2. The Future of School Speech-Language Pathology

Central to guiding the American profession of school speech-language pathology forward into the 21st Century is coordination of professional members working in the various parts of the field.  

Academic institutions preparing SLPs must know what school workers need, adapt curricula, update clinical training practices and promote changes in education colleges to support SLP preparation.  Some institutions do better than others. 

Overall,  faculties have been too slow to reform their educational programs, particularly at the graduate level.  The bloom of language theory and application ushered in in the 1970s flourished and then came the chill of winter.  It was difficulty to put in courses in language while courses in “cleft palate” and “cerebral palsy” lasted too long.  The traditional speech therapy curriculum did not yield to language while language expanded from syntax to semantics to pragmatics to cognition. 

For school SLPs, half of the graduate program should be in language.  A single course is the stone age.  And now “reading” is said to be in the scope of practice, and reading is an entire domain within itself.  School SLPs hunger for foundation work in reading, based on solid linguistic research.

Collaborative education needs to be a part of the SLP curriculum, along with RTI programming and qualitative assessment in the classroom.

More support for academic researchers is badly needed.  For the over 50,000 American SLPs, working in 100,000 national schools, the number of language researchers is far too small to cover all the emerging trends found in the school setting.  If there are 500 active SLP language researchers, they do so while having to work in the clinics,  teach large courses, show up for social gatherings and supervise clinical practice.  Deans hound them for publications and grants to win tenure while clinical faculty believe clinical education is high priority.  Young faculty members have their day jobs, and work on the weekends on their research. At the same time Ph.D. education has suffered so that programs do not have enough researchers to hire.

Some academic  deans know about speech and hearing problems, others know nothing.  Academic deans need to hear more about the field from professional groups.

In too many programs research is the lowest priority and students are not obliged to learn research skills.  Students even though they face great debt to go to school want modern methods to be competitive for employment.  They engage in magical thinking that the research just appears for them to use quickly for practical purposes.  And when they arrive on their jobs, they do not see themselves as having obligations to advance knowledge they can use.  If RTI comes along, or reading collaboration is critical, they wait for someone to deliver new information to them without making research efforts to implement and publish.

Academics find it almost impossible to do research in schools.  There are real access issues and it is difficult to drive away from campus to visit schools to collect data.  The research methods they have learned in graduate school give emphasis to “hard data” studies conducted in labs.  Deans respect them.  Survey and descriptive data are needed from schools to see what practice trends are materializing.  “Soft research” may not win a professor tenure.  At the same time on-campus researchers do not even know what the questions are to ask? 

Some research topics, such as to how accurately SLPs evaluate children for special education placement, appear to be objectionable in that SLPs might be embarrassed by patterns of documented misdiagnosis.

Without a strong background in language and cognitive science, they fall into the historical patterns of “speech therapy” where “articulation therapy” is king.

As our writing makes clear, public policy formulation at the national level has outpaced the profession.  Students are not exposed to national federal issues in education that directly impact the nature of school clinical practice.  School SLPs should read the new laws when they come out.  Otherwise, they are obliged to deal with second-hand information drifting down to them from state departments of education.

State professional organizations struggle to help members fight heavy caseloads but only a few SLPs help out.  What happens in Wisconsin is unknown to SLPs in Alabama. There is great need for coordination of state SLP school organizations for maximum effect on school standards.

The key organization to coordinate academic and school practice concerns, research, policy, practice and public relations is the American Speech-Language-Hearing Association.  It is the only entity available to coordinate all parts of the profession.  In the 1950s, the academic centers coordinated the “American Speech and Hearing Association.”  Then the academics established central offices.  The last university to hold ASHA was Wayne State University in Detroit.  The academic centers gave up a great deal of procedural control of the profession, by delegation of functions  to many  non-professional staff.

The National Education Association, many say, has become its own institution.

On the one hand the Association’s long arm reaches back into academic preparation to ensure students receive proper and ethical training.  When school SLPs lack training in reading as advocated by the Association, it must take pains through accreditation regulations that certified SLPs have the right background.  Here is a great coordination problem.  How does the Association keep academic preparation current with its own public advocacy?  

Simply publishing journals, holding conferences and posting electronic communications are insufficient without the right content.  The right content is relevant applied research with precise recurring focus so that school SLPs eventually “hear” the message about critical trends and practice changes.

Why are so many boys placed in school caseloads?  Why are so many non-disabled black, hispanic and native American children placed in special education?  How can SLPs “prevent” communication disorders through correct evaluation?  Researchers and policy makers have to ask the right questions to generate the right content.

SLPs lack an interest in research.  These attitudes begin in graduate school and continue on into practice.  It is unlikely academic researchers will ever have sufficient capacity to address practice issues in schools.  Then who is going to do the research? 

This is a pervasive problem in American schools.  Too little research is published to guide instruction.  Policies are made without research foundations; hence recent calls for evidence-based practice.

Even where there is a profound need among school SLPs, how do they participate in a process of reforming Association regulations and academic preparation?  In online publications we do not see requests for survey opinions and feedback commentary. There may be a few quick  notices to send it comments but systematic opinion studies are rare.

Communication is closed and top down.  Academic programs do a better job of soliciting donations than they do soliciting opinions about what school SLPs need to know?

Continuing education credits are weak because research foundations are weak.  Announcing that such and such is a “hot topic” does not solve applied problems.  In any area of research, 50 solid studies are needed to establish a foundation for practice.

Take for example the question of how school SLPs can evaluate language in the classroom.  Bravo to a few hearty SLPs who take it upon themselves to write up something on the topic but miscellaneous anecdotal findings are just that. 

Magical thinking extends to professional publications where Jane Doe and Judy Jones report on how they have successfully coordinated articulation therapy with RTI programming.  Editors believe that if a news note appears in print somehow a contagion of RTI projects will result and sweep the country.  Cheerleading isolated projects is not a program to improve the foundations and patterns of school SLP practice in the U. S.  Grassroots relations with schools need to be carefully orchestrated with productive outcomes in sight.  Writing one’s congressman is not a program.

What must be done with the two separate universes of “speech therapy” and “speech pathology?”  How is that they allowed to co-exist without reform?

Some vocal school SLPs have in effect argued the profession is trying to do too much.  A small profession needs concentration and priority.  Why should SLPs take on reading intervention when their caseloads of traditional disorders are overflowing?  Perhaps it is just another fad and distraction.  “Boutique speech pathology.”

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