasized in preservice university clinics, implicitly validating pull out service delivery in school settings. However, one must consider that pull out is not necessarily more effective in schools where collaborative programs are gaining ground.

Educational speech-language pathology should be judged on its own terms and should be researched in schools to validate any claims made.

Why Over-identification?

As one sifts through 35 years of policy views on the overidentification of at-risk children in U. S. schools clearly there is not much enthusiasm for discussing the subject and aggressively combating it.

Yes, the U. S. Congress has taken laudable concrete steps through idea legislation, but there is little “buzz” about this serious matter among professional organizations, governmental bodies and local schools.

Why?

We don’t really know the answer from an inspection of public records and commentary. But one possible answer concerns stigmatization.

Which professional organization wants to step up and say, “Yes, our members are misidentifying children in the public schools!”

Which state agency wants to say, “Yes, we have known about the problem for years but have done very little about it.”

There is a stigma attached to such public declarations! Better to be mute on the subject and hope it fades away.

But what of the children? It is clear that schools readily risk stigmatizing children, incorrectly placing them in special education, to say nothing about impairing their hopes for a good secondary education.

It seems, given the choice of stigmatizing themselves or children, adults prefer to stigmatize children!

1. SLP Collaboration

Richmond makes a case for greater SLP collaboration with teachers and provides suggestions. She writes:

“Are you overwhelmed with the number of students on your caseload, yet you constantly receive more referrals? Are your students progressing toward their goals fast enough? Do you notice that your students respond better when interacting with their peers than with you? Are your students transferring their goals to the classroom setting? There is a solution for all of these concerns: Collaboration” (Super Duper).

An article by SLP Susan Faucheux (Speech Pathology) reports on a school-based project of scholarly merit implementing a collaborative language and literacy program. “The project was designed to replace the traditional “pull-out” model of language therapy, with a “collaborative” model involving teachers from regular and special education and a speech-language pathologist.” Collected data indicated the program increased language arts skills while proving to be a means of addressing caseload issues:

“The Language Literacy Lab is a time efficient form of service delivery for SLPs with large caseloads of language-impaired students.”

Collaboration can lead to preventing misidentification in U. S. schools and reduce workloads as long as SLPs are willing to move away from pull out service delivery (cf. 12. SLP Dismissal / Exits).

“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).

One caveat is that neither SLPs nor teachers have sufficient background in collaboration at the level of technique and cooperation. Although collaboration has been heralded by various advocates as something approaching “best practice,” where are the data to support increasing application of this strategy? And why don’t SLPs do it?

Exits at 3-Year Reevaluation

For SLPs the three-year reevaluation under IDEA 2004 should be a landmark for evaluating for dismissal. The same can be said for learning disabled children. However, IDEA weakens school responsibility to take a hard look at progress and disability status. Parents can waive their rights to the reevaulation of their children, and they often do. Waiving reevaulation is portrayed as a time saver.

Every year a non-disabled child is kept in special education he or she is “re-misidentfied.” In the understanding of special education overidentification, this fact is lost on policy makers.

When SLI status co-occurs with SLD status, there is a tendency to drag SLI along from year to year as an add-on service. Curtailing reevaluations cuts down on time for IEP teams to reflect on the total welfare of the individual child.

Schools should advertise a goal of exiting many children by the end of three years. If they can’t do it, they should re-evaluate.

Here is the regulation (IDEA Legacy):

“A reevaluation conducted under 34 CFR 300.303(a):

…Must occur at least once every 3 years, unless the parent and the public agency agree that a reevaluation is unnecessary.”

Advice to Teachers

Special Education Resources for General Education in 2008 provides lots of information about the overidentification and special problems of minority children in education and how teachers can help reduce the problem. Here’s a sample:

“While students’ difficulties with learning can be caused by students’ disabilities, there are many other reasons why students might experience difficulties in school. These reasons include the general school curriculum not sufficiently addressing the needs of children from diverse backgrounds, stressful home situations, an inadequate general curriculum, poor prior instruction, or language differences. As a teacher, it is important to consider whether the difficulties a child may be experiencing in your classroom are the result of a learning disability or if the difficulties may stem from other causes such as the child’s lack of prior learning experiences” (Serge).

Good advice! We now know there is a gap in general education that special education has been filling. Special education has become a remedial service in part. Special education personnel should not admit non-disabled children just because general education lacks programs.

There is also a need for teacher awareness when it comes to misplacing at-risk children in special education:

“Whenever a disproportionate number of students are identified from specific populations of students as having disabilities, this group is “over-represented.” This issue has been of great concern for many years and touches on many elements of educational practice, from the referral process for special education, to the instructional strategies used by teachers, to our beliefs about poverty, race and culture.”

Conflicts of Interest for the IEP Team

Our analysis shows that a great many influences since 1975 have “caused” over-placement of at-risk children in special education. We can identify patterns which place members of the local IEP team in conflicts of interest. One assumes that local school administrators guide eligibility groups toward making objective decisions. However, it is more often not in the best interests of participants to turn away children from special education. Here are some suggestions:

1. Superintendents – benefit from financial gains for the school district.

2. Occupational therapists, counselors, physical therapists, reading specialists, speech therapists – benefit from employment opportunities through school contracts.

3. Regular classroom teachers – benefit from not having to teach difficult pupils.

4. Special education teachers – benefit sufficient numbers to justify out-of-classroom placements.

5. Directors of special education – benefit from having positive social outcomes of IEP meetings.

6. School psychologists – benefit from having positive outcomes of IEP meetings and a respected role in the district.

7. Parents – benefit from having their children receive extra services.

The idea of “Teamwork” overrides individuals. Members sense voting against placement is not in the spirit of the moment. Neither does dismissal catch the spirit. The “culture of compliance” centers around overidentification and retention fostering good will among team members with special interests.

Sometimes children are the only ones who advocate against placement. “My daughter requested to be able to be with her class instead of leaving for four 1/2 sessions a week for resource (3 half hour sessions for math and 1 half hour for speech). She said she has been embarrassed and didn’t like being away from her new classmates….In the meeting yesterday I was surprised when the ‘team’ suggested waiting until December (or longer) so they can watch her progress… I said no and that I wanted to honor her request to be with her new classmates” (City Data), 2009).

4. History of School Speech-Language Pathology

1940s

 The end of the Great Depression and financial hardships in schools occurred with the onset of World War II.  Women worked in factories and Rosie the Riveter was a popular emblem.  The war brought the return of revenues and optimism.  “During World War II (1939-1945), many servicemen developed speech defects as a result of war injuries. The need for speech rehabilitation services attracted large numbers of men and women to the profession of speech therapy. Many speech clinics opened, and research increased into speech problems and their causes.”  http://www.a2zpsychology.com

1950s

The campaign in the early 1900s to frighten Americans of handicapped people lead to laws excluding them from schools. They were excluded the way black children were blocked by Jim Crow laws. Parent advocacy groups began to fight against the government to promote education rights.  “Parents, who had begun forming special education advocacy groups as early as 1933, became the prime movers in the struggle to improve educational opportunities for their children” (Rethinking Schools, 2002).

Parent Advocacy

The way forward for the handicapped in schools centered around the rights of the mentally retarded. It was a catch-all category including children who were deaf-blind-retarded, brain damaged, palsied, abused and emotionally disturbed.  It contained autistic and epileptic children. Improved research and testing helped sort out subgroups but still parents saw weaknesses in school programs.  Typically retarded children were placed in “self contained” classrooms. While they were now being brought into schools, segregation continued. Critics spoke of “warehousing” the retarded.

Speech correction and special education teachers emphasized “naming” as a key cognitive skill to develop. Mentally retarded children practiced lists of nouns accompanied by picture cards. Linguistic science had not come into play in 1950.  The use of repetitive tasks held back mentally retarded learners. They sat silently for long periods of time without stimulation and social interaction.  

It was not uncommon that school rooms for retarded pupils were in old in under-used areas, across the road in dilapidated buildings, or in out of the way temporary structures.  Often there were handicapped access problems and difficulties using the playgrounds.  Even though the retarded were in school there was the feeling they were locked away.

Speech therapists went to these  rooms and adapted to the learning settings in style and procedure.  They did not take on the peppy behavior displayed in the elementary schools.  They were more somber to fit the occasion.  The speech therapists of the 1950s and 1960s were quite adapted to the practices maintained in typical schools.

Civil Rights Movement

Outside of typical schools civil rights was in the air and on the move. “The history of special education in the U.S. began after World War II, when a number of parent-organized advocacy groups surfaced” (History Special Education). Brown versus Board of Education of Topeka (1954) ended separate schooling for black children, and the Civil Rights Act of 1964 ended Jim Crow laws. President proposed his Great Society legislation which included funds for poor school children. Implications for the rights of handicapped children in schools were evident to Americans, especially parents.  The principle of civil rights protections for excluded groups was easily generalized.

2. SLP Caseloads

We see that special education enrollments have increased in the last 30 years at a stunning rate, and that one contributing factor is the placement recommendations of speech-language pathologists and psychologists to IEP teams. Children have been over-identified for special education, which means that high caseloads have been partially generated by error. IEP teams support quick placements.

Yet SLPs have taken the position that the problem is largely a matter of having too few SLPs working in schools. If a school district has 120 speech children, there should be three SLPs on duty to cover all components of case management (e.g., service, paperwork, coordination, consultation). The implication for administrators is significant. Not only do they have to pay for extra SLP hires, they must find employable SLPs. In many parts of the U. S. SLPs are hard to find and hard to retain.

Writing from Texas, S. McFadin advocates for “laws” to govern caseload size (ASHA Leader, November, 2009): “My director tries to consider guidelines, but without any law or protection as to the maximum number of students served / caseload size, it is hard for her to justify any additional SLP positions.”

The “scarce resources argument” made to school administrators is extremely weak. Their daily work centers around requests for more and more and more resources to satisfy the many school stakeholders who think their requests are urgent.

Congress has given SLPs, along with school psychologists and reading specialists, an elite role in assessing at-risk school children for special education placement. It has also given them the responsibility of reducing misidentification of at-risk children, particularly, non-disabled children (cf. Texas Solution).

Taking a leadership role, however, requires candor. For example:

1. There are no more surplus jobs in the proverbial pipeline to reduce caseloads.

2. School SLPs must search for qualitative changes in caseload management (such as collaborative preschool prevention programming and less direct service).

3. Admit that clinical education assessment has evolved, and changed, and must improve to correct misidentifications.

4. Role changes are being forced on SLPs by federal mandates (e.g., RTI, working in general education) without regard for the clinical traditions they value (e.g., articulation intervention).

Therefore, as a creative tool for reducing caseloads and workloads, reducing misidentification is an avenue for constructive change. It is something each and every SLP can do knowing it is ethically right and expected. Reducing misidentification is an aim that is mandated by the federal government, and every state. It can be explained to school colleagues and administrators as a necessary and important collaboration for long-standing FAPE requirements. No permission (nor guidelines, policies and laws) is required to advocate for proper eligibility management.

Reducing misidentifications extends beyond the scope of response to intervention programs, concerned with identification processes. It entails a long-term range of eligibility decisions, especially those on the back end where dismissal judgments are made.

1. SLP Caseloads

From 1970 forward you might say school speech-language pathology hit the perfect storm. Caseloads swelled to the point of unmanageability.

The profession had established an excellent reputation in schools, and the specialty was immediately on hand when PL 94-142 came along in 1975. This civil rights movement required all handicapped children to receive a proper education.

Two things happened to caseloads:

1. More children with severe problems came into schools. Clinical management became more complex and more difficult.

2. The law regulated SLP practice as to assessment and intervention. Legal paperwork had be submitted to justify decisions. Paperwork added to workload.

In the 1970s, the language revolution took place, and the specialty was renamed “speech-language pathology.” The era of phonology, syntax, morphology, semantics, pragmatics and cognition effectively doubled SLP workload.

In the 1990s, a strong push for SLP’s to take on school literacy services surfaced. This could become an entire new domain of practice.

Professional groups tried to get states to limit caseload size but with modest results. Professional groups tried to get schools to appreciate workload demands but with modest results. SLP frustration grew.

IDEA 2004 added pressures for greater involvement in cooperative ventures such as early intervention and response to intervention programs, with responsibilities tied in with general education. How does this affect workload?

While the winds of change buffet school speech-language pathology, what should be done about the misidentification problem, where Congress looks for solutions?

” We have a legal and ethical duty to ensure that students are not misidentified for special education and to ensure that all students have equitable opportunities to succeed” (Sullivan et al, 2009; cf. Misidentification Psychology).

Exit Difficulties

In a give-and-take exchange over one parent’s efforts to exit her daughter, we see how difficult it can be for some parents (City Data).

The mother (Pll) says:

“Why is there so much red tape connected to pulling a child out of the IEP program? Maybe a educator can answer this for me. Does the school get extra money from the government? Are they afraid of getting sued by a parent if the child drops out?”

A teacher (bigcats) replies:

“I’m not sure what your situation is, and I don’t know much about the financial side of things either..as a teacher, I would be reluctant to have a student who had an IEP stop having one unless they really seemed ready for that….I also would feel frustrated if there were some problem (speech, learning disability, etc.) that made it difficult for me to teach that child without additional services, yet those services were refused and I was held accountable for the student’s lack of success.”

Another (hey teach) teacher:

“I’m an educator and it doesn’t seem to be that difficult for a parent to remove their child from a Special Ed program. Yes, we do try to discourage such a move, because if the child did not need assistance, they would not be in the program in the first place. If a parent is determined to not allow their child to receive services, an IEP meeting is held, documenting all reasoning and opinions of both parents and teachers and then the parent signs their child out.”

Another (frogin4colorado) teacher:

“Yes, students who have an IEP bring in extra money for the school. This typically happens around Dec 1. Two, you are part of the team and you can deny services. The sped team will inform you of what could happen if no support is provided. After all is said and done, you can still deny services. But please be sure that it is what is best for your child before you do so. Can you get into the classroom and observe?

The mother (Pll) replies:

… My child has struggled with immaturity issues and is finally making great progress this year. I think the 1/2 hour a day (4 days per week) she spent in IEP would be better spent with her class. Yikes, I had to have two meetings with 6 faculty members before they would let me release her. Even though they started the first meeting showing papers and stats her great progress.

She adds:

“My daughter requested to be able to be with her class instead of leaving for four 1/2 sessions a week for resource (3 half hour sessions for math and 1 half hour for speech). She said she has been embarrassed and didn’t like being away from her new classmates.

[At a new school]. In the meeting yesterday I was surprised when the ‘team’ suggested waiting until December (or longer) so they can watch her progress since she is attending a new school this year. I said no and that I wanted to honor her request to be with her new classmates…

The ‘team’ wasn’t happy which was confusing to me because they just finished telling me how good she was doing! This is why I was wondering if there is money attached to resource or protocol that they don’t want to deal with…?

Another parent (LA_Parents) reports her experience:

…I want to get my son out of IEP and his teacher/school won’t let me. He is 5 1/2 yrs old now in Sp ed. Kindergarten.

This all started when my son was 3 1/2 yrs old. His speech was delayed. So we went through IEP process and had eligibility for
developmental delay. He did not learn much from school, but we worked with him and after a year, he was at a point comparable to other kids of his age.

We thought that he would get out of IEP. But to our surprise, during annual IEP, he was recommended for one more year in sp ed Kindergarten. In the IEP meeting we asked them what is it that other kids of his age can do and my son cannot ? But the IEP team did not listen to us….

Also, my son switched to another school in september , where his IEP continued. The new school said that we do not have a chance to evaluate the child and need more time to decide. Until then he will continue with his IEP…

…We have been working with my son. And I can tell, he is comparable or better kids of his age. He doesn’t have to be in sp ed. But the school has been giving indications that he will continue in sp ed next year in 1st grade as well. I have been frustrated. My son does not need sp ed. The school just needs kids in sp ed to get their funding….”

Another (wsop) parent reports:

“… In my case the school district was pushing for an autism dx, probably for the funding. At the same time they were not offering services such as speech, OT, etc., but wanted to place him in a self contained classroom, and in fact were insisting on this! Who wins in this situation? My son was and is totally capable of being educated in a typical classroom with his typical peers, but they wanted all the funding that comes with an autism dx and the cheapest route for them was to stick him in a self contained. Sounds like a barrier to learning to me.”

Another parent (marylee54):

…finally got my son out of special ed. Basically, you can take them out anytime. Request a dismissal ARD that’s what the D in ARD stands for Dismissal. Write up something to the effect that you request to discontinue any further special ed services.

They didn’t like it, tried to keep the IEP open with modifications, yadda, yadda, but I stood my ground. legally, they can’t force your kid onto a program without your consent, although they try to make you think they can.

My son was diagnosed with ADHD, which I doubt, and placed in Spec Ed about 3 years ago. His school experience has been negative since then. he detests being pulled out for “resources” it was affecting his peer relationships, and basically benefiting the school via funding, and giving the teachers an excuse for not teaching him….”

(We’ve edited comments for focus and readability. There are more interesting comments to read at City Data.Com.)