7. The Future of School Speech-Language Pathology

The starting point for reforming school speech-language pathology to eliminate bias is the overhaul of academic preparation. Basic training should be the same for all graduate students with respect to time spent, credit  hours, costs, curriculum and clinical training. A single learning model must  be adopted giving emphasis to cognitive-linguistic principles constrained by medical and cultural factors.

The core curriculum for all students should reflect a commitment to knowledge of education theory, history, practices and law.  Real clinical skill development in consultation, collaboration, reading and classroom assessment should span all years of training.  Assessment must consider dual criteria to characterize both clinical and learning standards, consistent with evidence based practice. Clinical supervision should change to include practical development at the college clinic.  All students should take courses in education and these courses should be scrutinized by accreditors.  All students should take the same work in swallowing and reading.

Traditionalists reading this text are hitting the ignore button. They assume hospital SLPs do not need education background.


Since IDEA was made the law of the land, children from birth to age 22 are subject to local school jurisdictions.  All speech-language impaired children have IEPs requiring progress in the general curriculum as a standard for intervention.  Hospital clinics seeing children are involved in education whether  they recognize it or not.  Hospital evaluations should consider educational standards and address IEP goals.  Transitions from preschool to school moving children from family plans to IEPs often involve a careful SLP translation of medical to education goals. Hospital personnel are invited to IEP meetings, and physicians know they must make recommendations for school placements.  Ultimately, a Fragile X syndrome child  must have educational goals for academic learning.  Medical findings do not typically predict performance on communication tasks and school achievement tests.  SLPs must know both sides of the fence, medical and educational. A physician referral recommending “speech therapy” is meaningless.

Training retained its imbalance for medical-model principles when in the 1970s ASHA moved academic training to the graduate level. Faculties simply moved their  courses to the graduate level little or no redesign. Thus costs and content duplication expanded, while school SLPs had to still take extra work in education, and rely on expensive continuing education courses to fill in the knowledge they should have acquired at the preservice level. The fact is that medical model speech therapy notions died in 1960, and find no support in terms of evidence based practice.

The root cause of perpetuated bias was the somewhat cynical decision of the 1930 speech professors to set up school practice as a “cash cow.” This is to say, the motive was not to prepare speech correction students well for school work but  to use their enrollment as a basis of program development.  Now this notion has crashed down from its own weight.  More than half of the ASHA members are school SLPs, and by  comparison medical speech pathology has faded into isolation and jeopardy.  What’s more, future ASHA growth will be enhanced by the demands of IDEA legislation and requirements.  More SLPs will be needed because of federal mandates.  Speech therapy is dissolving into feeding and swallowing intervention at the fringes of mainstream models.

1960 is gone.

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