Monthly Archives: February 2012

ASHA Governance and School Speech Pathology Practice

Tracing through the history of  The American Speech-Language-Hearing Association gives one ideas and impressions about governance and organization shaping school practices in American schools.

Governance is the act of governing. It relates to decisions that define expectations, grant power, or verify performance. It consists of either a separate process or part of management or leadership processes…In the case of a business or of a non-profit organisation, governance relates to consistent management, cohesive policies, guidance, processes and decision-rights for a given area of responsibility… ” (Wiki)

“The duty of decision-making is a cornerstone of professional associations, entrusted to the those elected to the organization’s governing body — in ASHA’s case, the Board of Directors” (Chabon & Pietranton, ASHA Leader, 2012, March 13).

Mr. Chang, swan-goose and friend, Lakeside, Arizona

Over more than 100 years of organizational activity, capture of  school speech pathology by a small group of academic speech therapists in 1925 established organizational bias against those who did not want to work in hospitals and clinics, and who wanted to work with school children. School practice was flourishing up to 1925, whereas speech therapy practice was almost non-existent. Medical-model thinking was imposed on school speech pathology by the careful selection of executive directors, central organization in Washington, D. C., and non-profit status. Medical model leaders used the rapid growth of school speech pathology as a revenue base for continued funding of narrow and often arcane speech therapy research, teaching and practice.  It took until 1970 for ASHA governors to take even a modest step toward supporting school functions by way of a small office for school issues and programs, an office which remains virtually the same today even though more than half of ASHA members work are in education.

The production of doctoral graduates preparing for leadership in schools  was  nil. Doctoral education was heavily invested in medical-model research and coursework.  The rapidly growing school section of ASHA went without leadership in school speech-language pathology.

In the meantime ASHA was flat-footed when it came to addressing the effects of the civil rights movement and federal legislation on school practice, beginning especially in 1975.  The small office struggled to address issues but was overwhelmed and under staffed.  ASHA governance continued to be biased toward medical model thinking, leaving preservice training in status quo.  A whole generation of graduates completed their careers with insufficient background with respect to the massively changing school environment.  The  deep bias favoring medical-model thinking blinded governors as to trends in school practice..  It is difficult to govern something one does not understand, if one has not practiced in schools.

Executive Director Position:    Speech correctionists were excluded a priori from the position of Executive Director of ASHA. A direct chain  from the male founders to the present day promulgated medical model thinking: Wendell Johnson (1931-1941, Iowa, de facto);  D. W. Morris (1941-1948, Ohio State):  George A. Kopp (1948-1957, Wayne State University); Kenneth O. Johnson  (1958-1980, Stanford Medical);  Frederick T. Spahr (1980-2003, Pennsylvania State). The last in the chain is a woman but no language specialist has ever  been selected, nor a doctoral-level professional with extensive school background.”  (Women Lost)

A clown on mainstreet.

Adopting the non-profit  structure imposed greater inflexibility on ASHA.  Whereas universities up to 1970 provided the fire power for organizational growth of the young profession, executive directors put their energies into the non-profit mission.  University programs lost their influence while sustaining “speech therapy” training.  ASHA became less nimble because it was investing both in gaining control of credentialing and establishing the non-profit base in Washington.  Becoming a strong national cartel for speech therapy services was the larger agenda.  From the beginning, the school  segment of the profession was the profit center to fund organizational growth.

With status quo operating unquestioned, and academic control diminished, ASHA governance took professional leadership in the direction of service to the non-profit medical model credential-control mission, a mission heavily influenced by director Kenneth O. Johnson, 1958-1980. The role of president of the association continued to be eroded giving executive directors greater de facto power and influence.  Presidents rotated through on one year appointments, insufficient time to produce lasting results, while allowing the one-size-fits-all training plan to carry on with little or no innovation to support school clinicians.  To bring the cognitive-linguistic model into training in the 1970s, no small amount of resistance operated.  Even now the literacy domain as an extension of language pathology has fallen years behind in development though it is central to emerging school practice demands.  Attention to literacy training in the university programs languishes. Upon his retirement Frederick T. Spahr, 1980-2003, admitted language had been a vital step forward for the profession although the movement had not received wide support.

For school speech-language pathology to receive full support for its changing mission,  it needs to be a separate ASHA division with separate graduate school major to rectify the historical mistakes by ASHA governors and to break away from cartel strategies.  We have developed here the rationale for  “educational speech pathology” parallel to educational audiology, pointing out repeatedly that school pathologists are half the ASHA membership.

Yet school speech-language pathology continues to be submerged in current institutional thinking: “ASHA exists to enhance the professional lives of audiologists, speech-language pathologists, and speech, language and hearing scientists, and through us, the lives of individuals with communication disorders”   (Chabon & Pietranton, ASHA Leader, 2012, March 13).  Science and  audiology get separate billing following old-line preferences dating back to D. W. Morris, 1941-1948 and George A. Kopp, 1948-1957.  These narrow technical areas receive support from the school SLPs who provide the force behind the profession. Under the present structures, there is not way to give full billing to school SLPs. School practice is just another practice area, “school-based” versus “prison-based” for example.

The Board of Directors should seek to overhaul speech-language pathology to include a separate ASHA division, properly supported in concept, advertising and funding. Policy should reflect changes in curriculum knowledge unique to educational settings.  Students going into school work should all have the background described in the course description developed at the Brooklyn College (New York):

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.

Such preparation should be incorporated into clinical clock hour experiences in university speech and language training centers.  IDEA -2004 procedures should become a part of the work with those school children who have educational plans (IEPs). Proper diagnostic experience should  reinforce educational principles, and CCC training hours should be granted for such training.  One way or another, the Board of Director must make sure preservice training is appropriate for school clinicians.  One cannot count on colleges of education to provide linkages to IDEA requirements.

Window looking out.

The ASHA Board of Directors is soliciting input. President  Chabon has approved input to the Board, using an InTouch form for this purpose.

We advocate an overhaul of school speech-language pathology to remove historical bias favoring medical speech pathology.  The bias started in 1925 with the capture of school speech correction, and the “FOUNDER’S SYNDROME’ has operated ever since:

Founder’s syndrome is an issue organizations face as they grow. Dynamic founders with a strong vision of how to operate the project try to retain control of the organization, even as new employees or volunteers want to expand the project’s scope or change policy.”  (Wiki)

The cognitive-linguistic model was eventually accepted in the 1970s but never allowed to blossom fundamentally in support of language, culture and learning in schools.

Prior  comment:  “Consider the size of the National Association of School Nurses.  In 1968 NASN started with NEA as a department. In 1979 it became a separate non-profit organization.  Today it lobbies in Washington, has a national network of state organizations, advertising plans, board members, annual conference, two publications, radio service, bookstore, national president, and a full-service web site.  All of this is accomplished with 14,500 members.”

http://nasnupgrade.nasn.org/”

John M. Panagos

Describing Special Education Over-identification

Still under construction

One encounters hundreds of  internet articles on over-identification not easily generalized for the broader view.  Here we begin to define terms, variables and issues in support of the broader view.  Description of the problem is essential. Theories explain and predict.

The Kennedy family advocated for retarded citizens. This is Mrs. Kennedy. Her husband was President John Kennedy, and he too advocated for rights of children.

IDEA 2004 STANDARDS

IDEA 2004 sets clear standards for proper identification of at-risk children for placement in special education.  The flow of regulations is downward from congress, the executive branch, the supreme court, the department of education, state agencies to superintendents.  The local superintendent represents the Local Educational Agency (LEA) to the State Educational Agency (SEA).  IEP teams make placement decisions and parents approve or disapprove.  Teams consist of evaluators, regular classroom teachers, related services personnel, special education teachers and parents.  Facilitators guide decision-making on behalf of the LEA.

http://ed.gov/parents/needs/speced/iepguide/index.html

Appropriate Identification

Placing disabled school children in special education who meet placement criteria, on a case-by-case basis, with reference to IDEA categories, Child Find requirements, and FAPE regulations.  

Well prepared eligibility teams understand IDEA requirements and take time for objective decisions.  The district facilitator has strong background in the law, group dynamics, community norms and staff qualifications. The director of special education monitors placements for fairness and accuracy.  Children are placed and retained in special  education by IEP (eligibility) teams.  They listen to evaluation reports by teachers, psychologists, doctors and speech-language pathologists.  The criteria are clinical and educational.  Teacher reports emphasize academic performance.  Official  paperwork is filled out, signed and kept  on file.  The team can say no to admission.  In over 100,000 American schools, millions of IEP meetings are held yearly.

Multiple Identifications
Placing disabled children in more than one IDEA category for  parallel or collaborative interventions.
Many children placed in special education have symptoms of different disabilities, such as TBI pupils needing physical therapy and speech-language pathology, or intellectually challenged pupils needing occupational therapy, speech-language pathology and sight intervention.  The IEP reflects the selection of services from different specialists.  Dismissal from one category eligibility does not preclude continuation in another. Children are dismissed from the speech and language impairment while specific learning disability status continues.

Least Restrictive Environment (LRE) Identification

Placing disabled children in learning situations appropriate in location, intensity and peer access.

The location can include the regular classroom with support, resource room, the speech room, or off-campus facility.  Intensity concerns the amount of treatment time assigned to any one category intervention.  Peer access concerns the amount of time spent with children who are not enrolled in special education.  IEPs show which specialists provides services.  The well-prepared IEP team recognizes the wisdom of constant re-assessment of LRE placements.

Continuing Identification

Continuing  placement in special education to sustain and improve academic performance through one or more interventions.

Where one or more interventions do not mitigate effects of one or more disabilities, and where reaching education goals has fallen short, special education status can be renewed.  Each year the IEP team meets to deliberate on the success of the educational plan.  There must be one evaluator (psychologist, reading specialist or speech-language pathologist) present to report on disability indications. Special education teachers confirm progress or the lack thereof. Special education children can be renewed for another year of selected services as recorded on the adjusted IEP form.  Extra meetings can be held during the year if questions arise.  Three-year evaluation is required.  Well-prepared IEP teams promote dismissal from special education in timely fashion.

CATEGORY DETERMINATIONS

Canada

DISTORTION OF IDEA 2004  STANDARDS

In local school IEP meetings the foregoing IDEA standards are distorted in application:  “Distortion, a statement that twists fact; a misrepresentation” (Free Dictionary).  On IEP forms, and in oral comments, disability characteristics are misrepresented.  IDEA category criteria and FAPE regulations are violated by the collaborative actions of  IEP teams.  The U. S. Office of Civil Rights documents violations of  children’s rights:  “An important responsibility of the Office for Civil Rights (OCR) is to eliminate discrimination on the basis of disability against students with disabilities. OCR receives numerous complaints and inquiries in the area of elementary and secondary education involving Section 504 of the Rehabilitation Act of 1973, as amended, 29 U.S.C. § 794 (Section 504). Most of these concern identification of students who are protected by Section 504 and the means to obtain an appropriate education for such students.

http://ed.gov/about/offices/list/ocr/504faq.html

Several types of misidentification are suggested by our findings. There are many ways in which IDEA standards are violated with respect to the education of “struggling children.”

Inappropriate Identification

Placing children in special education who are not disabled or who need only remedial support via general education programs, thereby violating FAPE  protections.

“Inappropriate” means decisions violating IDEA 2004 eligibility regulations.  The IEP teams place non-disabled children, make careless LRE decisions, or fail to dismiss in timely fashion.  Contacts with normal peers are limited.  Statistical observations indicate IEP panels place more children than is justified by IDEA 2004 standards.  “An analysis of U.S. Department of Education data shows that the percentage of students in special education varies widely among states. While Rhode Island tops the country at 18 percent, Texas, at 9 percent, is at the bottom. The average percentage across all states is 13 percent, and two-thirds of states are above that number, according to the data.”

http://www.disabilityscoop.com/2012/01/25/state-special-education-rates/14849/

Girl Scouts Marching on Main Street.

Over-Identification

Placing school children in special education at a rate higher than justified by disability criteria and statistical norms.

The most recent example is the over-identification of  learning disabled children.  Many vulnerable children who do not fit into the regular classroom are referred to special education for need of ordinary remedial services.  Boys are over-identified compared to girls.  Deficiencies in general education remedial instruction are central to the problem.  Hispanic children who lack English language abilities can show up in special education because school administrators do not know how to provide second-language programs.

Under-Identification

Not placing disabled children in special education who are entitled to placement at least by statistical norms.

Girls are less often identified for special education.  Most teachers are women and therefore a bias might operate.  For years autistic children were under-identified considering current trends indicating a growing number of  autistic children in special education.  TBI pupils involved in sports programs might be under-identified.

Disproportional Identification

Placing non-disabled minority children in special education with reference to the proportions of such groups in the school district.  

Historic patterns of blocking minority children from school attendance continue to operate in schools.  Shunting into special education became another means of  isolating minority children from mainstream children.   The patterns have included abuses of  IDEA provisions of Least Restrictive Environment for special education instruction. The tendency to keep children enrolled indefinitely without dismissal and adjustments in LEA is rampant.  Members of IEP teams often carry out misplacements unwittingly, or seek to please school authorities while remaining mute about misidentification.  The problem nationally has been known since the 1960s.  Black children are particularly vulnerable.  

Substitute Identification

Substituting special education placement for general education remedial support.

Many “struggling children” including those who are “poor” and “disadvantaged” need remedial support along the lines of Title I programs.  These programs have failed for many children.  Regular education teachers do not have teaching skills suitable for matching up with learning styles and needs.  Or general education teachers are over-taxed by difficult-to-teach children in their classrooms.  General education takes advantage of sending struggling children to special education where skilled remedial teaching is available.  The children suffer the stigma of special education placement along with lowered educational expectations.  Where Response to Intervention programs have been established, fewer children are enrolled in special education. 

False Identification

Placing disabled children in the wrong special education placement categories.

The best known example is placing low-performing children in the special education category for retarded pupils.  Black children faced this school pattern as a true civil rights concern.  Placing gifted children in the learning disability category because of learning style differences is documented.  Categories of Disability under IDEA 

Mis-Timed Identification

Placing children in special  education who should have  been placed at earlier times, or later times beginning with preschool education.

IDEA covers Part C for children up to the third birthday, and Part B for school-age children, including preschoolers  (http://www.nichcy.org/schoolage).  As at-risk children pass through the developmental years into formal education, wide-ranging assessment protocols produce irregular data and placement decisions.  Placements in Part C programs based on medical and behavioral assessments cause the placements to carry forward into the elementary school as experts wait to see how “progress in the general curriculum” advances.  Other children are not identified under Part C and move forward without remedial support.  In a different category, Traumatic Brain Injury pupils are identified late because they are not referred for evaluations.

Insufficient Identification

Placing children in special education where placement evaluations are incomplete and / or  irrelevant to the general education curriculum.

This is a subtle type.  It concerns the transition to elementary school and identification during the preschool years.  Often medical personnel identify disability and indicate the need for special education services before local schools evaluate for placement.  IEP teams go along with early judgments without consideration of educational criteria.  This involves the “wait to fail” problem.

Forced Identification

Placing  at-risk children in special education because of legal and / or pressures on school district administrators.

Courts, attorneys, local advocates, school authorities and parents can all bring strong pressures on IEP teams to make alternate placement determinations.  Court cases have   shaped decisions about particular children, or numbers of children in a class.  Strong-willed parents through knowledge, skill and legal appears bring about changes not otherwise made.  Superintendents push on special education personnel to place more or fewer children in special education by using budget considerations as ad hoc criteria.  Special education pupils can refuse to be in special education.

Recurrent Misidentification

In spite of IEP meetings, keeping children in special education year after year without dismissal and without meaningful adjustments for least restrictive environment.

This amounts to what has been called historically, “Warehousing.”  On a grand scale,  the Supreme Court’s establishing FAPE rights forced local schools into a process of adherence to Least Restrictive Environment.  Parent advocacy groups such as the ARC forced the issue.  On a lesser scale, the problem remains at full intensity. Many schools still keep children in the same IEP straight-jacket for years, even “carrying paper” on them when services are no longer needed.  Many parents, too, will not let their children out of special education. Failing to dismiss promptly is a major problem in special education.  Warehousing is a  negative global attitude to all aspects of testing for special education determination.

http://www.uiowa.edu/~c07p224/abstracts/IDEA_and_overidentification.htm

FRONT-LOADED BIAS VS BACK-LOADED BIAS

First determination of special education placement is the point at which Front-Loaded Bias comes into play.  It accounts for national statistics showing American schools are biased toward the over-identification of at-risk children for special education services and interventions.  Specific learning disability is commonly mentioned as the prime example.  The U. S. courts and the U. S. Congress have brought this problem to public attention and have pushed the U. S. Department of Education into regulatory actions to reduce over-identification.  Disproportional placements of non-disabled minority children continue to receive some discussion nationally.

Back-Loaded Bias in contrast is continuing to inflexibly keep children in special education even when they are non-disabled, and continuing to let their LRE placements languish from year to year.  Here the courts, congress and the department of education pay little or no attention to what might be called the “unintended consequences” of IDEA regulations. Parents believe it is best for their children to be in special education and when they object IEP teams push back.  Academics are unable to do site-based studies of the statistical patterns of long-term identifications. Pressure to ignore the 3-year evaluation sustains the problem.   Minority students such as native American and black children become long-term victims of back loaded bias.  In some states and in some schools such results are disgraceful.

CAUSES OF OVER-IDENTIFICATION

Any explanation of over-identification must start with questions of why engineering efforts to rectify the problem have little impact over many, many years.  Amy Zirkelbach writing in 2002 laid out the problem nicely:  ”

“Concerns about the overidentification of ethnic and culturally diverse students in special education first gained national attention in the 1960s as civil rights advocates, educators, administrators, and policy makers began raising questions about the overrepresentation of minority students in classes for the mentally retarded. To a great extent, disproportionate placement still remains today. Although the problems varies from state to state and region to region, it is seen as an ongoing national problem which may result in students who are unserved, misclassified or inappropriately labeled, or receive services that do not meet their needs. Disproportionate placement of these students into special education classes may be seen as a form of discrimination.”

http://www.uiowa.edu/~c07p224/abstracts/IDEA_and_overidentification.htm

Proof of School Speech Pathology Over-identification?

One of our SLP visitors posed a critical science question for all of us to consider.  Here is the comment:

“I wonder where you get your data. SLP’s have to substantiate eligibility with standardized tests and data of progress. With our caseloads, there is no way we would take on a child that didn’t need it! That said, new regulations require language services that formerly were not covered if it could be shown that a child had a concommittent intellectual disorder. The result of that regulation is that practically any intellectually disabled child also receives language services.”

Kids stuff for school.

Our quick answer was designed to touch on some “evidence” on the matter:

“Take a look at “About Us” for the premise, and consider the many posts covering disproportionality, over-identification, least restrictive environment and failure to dismiss. Consider actual clinical examples and the use of aggregate data. For IDEA 2004 renewal, consider how the law was changed to reduce LD over-placement because of issues of construct validity for test interpretation. We argue for improved skill development. Consider the content of “Themes of Interest II.’ Look at, “SLPs Can Lead Over-identification Preschool Prevention Programs.”

Yes, the question posed is excellent and the right one.  It goes to the question of what constitutes proof.

Dr. Jay Greene and his colleagues demonstrated the influence of a macro variable on the over-identification of at-risk children for special education placement and retention, financial incentives for local superintendents  to increase the population:  “There is a statistically significant positive relationship between bounty funding systems and growth in special education enrollment. Bounty funding results in an additional enrollment increase of 1.24 percentage points over ten years.”  2002  (Congress did address the problem.)

http://www.manhattan-institute.org/html/cr_32.htm

School SLPs are instrumental in placing children nationwide, and therefore we can say they have made decisions influenced by financial patterns in their districts.  Likewise, they are influenced by state policies: “An analysis of U.S. Department of Education data shows that the percentage of students in special education varies widely among states. While Rhode Island tops the country at 18 percent, Texas, at 9 percent, is at the bottom. The average percentage across all states is 13 percent, and two-thirds of states are above that number, according to the data.”  Thus in Rhode Island  SLPs are part of a pattern making them more likely to recommend children than SLPs in Texas, and so forth.

http://ed.gov/about/offices/list/ocr/504faq.html

We infer working school SLPs are not aware of the patterns of over-identification in their caseloads, while the known problem is older than the SLPs:

“Concerns about the overidentification of ethnic and culturally diverse students in special education first gained national attention in the 1960s as civil rights advocates, educators, administrators, and policy makers began raising questions about the overrepresentation of minority students in classes for the mentally retarded. To a great extent, disproportionate placement still remains today. Although the problems varies from state to state and region to region, it is seen as an ongoing national problem which may result in students who are unserved, misclassified or inappropriately labeled, or receive services that do not meet their needs. Disproportionate placement of these students into special education classes may be seen as a form of discrimination.”   Amy Zirkelbach, 2002

Recommended is the following post  for the practical implications of managing identification:

How One SLP Manages Caseload and Eligibility

SLPs need to take heed of the  conditions around them:  “

“While African Americans make up approximately 17 percent of public school enrollment, they account for 31 percent of students identified as having mental retardation or intellectual disabilities, 28 percent of students labeled as having an emotional disturbance, and 21 percent of students who have learning disabilities. Some of these categories aren’t pure medical diagnoses, calling judgment, and perhaps bias, into play.”

http://blogs.edweek.org/edweek/speced/2012/01/a_new_initiative_hopes_to.html


American Speech-Language Pathology and Black School Children

The American Speech-Language-Hearing Association needs to take a strong public stand against the over-identification of non-disabled minority children, particularly black children and bilingual children.  There should be a clear policy statement rather than random news items.  Global summaries about “multiculturalism” are empty.  School SLPs continue to over-place non-disabled children because of linguistic and cultural differences they confuse with disability. Current advisory statements lack focus and proper applications to reduce placement errors according to IDEA 2004.  University clinics should incorporate proper procedures into clinical experiences, and special education status should be a clinical consideration.  Courses should contain specific decision-making placement criteria for accurate assessment to protect FAPE.  The profession needs to take action!  The treatment of black children is a national disgrace and all professional groups need to make that different.

School SLPs can make the excuse this is an “emerging issue.”  The problem is well documented as an historical fact.  Edward Fergus, writing for Essential Educator (http://essential educator.org/), ”Distinguishing Difference from Disability: The Common Causes of Racial/Ethnic Disproportionality in Special Education,” reports:

“Since Lloyd Dunn’s report (1968) on the overrepresentation of Black and Latino students in special education countless federal, state and district reports, as well as research studies exist that document the various facets of educational practice impacting these rates….”

Now we receive this troubling report:  “While African Americans make up approximately 17 percent of public school enrollment, they account for 31 percent of students identified as having mental retardation or intellectual disabilities, 28 percent of students labeled as having an emotional disturbance, and 21 percent of students who have learning disabilities. Some of these categories aren’t pure medical diagnoses, calling judgment, and perhaps bias, into play.”

http://blogs.edweek.org/ edweek/speced/2012/01/a_new_initiative_hopes_to.html

Amy Zirkelbach writing in 2002 laid out the problem nicely:

“Concerns about the overidentification of ethnic and culturally diverse students in special education first gained national attention in the 1960s as civil rights advocates, educators, administrators, and policy makers began raising questions about the overrepresentation of minority students in classes for the mentally retarded. To a great extent, disproportionate placement still remains today. Although the problems varies from state to state and region to region, it is seen as an ongoing national problem which may result in students who are unserved, misclassified or inappropriately labeled, or receive services that do not meet their needs. Disproportionate placement of these students into special education classes may be seen as a form of discrimination.”

ASHA directors need to pay attention to this part:  “Although the problems varies from state to state and region to region, it is seen as an ongoing national problem which may result in students who are unserved, misclassified or inappropriately labeled, or receive services that do not meet their needs.”

A starting point might be for every SLI school child enrolled in a university speech and hearing program in which students receive clinical clock hours for service have an IEP on file and integrated with clinical decision-making supervision.