Monthly Archives: August 2010

2. New School Phonology

We argue that the early diagnosis of SLI around first grade masks the identification of learning disabilities. LD cases “.. are buried in the SLP caseload in the speech and language impairment (SLI) category. A significant portion of SLI pupils morph into LD children. The underlying pathology for the two categories is the same, a genetically-based cognitive-linguistic processing disorder (Speech genes).”

The label “articulation problem” or “artic problem’ is a large factor in the misidentification of language and learning disability problems.

 

“Artic problem” has been the bread and butter evaluation category for 100 years. It is identified with the SLP role, or the “speech therapist” role. Educators have studied it in their Introduction to Special Education courses. Teachers make preliminary articulation diagnoses when they refer children to special education. Teachers expect SLPs to work on articulation and expect therapy to continue until all sounds are corrected. Low-intelligibility children are harder to teach.

The problem is that most school articulation problems are symptomatic of language and learning disabilities. They are indicative of linguistic processing problems that show up later as literacy issues. Hence, the articulation label masks the problems that evolve into academic problems. Interfaces are lost through over-particularization. We can no longer see the underlying issues because we are dwelling on “surface phenomena.” “Phonology is an abstract system, serving perception and production equally, and supporting the expression of meaningful sentences, whether written, spoken or read” (Panagos, 2007).

The articulation label is not the only problem contributing to misidentification. Psychologists make great use of quantitative test results without much regard to the description of cognitive-linguistic problems. They have followed the discrepancy model. Herein lies the fact that interfaces with underlying cognitive linguistic processing issues are lost. Over-particularization precludes inferences about language and “articulation problems.” Hence, misidentification of LD is partly a data problem. What data are used to label and qualify?

Why Special Education Teachers Don’t Exit?

 It is one thing to put non-disabled  ”struggling students” into special education.  It’s something else to keep them their indefinitely.

A school speech-language pathologist noticed special education teachers at the middle school never brought up the idea of exiting a child from special education.  The most obvious answer is they are not evaluators.  School psychologists dominate the business of recommending eligibility based on objective observations.  Special education teachers do the teaching and goal-improvement checks. 

There is a disconnect where this happens.  It is a systems problem.  Excluding three-year re-evaluations, when they are optionally carried out, school psychologists are not in the business of exiting children from special education unless it is in the context of the IEP team.

The special education teachers do not think it is their duty to evaluate to dismiss.  Systems problem.

This does not hold for speech-language pathologists who both teach and test.  There is a strong over-riding institutional bias toward keeping special education children in the system.  Money is mentioned as one reason.

SLP Perspective on Overidentification

Why are there so many children in special education?

Before 1950 special needs children were underrepresented in schools. IDEA legislation pressured teachers into taking and “mainstreaming” greater numbers of handicapped pupils. Federal financial incentives helped inflate enrollments. Numbers grew faster than predicted by underlying social and medical disability. Unknown is the extent to which local administrators advanced enrollments for financial gain.

Poor coordination of federal, state and local regulations produced variation of eligibility standards across the country. Eligibility decisions as determined by local IEP teams drifted in many directions. Confusing and costly divisions between general education and special education for remedial and special education services contributed to the fragmentation of educational programs. It created the necessity of “referring” to special education to access types of instruction unavailable in general education.

Misidentification of special education children accounted for flawed placements of disabled and minority children. Learning disability placements grew wildly, suggesting a “waste basket” category in which non-disabled children were placed. Inexplicably, males were placed more often than females. Black and “disadvantaged” children the same. Children who simply had no means of learning English were identified as learning disabled.

Regular classroom teachers began to drive eligibility. One explanation is that they are ”bothered” by by distractible learners in the classroom (Congress Report).

Parents and parent advocacy groups insisted on having their children placed in special education with little regard for the stigmatization of such placements. Attorneys gave assistance. Administrators became afraid of parent complaints and potential legal setbacks. Their focus was on school record-keeping to ward off state auditors.

School psychologists placed the majority of America’s special education pupils. Public policy debates did not address the influence of any one profession on admissions. Psychometric standards for the placement of learning disabled children are now in dispute – i.e, the “discrepancy model.”

School speech-language pathologists have made certain “grassroots” efforts to reduce their caseloads but no similar effort to take responsibility for over-placing children in special education. In the school hierarchy, they accepted a minor policy role in eligibility determination. SLPs help place 20% of special education students nationwide, so they have ample opportunity to address off-target placements within their job category.

An ASHA panel describes how SLPs should exercise leadership in the school setting: “In the context of educational reform it is important for SLPs to assume a leadership role in defining and articulating their roles and responsibilities and in ensuring that students’ educational needs are met…They must themselves keep abreast of the changes reform brings” (ASHA Policy, 2009). Eligibility reform is needed to make sure the right children get the right services.

Speech Pathology Prevention in Schools

Prevention is a long-held professional goal of speech and language pathology.  In schools, the best opportunity is to reduce the number of pupils needlessly placed and retained in special education.  Even though special education personnel, including SLPs, complain about having big caseloads, most do not take responsibility for aggressively screening out non-disabled minority children.

Middle School SLP Exits

Elementary school is where basic skills characterize special education — reading, language, speech, computation, writing. Special education programs are akin to Response To Intervention. If the programs are effective, non-disabled children in time should be dismissed. Children with functional articulation problems should be coming out of speech. Moderate-to-severe language cases should be exited if they can “access the general curriculum.” Many learning disabled children should be overcoming literacy deficits.

However, the national trend is for middle school personnel to forego dismissal. Learning disability enrollments remain static until high school, where dropping out is the major exit procedure. Children with moderate-to-severe language disorders, often minority children, move toward high school enrolled in special education. Speech and language cases are pulled along with other disability categories. Parents are afraid exits will deny their children needed interventions.

For middle school children, it is often unclear who should recommend exits. School psychologist? Special education teachers? Speech-language pathologists? Reading specialists? Directors of special education? Regular education teachers? Parents?

Special education pupils in middle schools are at risk in two ways. First, there is stigmatization, and we know about that. Second, basic skills instruction doesn’t fit high school.

Middle school children should move beyond basic skills even if the skills are imperfect. In high school, they must participate in rotating classes and subjects. They should be able to self advocate so teachers know their special needs (i.e., modifications). Their esteem should be high. They should be able to communicate socially with peers regardless of their linguistic intelligibility. They should have sociolinguistic skills for using genres of speech across contexts. Where appropriate, they should be anticipating vocational placements that they are heading toward with high school graduation. Prolonged basic skills instruction can impede progress toward high school graduation. It reflects classic pre-1975 special education where children sat across the road in the old brick building doing meaningless tasks.

Not only do students get stuck in special education, they get stuck doing the same things over and over without anyone’s anticipation of where they should be going. There should be a 12-year philosophy of special education that points students from the beginning toward realistic and dignified lives. And they should leave special education if at all possible.

SLP Caseload Eligibility

As a part of Strategic Eligibility Management (SEM), the alert SLP must start off whittling away at his or her individual caseload to reduce size and misidentifications in an ethical manner. Beyond this, the SLP is interdependent with other SLPs who might be creating placement “leaks” in the special education system. Caseloads are passed on from preschool to high school, and one can inherit the shaky eligibility judgments of others. Some SLPs also exit children rarely because of the difficulties of doing so. Sometimes SLPs do find themselves cleaning up a poorly managed caseload. Chances are new graduates do not know about the over-identification of at-risk children because it didn’t come up in their graduate programs and because of the stigma associated with it (cf. Why Over-identification). They are working strongly for compliance, getting along and keeping their jobs.

Placement “leaks” in the system must be diagnosed. Where and how are they occurring? Who is involved and how can they be gently influenced to make better professional judgments? How does peer pressure come into play? Where is judgment breaking down?

POINTS OF ENTRY

Child find. According to IDEA, schools must advertise in the community for referrals of at-risk children. They must arrange for screening sessions open to the public. Which SLPs are involved with this? Are they influenced by staff opinions?

Parents. Any parent can within a district (LEA) refer his or her child directly to the office of special education. The school by law must respond. Pressure is placed on the school for quick action, action that usually entails placement. “Rush to judgment” must be controlled.

Transfers. Children who bring active IEPs into the school district transfer their eligibility. The school may review the adequacy of the plan and how it will be carried out. It can review the disability judgment. Too often special education placement is automatically accepted. SLPs should flag questionable IEPs.

Home schooling. Parents who home school within the LEA are entitled to special education services. They must go through the standard eligibility procedures. One must watch for short-cuts in standard procedures.

LEA schools. Private and charter schools within the LEA can refer their pupils via parents to special education. The LEA must take the referral. Such referrals sometimes come in during the summer, when SLPs are on vacation.

0-3 years. Children who are made eligible for remedial support services must transfer into the LEA shortly before age 3 years. They bring an eligibility determination with them. The determination can be based on various disability criteria, and SLPs might believe they are obligated to accept the transfer information as is. Medical opinions must be translated into educational categories.

3-6 referrals. Kindergarten teachers and sometimes Headstart teachers can refer children to special education. Some at-risk children are identified through screening programs. Special education criteria change with regular school placement. How do developmental criteria translate into educational criteria?

6-21 referrals. At-risk children are often referred by elementary teachers as their academic learning patterns become evident. Referrals can be made throughout the school years, as, for example, in cases of traumatic head injury (TBI). Some teachers make questionable special education referrals. Pre-interventions must be considered, too.

Eligibility criteria vary with age, program and disability. Misidentifications can occur at any step. For example, migrant children sometimes bring out-of-date IEPs to their next school. Hurried acceptance can sustain misidentification.

Death of the SLP “Pull Out” Model

For 100 years school SLPs have relied on the pull out method of service delivery.  It is tradition!  And one almost impossible to change.  The readers of this post will make a mental note but will not change their behavior.  In 2010 they will report for the new school year with the same mind-set to provide direct service.  They will likely feel held back by large caseloads and dependency on administrators to provide more SLP help.  Some will BURN OUT!

Experts will mask the problem using polite speech: “School SLPs now have many creative opportunities to adapt their service delivery to the unique needs of the children in their caseloads.”   They will see impossible challenges and exotic ideas as “exciting possibilities.”

From prior posts here are the facts:

1.  “In 2008, Cirrin and Gillam published a review article suggesting there is no evidence of pull-out’s superiority over other service delivery methods. What’s more, there were no data showing that a particular number of direct sessions per week is optimal (Cirrin, F. M., & Gillam, R. B., Language intervention practices for school-age children with spoken language disorders: A systematic review. Language, Speech, and Hearing Services in Schools, 39, 110-137, 2008). ”  There is nothing holding back SLPs from making changes in service delivery.

Window looking out.

2. If SLPs use pull out all the time they are ignoring federal regulations, specifically, Least Restrictive Environment (LRE).  Throughout our posts we have documented the “opportunities” to grade placements to make service delivery more manageable and reduce caseload size while doing the right thing.

3. We are facing Response To Intervention (RTI) and other collaborative systems coming at us fast.  Do we realize we have to surrender half of our pull out time to do mandated cooperative programs?  We must move away from direct service toward collaboration.

4. Do we consider that Collaborative Programs might produce better results than direct service programs?

Of course, pull out is not literally dead.  But it is only one effective strategy among many for Total Case Management.

Update

This continues to be a popular post. ASHA in 2013 is soliciting opinion on pull out, and did so through its Facebook site. In 2007 we see another study addressed issues:

Classroom-Based Versus Pull-out Interventions: A Review of the Experimental Evidence
McGinty, A. S., & Justice, L. M. (2007). 
EBP Briefs, 1, 1-14.

Found only 3 studies meeting the selection criteria for review. ”

“The fact that only three studies were able to meet design-based evidence standards for inclusion in this review highlights the dearth of evidence regarding various service delivery models, and the lack of a clear effect for classroom-based over pull-out intervention in one of the three studies suggests the need for future, rigorous evaluations of classroom-based models of therapy for more conclusive answers” (p. 12).”

http://www.asha.org/Members/ebp/compendium/reviews/Classroom-Based-Versus-Pull-out-Interventions–A-Review-of-the-Experimental-Evidence.htm

October 2014 Update

We continue to track this issue, and now see it relates to the CAA accreditation process for sustaining excellence in graduate education. Clearly CAA cannot address second-order change and service delivery is one example. It micro=manages accreditation in terms of small strands of procedure and practice standards. So far we have found no evidence that it can address “the big picture” as to major trends requiring significant reorganization of academic preparation. Lip service is paid to evidence-based standards and practices.