Monthly Archives: September 2011

Knowledge for School SLP Certification

Throughout our posts we’ve identified issues concerning the readiness of SLP graduates to cope with the knowledge demands placed on them to serve special education pupils within the framework of IDEA. One must trace back to academic and clinical preparation requirements and experiences to see whether antecedent preparation is in place. The American Speech-Language Hearing Association is presently soliciting comments on its revised clinical certification standards.  Presently it is not possible to generalize about SLP academic preservice preparation in America. But we can posit the obligatory background knowledge SLPs need in 2011.  Accordingly, we are impressed with the opportunities graduates of the Brooklyn College (New York) have to take on-target coursework in special education supporting modern practice in schools. Every school speech-language pathologist should have the topical experiences described.

Educ 7672T Teaching in Least Restrictive Environments

30 hours plus conference; 3 credits

Strategies to integrate and support students with special needs in least

restrictive environments. System and organizational change theories and

strategies for developing models of inclusive education. Focus on curriculum

and collaborative processes with other professionals including co-teaching,

consultative, and itinerant models. Engagement of family members in

collaborative efforts. Students will implement a consultative/collaborative

project. Field experiences in a variety of school and community settings.Cottage on the sea

Comment

This content, however, might well be in the speech-language pathology curriculum per se, under social  language and learning.  Since 1975 it is central to the role of school practice and not an enrichment content to be taken electively.  Typical university speech and language centers should emphasize the skills needed to implement the knowledge described above.  For example, they should learn evaluation methods which are related to children’s progress in the general curriculum at  school.  All the children who routinely go to on-campus clinics fall under IDEA requirements.  Many have school IEPs and goals to meet related to the general curriculum.

In planning for on-campus experiences students should write lesson plans suitable for IEP uses.  They should collaborate with parents and teachers as they carry out their practicum training lessons.  They should consider recommendations for placement and retention.  They should consider potential mis-evaluations, especially for minority children, and practice prevention of disproportionality.  Those who are heading for hospital service or private practice need the same modern skills taught to them in the college speech and hearing center.  There are children in hospitals and there are children seen privately.

Perhaps the one-size-fits-all curriculum can survive if it does not give priority to the medical model over the educational.  Integration in both directions can level the playing field.

“With more than 100 languages spoken on campus and nearly as many countries 
represented among its student body, Brooklyn College is one of the nation’s most
diverse. According to Diverse, a magazine dedicated to issues of diversity in
higher education, it is one of the top 100.”

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How One SLP Manages Caseload and Eligibility

We are fortunate to consider the experiences of one school SLP dealing with the eligibility process and its impact on caseload size

“The load for case management mushroomed as the autism eligibility encompassed more children. Communication disability is often the next eligibility to come into play with children who are not making progress. Often children come with a diagnosis from early childhood and are already SPED eligible. I am finding RTI is keeping children from switching to LD or other eligibilities and they remain on my caseload for case management until I dismiss from the CD eligibility. I get pressure to keep them because they are often receiving other services under the umbrella of the CD eligibility. Parents sometimes play a role in this, because they would rather have the CD label than MR or ED. It creates a caseload of kids where the eligibility is not a good representation and the SLP is doing the case management of some very high needs kids. That is one reason why SLP case loads seem high for CD eligibility.

I find I’m doing a better job identifying or not identifying children from ELL backgrounds because of better tests and ELL support people. I don’t feel I am over identifying but I do feel some have the wrong eligibility because of the reasons I stated.

Administrators do not understand the difference between case management and caseload numbers. They keep counting the numbers and assume every child is your typical CD artic kid. This his been a continuing problem and is coming to a head as they have cut back on SLPs and put us into more buildings according to the numbers. I can not address the needs of the children with autism and train their assistants when I am not in the building

Kids stuff for school.

on a daily basis. They believe we can go back to the 70s and serve large numbers but forget the requirements of IDEA that have been added and also don’t realize the high needs kids.
Administrators also do not understand what SLPAs can do.”

CJ Monty

4. The Future of School Speech-Language Pathology

We have found through our series,”The History of  School Speech Pathology,” that history does repeat itself.  Our history follows a pattern where school speech-language has not matured as a discipline because of  the long shadows of clinical tradition.  

In an analysis of how 1975 changes in public policy were processed, we identified basic issues. They did not involve funding. Rather, they involved problems of perspective, organization and problem solving. To this day, we still talk about “speech therapy” in the school setting.

We saw how workload was the pivotal issue of the latter part of the 20th century. One whole generation wrestled with it.   The future, we argue, now revolves around the role of the school speech-language pathologist. It transcends workload management and reflects advancing American public policy issues in this century.

A clown on mainstreet.

30. The History of School Speech Pathology

Does history repeat itself?

In the last post we looked at IDEA issues as they have been folded into caseload debates.  One generation of school SLPs is now retiring without resolution of the problem.

Now the process is repeating itself.  

In several posts the topics of collaboration and response to intervention have been examined.  We are following the same patterns as before with no end in sight. 

As beloved Dick Vitale might say, “Burn out city, Baby!”

 

 

17. Response to Intervention Success

A progressive for-profit group under Global Scholar continues to release reports on progress made in American Schools as to the implementation of Response to Intervention.  The fourth annual report is supported by NASDE, CASE, AASA and RTI Action Network.  The report, based on survey data, was issued electronically to interested parties.  Accordingly, results showed:

* 68% of school respondents indicated implementation of RTI programs at various stages of development.

 

* 80% reported full implementation is happening in elementary schools

 

* Reading is the domain most often addressed by RTI programmers.

 

* 80% report reduction in special education referrals.

 

School speech-language pathologists should check with their local 

districts to see how they can contribute.  RTI can be used ethically 

to reduce SLI caseloads, addressing the SLI goal of the prevention of 

communication disorders in the larger society.  However, SLPs need 

to be flexible on their role expectations. Collaborative education is 

key. 

Old stone dwelling near stream

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.