Monthly Archives: October 2011

Events in the History of School Speech Pathology

We offer a summary perspective on the history of American school speech-language pathology as a component of the broader profession.

Girl Scouts Marching on Main Street.

It might seem that school practice is defined naturally by general practice, delineated by the requirements of the certificate of clinical competence as understood in the United States.  One national association, one certificate!  In fact, one can imagine many configurations for professional preparation, organization and certification.  Whereas speech-language pathology in the U. S. falls under a single umbrella organization, school psychology and school nursing are managed by separate organizations.  Psychology is hard to put under one umbrella — I.E., clinical, experimental, industrial, mathematical, educational, academic, etc.  It seems early on school psychologists adopted the idea that the education setting required specialization with respect to learning ability and teaching.  A clinical psychologists would have some skills for school children but would lack many others.

Indeed, speech pathology tried different organizational patterns from its start in 1910.  It was a part of different academic disciplines and influences before it pushed to become independent.  It moved forward through the war years under the influence of many strong personalities and competing visions.   In 1960 the nascent organization moved to Washington, D.C., and thereafter organized as a non-profit group legally distinguishing it from universities charters.  A series of professional managers put their stamps on planning and development.  Primary goals were to keep the organization intact, grow the membership, develop a management system, and control accreditation and certification.

From 1960 to 2000 energy was put into assuring independence academically and professionally.  School speech pathology was not well adapted for the civil rights and federal influences coming into focus in 1960, and therefore stresses were placed on SLPs to acquire far-reaching new skills through continuing education and school inservice.  At the same time the parent organization was investing resources equally  in “medical speech pathology,” as some have called it, and other divisions nurtured under  the organization umbrella.  Adhering to non-profit rules grew in importance and diminished the direct influence of academics.  Resources for public relations, advertising, website management, legal support, human resources, facilities, editors and administrators were shared across departments.   Priorities did not give emphasis to school speech-language pathology though school SLPs amounted to half the membership.  An organization of global design tended to fold all specialities into one institutional system more easily communicated to the professionals and the general public.  On the other hand, it diluted interests in school forecasting, accommodation to change and preservice education.

The dominant organizational philosophy was to view speech-language pathology according to the “medical model” with special emphasis on medical science and instrumentation.  The dominant organizational philosophy was not to view speech-language pathology according to educational principles and practices.  A paradox ensued, namely, the numbers of school practitioners came to be greater than the hospital practitioners when the medical model was central to academic preparation and association priorities.

Beginning 1905

School speech-language pathology began as an organized activity in roughly 1905, when surveys of speech problems in schools established a significant need. Before, individuals studied speech defects in hospitals but “speech correction” within education established educational and service programs within schools.  New york, San Francisco, Chicago and Detroit were among the early schools to sponsor speech corrections services.  The “pull out” service model was developed as an extension of extra help for children with speech defects.  The idea of  one-on-one “lessons” helped define remedial methods we still use today.  Speech correctionists improved letters children could not pronounce.  Most were female.

Speech correction departments were formed at the University of Wisconsin, Ohio State University, University of Iowa and Wayne State University.  In larger perspective, these early academic and school programs established the profession we now see around the world, in Europe, India, South America, Japan, Canada, South Africa and Australia for example.

Take Over 1931

Speech correction within education was organized and growing nationwide when a small group (n = 25) of midwestern college professsors agreed to capture speech correction to increase membership in their new organization.  They wished to break away from speech and drama departments and have greater status on campus.  Their interests were heavily influenced by medical thinking associated with explanations of stuttering.  They saw  themselves as researchers originating methods in college clinics.  Whereas school speech correction teachers were women, the professors and associated physicians were men.  The professors set up their own standards and practices effectively excluding speech correction teachers from significant status in their organization.  Yet the professors’ organization absorbed speech correction methods, incorporating them into a “speech therapy” framework and creating ambiguity as to what was educational methodology and what was clinical.

A two-tier status system put school practice at the lower level.  This bifurcation has been sustained until now.  It pervades policy formation in ways current leaders do not grasp for lack of historical analysis.  It has made school practice a second priority.

Move to Washington, D. C. 1960

The professors’ organization prior to 1960 was managed by the professors in their various roles as members of the organization.  The University of Iowa, The Ohio State University, and Wayne State Universities provided voluntary locations for the American Speech and Hearing Association.  Professors volunteered to handle treasurer duties.  In 1960 ASHA moved to Washington, D.C. renting a modest space for association headquarters.   A full-time executive director was hired.   There was no change in the status of school speech-langauge pathology.  Training remained the same with coursework taken in education to allow speech graduates to practice in the school setting.  The medical model was solidly in place, and implicitly reinforced neglect educational speech-language pathology.

Old stone dwelling near stream

Master’s Degree Required 1965

To become a certified speech pathologist, the American Speech-Language-Hearing Association increased academic requirements to include graduate education.  However, with the growth of credit hours available, no increase in school SLP preparation was defined and implemented.  The medical model curriculum was sustained but on a larger scale. School preparation continued to be accomplished through elective coursework in colleges of education, a pattern of academic preparation carried over from the 1930s.

Language Counter Position 1968

Activist mounted an independent movement to bring language assessment and intervention into the field.  There was resistance from the medical model establishment whose advocates traced back to the founders’ vision for the field.  For schools the language movement brought into practice cognitive-linguistic models having greater value in educational settings.  The speech therapy tradition was closer to the non-cognitive positions of physical therapy in schools.  Cognitive-linguistic models set the stage for interfacing with reading and academic programs.  In the face of overwhelming evidence, academic programs added language work to the curriculum and the name of the profession was changed to the American Speech-Language-Hearing Association.  Director Spahr upon his retirement noted  that the Association had been fortunate to have language brought into the field.  Nonetheless, educational speech-language pathology did not receive the attention it required to avoid stunted development.  It stayed in its second-rate position.

Non-Profit Status (date unknown)

The Association became a non-profit organization and that move was a game-changer.  One can compare the change of status to formation of the National Collegiate Athletic Association, establishing authority over college sports competition but sharing authority with universities whose interests were not always the same.  The NCAA came to be challenged by the courts over anti-trust issues.  Universities had their own legal status and responsibilities to state constitutions.  ASHA likewise became a legal entity as well as a professional organization.  Much money and energy was put into creating a successful non-profit organization apart from professional affairs.  This organizational challenge did not favor fundamental changes such as shifting the mission to provide greater support for school SLPs.  Support continued to be folded into the overall mission with shared resources.

School Office 1970

ASHA established a school office and publication to highlight school issues.  School SLPs gained some recognition but the office organizational structure remained static in relation to the overall growth in the numbers of school SLPs.  It did not evolve to become a major division of ASHA.  The staffing level (doctoral vs. master’s) was inconsistent and the voice of the school office was advisory only.  It shared resources with smaller programs contributing less financially to the overall budget.

IDEA Breakdown 1975

While focus continued on organizational improvements and medical model thinking for academic training, civil rights issues brought on changes in American education for handicapped persons.  The SLP role was changed by state and federal mandates but the certification curriculum did not prepare SLPs for this new role and content demands.

Continuing Education 1980

Rapid change in schools tied to the inclusion of disadvantaged children, and rapid change in the scope of speech-language pathology theory and intervention, produced rapid growth in school scope of practice.  IDEA required consultation and collaboration, with cognitive-linguistic programming tied to progress in the general curriculum.  Assessment changed radically to include assessing impact on academic improvement.  Though the academic credits in speech-language pathology doubled in 1965, only through general language courses added in the 1970s were the content deficiencies of school practice addressed.  Somehow feedback to the academic centers to update their programs was a non-factor.  Hence, the field turned to continuing education programming to address fast-moving school content.  Only a few strident voices spoke to the growing imbalance between preservice and inservice demands.  Rather than to address the substance of the scope of practice issue, it  was allowed to play out as a workload issue, to be resolved through required continuing education.

Directions

Dr. Jean Blosser has adopted an outlook favorable to school reform along the lines of our historical sketch here.  Her work has been updated in a 5th edition of  an important book:

“Nearly 55% of ASHA-certified speech-language pathologists work in school settings. The numbers are even higher when non-ASHA certified pathologists are considered. There are only a few resources that address service delivery, as opposed to assessment or treatment of specific communication disorders. School Programs in Speech-Language Pathology is designed to provide both new and experienced practitioners with solutions and strategies for the challenges they face in the complex and ever-changing world of school-based delivery.

Most books for school-based speech-language pathologists focus on different types of intervention and diagnoses. School Programs in Speech-Language Pathology focuses on service delivery, program design, and how to organize and manage an effective program. Additionally, this resource covers meeting state and national standards, following federal mandates, and how to relate to and communicate with colleagues and parents.

The organization, questions at the end of each chapter, real-life examples, collaborative strategies, research foundation, and usable forms all make this book very practical for university students, existing school-based practitioners, and program administrators.”

School Programs in Speech-Language Pathology Organization and Service Delivery

Fifth Edition, 464 pages, Illustrated (B/W), Softcover, 7 x 10″ N/A , ISBN10: 1-59756-403-6, ISBN13: 978-1-59756-403-8,  11.14.2011

Jean Blosser, EdD, CCC-SLP

Money and Organization

What Dr. Blosser does not address is the hidden issue of what responsibility professional organizations play in advocating the right public policies to foster appropriate school practices, particularly the American Speech-Language-Hearing Association.  There is a blank spot in most accounts of what clinicians should to do in schools, where policy formation comes in.

Clearly, school practice is at the heart of American SLP practice.  It should receive more funding and mission support within ASHA, counteracting biases favoring the medical viewpoint.  There  must also be a recasting of  the university curriculum to support the fancy trends Dr. Blosser identifies, such as collaboration.  “Be professional and get out there and do wonderful things.”  The “wonderful things” should be grounded in ASHA policy and preservice preparation.  Awareness of federal trends is not enough.

SLPs Can Lead Over-identification Preschool Prevention Programs

The evolving role of the school speech-language pathologists affords opportunities for true national school leadership with respect to early intervention to prevent academic shortfalls and over-identification. In taking this proper role a stronger position should result as to caseload management, innovation and professional growth.

Overview

Early intervention is a long-held ideal but leadership and implementation lag.   Researchers publish but applications to educational assessment and intervention are limited.  There are published guidelines for school practice but they do not adequately describe leadership, and relate practices to IDEA 2004.   No other specialty is as well positioned or as well prepared as school SLPs.  However, conditioning leads them to believe they are “service providers” who should be open to “collaboration” and a passive service role.

Need

The national need is great to prevent school failure, especially for minority children.  In our post,  “Prevention of Over-identification: 112th Congress,” we reported on proposed legislation aimed partly at reducing educational patterns of disproportionality:

S.541 — Achievement Through Prevention Act (Introduced in Senate – IS)

S 541 IS

112th CONGRESS, 1st SessionS. 541

To amend the Elementary and Secondary Education Act of 1965 to allow State educational agencies, local educational agencies, and schools to increase implementation of schoolwide positive behavioral interventions and supports and early intervening services in order to improve student academic achievement, reduce overidentification of individuals with disabilities, and reduce disciplinary problems in schools, and to improve coordination with similar activities and services provided under the Individuals with Disabilities Education Act.

The Act pinpoints the need to put early intervention at the center of prevention programming which include Response to Intervention.  RTI has been implemented nationally with most efforts attached to elementary school performance and reading.  ASHA guidelines indicate prevention an SLP responsibility, though they do not embrace issues of over-identification and disproportionality.

Evidence-Basis

Unstable state funding of preschool programs has impaired progress in the design and implementation of early intervention programs in American schools, in spite of the fact educators agree on the absolute desirability of such programs.  In a prior post, The Heinz Solution, we reported the following:

Joe Smydo, writing for the Pittsburgh Post-Gazette (October 23, 2009), reported on a major study of the effects of pre-kindergarten classes on the early education of poor and developmentally-delayed children vulnerable for special education placement. The study lasted three years and involved 10,000 children. Results indicated a boost in the development of social and academic skills. The children improved in math, literacy and social skills. The study was supported by The Heinz Endowments.

Girl Scouts Marching on Main Street.

Pre-K programs are sometimes dropped by school administrators but the study showed:

1. “Pre-K Counts classes benefited children of various racial and ethnic groups.

2. Classes rated high-quality had more dramatic effects on children than those judged to be of lower quality.

3. Despite poverty and other disadvantages, 80 percent of children in the study demonstrated skills necessary for success in kindergarten — well above what would have been expected without the program.

4. While the participating school districts traditionally placed 18 percent of high-risk children in special-education programs in kindergarten, only about 2 percent of Pre-K Counts children required those services.

5. The children in the study ranged in age from 3 to 6 and attended classes for four to 24 months. Those who spent more time in the classes had larger gains than peers who attended for shorter periods.”

SLPs should be able to reduce their caseloads through leadership of preschool prevention programs.  RTI program reports also indicate reductions in special education placement.  Yes, collaboration is one skill component of SLI participation but without a knowledge base of the IDEA issues and applications it is merely an attitude about cooperation with others.

Wait to Fail

With reference to the post, New School Phonology: Wait to Fail!, the issue of wait to fail was pinpointed in connection with the correct assessment of phonology and articulation:

“The President’s Commission on Excellence in Special Education (2001) found American schools follow a pattern members called wait to fail.

“Finding 2: The current system uses an antiquated model that waits for a child to fail, instead of a model based on prevention and intervention. Too little emphasis is put on prevention, early and accurate identification of learning and behavior problems and aggressive intervention using research-based approaches. This means students with disabilities do not get help early when that help can be most effective. Special education should be for those who do not respond to strong and appropriate instruction and methods provided in general education.”

Prevention

idea.ed.gov (Legacy 2007) provides a summary of what state and local school districts “must” do to monitor incorrect placements in special education. Here is the basic requirement:

“The State must have in effect, consistent with the purposes of 34 CFR Part 300 and with section 618(d) of the Act, policies and procedures designed to prevent the inappropriate overidentification or disproportionate representation by race and ethnicity of children as children with disabilities, including children with disabilities with a particular impairment described in 34 CFR 300.8 of the IDEA regulations.[34 CFR 300.173] [20 U.S.C. 1412(a)(24)]“

School SLPs should play a pivotal role in the prevention of over-identification.  Right now, they hardly know what it is.  ASHA’s online policies and guidelines ignore the topic of over-identification as an issue and a critical component of prevention.  One cannot have a respectable prevention policy without addressing forthrightly and publicly the IDEA requirement for SLPs to prevent over-identification and disproportionality.  The proper policy outlook should be a gateway to caseload management and job satisfaction.

Mis-identification

We take the view that school SLPs can reduce the mis-identification of learning disability cases through  their roles as early education specialists.  “Many phonology children should be categorized by SLPs as learning disabled rather than SLI.  Say a five-year old boy has 5 or more articulation errors and falls two standard deviations below the mean on an articulation test.  This is an LD child if placement in special education is required. SLPs are prepared as well as any school employees to place children in the SLD category at the preschool level of linguistic learning and academic prediction.

The problem of phonological delay and disability will limit and predict subsequent language and reading performances before teachers and psychologists can detect problems. There is a good body of research showing “artic cases” morph into language and learning problems later, as well as social and academic success problems later. Fooling around with them as “artic cases” and then dismissing them after sounds are corrected is to abandon these children just as they are entering a critical stage of great academic need.” (New School Phonology: Wait to Fail)

Comment

School speech-language pathologists are educated to be willing service providers.  They need continuing education in leadership and access to a clinical doctorate with an emphasis in education so they can take on the role they should be taking on, that of designing and leading prevention programs.  Health-care professionals are all in the “misery industry.” They benefit from the sickness of their clients and not from their health. As we point out above, prevention is a gateway to professional wisdom, opportunity and effective policy.