Monthly Archives: June 2014

ASHA Continuing Education Program Successful!

A July 2014 press release indicates the continuing education program has reached a milestone:

“ASHA CE celebrates its 35th anniversary!

Thirty-five years ago, ASHA first started approving organizations as ASHA CE Providers. At that time, Jimmy Carter was President, the Steelers beat the Cowboys in Super Bowl XIII, and “YMCA” was the top song of the year! Find out more about our “35th” and the ASHA Approved CE Providers who have been part of our continuing education journey.”

A clown on main street.

A clown on main street.

New School Phonology: Integrative Phonology for SLP Clinical Applications

Over the years I have noticed scholars picking up on early work we did at Kent State University in the 1970s addressing trading relationships in phonological and grammatical production as factors in clinical intervention. It is a robust factor and appears in normal language development. A primary aim of this line of investigation was to demonstrate sound-by-sound treatment is invalid for the most part. I believed we could change intervention to make it more efficient, significant and enjoyable for clinicians and children. However, when I returned to school practice for four years in Arizona schools I found that the treatment of “articulation disorders” lagged far behind. I wondered why the American Speech-Language-Hearing Association had allowed this to happen. This lead me to questions how ASHA keeps practice up-to-date through management of curriculum trends.

Definition

Integrative phonology means teaching sound structures in relation to grammar, meaning, prosody and information processing constraints. Because of integration one can expect broad generalizations across all components of expression. For example, treating articulation should improve morpho-syntactic development as well as sounds. Teaching isolated language structures out of context should be avoided and the motivation of the child should be considered. Phonology is essential to generalization of learning and academic performance.

Generalization

Integrative phonology can reduce the fragmentation of the scope of practice by mapping relationships among the different types of treatment:

“speech sound production
articulation apraxia of speech
dysarthria a
taxia
dyskinesia
phonology
morphology
syntax
semantics
pragmatics (language use, social aspects of communication)
literacy (reading, writing, spelling)”

In the area of literacy, what’s more, integrative phonology addresses methods of teaching phonological awareness within a linguistic hierarchy fostering articulation improvement charted in IEPs.

Best Practice

From the very beginning we sought to combat the teaching of isolated linguistic structures outside of the communication context. We observed some indications that children treated this way developed side effects, such as faulty generalization, disfluency and rule misapplication.

During my four years as a practicing school SLP I studied articulation / phonology practice and concluded it was out-of-date in American schools. I submitted a paper on the topic to The ASHA Leader and withdrew it after the editor said, “This wouldn’t do any good.” My impression was that this candid point of view was a public relations problem for ASHA. The paper was published elsewhere and was received favorably. I began to suspect ASHA was more concerned about image-making than improving graduate education.

I have always envisioned the simplification of developmental intervention by integrated treatment plans aimed at generalization across communication components. I imagined SLPs using their energies wisely to maximize improvement by letting generalization do the work. In school settings I saw 20 to 40 percent improvement of untreated sounds of the high functioning children.

At one of my practice sites I took on a boy with cleft palate impairment. He had been in treatment for several years for sound-by-sound treatment of affected sounds. His frustration level peaked and there was no evidence sound practice was the answer. In papers I have written I have pointed out that typical articulation treatment can be too aggressive, obliging clients to say sounds when their motor-speech systems cannot respond to the pressure. For 50 years articulation treatment have been production oriented. We know speech development is impaired but we continue to push the limits for “correct production.” I believe there are side effects if one notices.

I noticed with this boy that sound production was not the significant problem. He made sound errors because he could not produce rapid antagonistic syllable sequences using a faulty speech mechanism. The palate had been repaired but was scared and movements across syllable boundaries in words were slow and inaccurate. Of course when long words and phrases were targets, there was no chance of sustaining grammatical prosody to hit the embedded sounds accurately. Articulation errors were a symptom of syllable/morpheme production issues. I rewrote the IEP goals so rhythmic syllable production was a higher-level aim. He would have to hit sound targets in creative ways to suggest correct execution. (Many years ago a paper was published in JSHD about a client who had no tongue but intelligible speech. The acoustic effect is what is important.)

What I did was to give the boy relief from his labors of producing sounds. A “top down” and perceptual approach was adopted. The first aim was to maximize fun and success. He had had very little pleasure from speaking for therapy purposes.

My first task was simply to see if he could count the number of syllables in words. “How many syllables are in school bus?” When he said two, I was excited and he realized he got it right. No hard work. He was able to move on to find word boundaries and stress in longer words, and grammatical stress in phrases. No problem. Eventually I dropped to the lowest level of the linguistic hierarchy to see if he could perceive some of the sounds he could not produce in syllable sequences. This was more difficult but he could with extra tries. Perceptual skills seemed to be intact and available for phonological learning.

I began to read about phonological awareness for literacy training as understood in education. This method is nothing more than phonological intervention in the perceptual domain except there is a print connection.

I switched my articulation clients over to phonological awareness training and began to believe this could help production problems improve while facilitating reading development. Using prosodic contours with embedded features is a general approach with great promise to facilitate language development. When particular children have impaired speech production mechanisms, prosody intervention integrates and nurtures linguistic processing, placing less demand on brain resources for language development.

Prosody exercises are easy to design for success and fun. Music can be brought in for ear training the melody of speech. The boy had limited vocal range for speech and song could have helped him.

Diagnosis

I began to realize, as well, that SLPs misdiagnosis young children with pervasive linguistic impairments, i.e. “learning disabilities” (developmental Broca’s aphasia). By calling these children SLI and treating articulation narrowly they prevent early diagnosis of learning disability.

A child with multiple articulation errors in speech can be dismissed too early, before the learning disability comes into focus as a result of classroom instruction. SLPs take themselves out of the treatment process too early, and LD identification happens too late.

Public Policy

On the public policy level I took the position that ASHA appears to have no central curriculum process to identify, clarify and implement critical changes in school practice. This “evidence-based” approach goes a long way toward improving ASHA accreditation “standards” as promulgated by The Council on Academic Accreditation in Audiology and Speech-Language Pathology (CAA). Certainly, phonology would be central to a credible accreditation system of standards.By linking communication development to learning as IDEA did one must change theory and method for graduate education. Years go by without changes in graduate education. Deflecting new and current practice into continuing education is wrong.

John M. Panagos

July 7, 2014

ASHA has used a FACEBOOK post to direct attention to the clinical summary of this new content:

http://www.asha.org/Practice-Portal/Clinical-Topics/Articulation-and-Phonology/

Reforming the ASHA Presidency for Progress

Tracing through the history of ASHA’s questionable curriculum leadership for school speech-language pathology, it becomes clear the Board of Directors has the final authority to make corrections when it wants to.

“Key to reform is to create a different role for the president of ASHA. Deep historical uncertainty over the roles of the director and the president lingers. We must have leadership accountability. Someone must be clearly in charge of all business on behalf of the membership. The notion of mutual cooperation masks the authority issue. Kenneth Johnson did much as the strong executive leader but that role turned out to be inappropriate for the Association. The president must have full authority and responsibility so we know where the buck stops. All this is clear and central to reform.”

Strong Leadership

The relationship with the Chief Executive Officer must continue to evolve leaving behind fully the era of authoritative leadership by Kenneth Johnson. The President must not accept the role of “chief coordinator:”

“The President works in partnership with the Chief Executive Officer to achieve the mission of the Association and to optimize the relationship between the Board and staff.”

http://www.asha.org/About/governance/BOD/President/

The president should function in the manner of the president of the National Education Association. The NEA president as described in its documents has strong authority to conduct business, including representing the Association in policy matters, preparing the agenda for governing bodies and appointing chairpersons and committee members.

Vision

The president must shed his or her agenda of idiosyncratic personal interests and address the concerns of all members. There must be a well articulated vision of how to move the Association forward philosophically, scientifically and operationally.

Who have we been and where are we going?

The president should deliver a yearly “state of the union” address at the national convention in a large ballroom where many members can come and ask questions. We should hear about the issues of the year, challenges and new directions the president has crystalized for us.

http://www.nea.org/assets/docs/2013-NEA-Handbook-Bylaws.pdf

Focus

The president should serve for one or two three-year terms and be paid very well. The silly rotation of three presidents for one year stints should be abandoned to combat leadership by committee and second-guessing. The Board of Directors must be streamlined to support the president’s authority and range of activities. There should be a vice president to serve when necessary and a secretary who furiously tracks Association business. The president should manage ongoing business, making sure THINGS GET DONE!

Mission creep must be addressed to focus on the most important business. Now ASHA sprawls in so m any directions accountability requires a fortune-teller.

Accountability

Members should be able to vote to recall the president.

New School Phonology: The ASHA Position

June, 2014

ASHA is preparing a document on “speech sound disorders” used as a ‘UMBRELLA TERM” referring to deficits of phonotactics, phonological representations, prosody and motor performance impacting speech sounds and speaker intelligibility. It is a “policy document” presenting guidelines for practice in all settings.

We look forward to hearing more about the project.

You can see our earlier posts on the subject, where we emphasize integration of phonological and language systems for cognitive-linguistic processing.

John M. Panagos

http://www.asha.org/Practice-Portal/Clinical-Topics/Articulation-and-Phonology/

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Requirements

An ASHA policy statement on phonology should meet several requirements to validate it for graduate education, accreditation and clinical practice. The ASHA Board of Directors will complete the listed requirements.

1. The policy should be evidence-based and consistent with theory and research.

2. The authors should be listed and the document should appear in a logical location on the ASHA website.

3. The policy should build upon past ASHA policy documents.

4. Terminology (nomenclature) should be internally defined and used consistently.

5. Comments from practicing SLPs should be gathered and reported in the ASHA Leader.

6. Policy content should be incorporated into the Scope of Practice Document.

7. The policy statement should be INTEGRATIVE eliminating duplicate and confusing terms.

8.Sample case study material should be included to illustrate best practice.

9.The policy should be mailed to each program director of the country’s academic programs.

10.The Chairperson and The Council on Academic Accreditation in Audiology and Speech-Language Pathology (CAA) should sign off on the document and incorporate it into accreditation standards.

CAA

The accreditation “standard” for articulation and phonology demanded by CAA is virtually no standard at all. Each word is merely listed and that’s all. Imagine the American Medical Association stating in a single word that “surgery” is a training requirement for doctors.

July 7, 2014

ASHA has used a FACEBOOK post to direct attention to the clinical summary of this new content:

http://www.asha.org/Practice-Portal/Clinical-Topics/Articulation-and-Phonology/

ASHA Has No Way of Addressing Second-Order Curriculum Change

Our review suggests the CAA is incapable of second-order change:

“Any change which takes place at a higher logical level than the problem state. This allows the change to affect the system, thereby rendering the erstwhile problem harmless, irrelevant or useful.” (http://www.inspiritive. com.au/glossary.htm)

Second-order change requires “new ways of thinking, shifting gears, transformation to something quite different, an informal beginning, new learning and a new story told.”

http://www.thenationalacademy.org/ready/change.html

CAC dwells on first-order thinking — lists of procedures and curriculum strands.

Collaboration

Let’s return to collaboration.

On the public relations / marketing side ASHA experts have launched a campaign, “The Power of Interprofessional Education and Practice; Full Team Ahead” published in the ASHA Leader (Vol 18, No 6 June 2013),collaborative practice associated with medical settings. But CAA treats collaboration as a listed behavior and nothing more. After years of study, the new standards starting in September of 2014 ignore “Interprofessional education and practice.”

The deep reason, of course, is CAA cannot create curriculum programs effecting second-order change. Academic programs would be required to retrain and retool to support collaboration in training programs, and they are said to exist in silos.

In the meantime ASHA proper marches forward with dramatic calls for collaborative education for SLPs.

ASHA Accreditation Standards and the CAA

The CAA focus is on procedures without curriculum reform. It is a tin man without a soul.

Consider professional nomenclature to parse speech-language pathology according to science rather than political fads.In 1947 Samuel Robbins wrote a scholarly paper on the “Principles of Nomenclature and of Classification of Speech and Voice Disorders” (Journal of Speech Disorders March 1947, Vol.12, 17-22). He argued precise formal classification is essential for speech science.

Now jump forward to 2011 to the ASHA Summit on “Clarifying and Promoting the Regulation of Clearly Differentiated Provider Roles.” The panel came up with this proposal:

“To address the misunderstanding and misalignments that can result from the lack of a shared nomenclature,
ASHA should develop (or revise) and publish a lexicon for the field of speech-language pathology. Where
necessary, the lexicon may acknowledge the range of terms now in use, but the intent should be to promote
a shared vocabulary…”

CAA must deal with such fundamentals in a scholarly fashion. It must do more than administer accreditation applications.

http://www.asha.org/uploadedFiles/2011-SLP-Summit-Report.pdf.

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.

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.

Here is a prior post on the subject of roles and classifications:

Prior Post

As we have pointed out in a prior post, more often web authors use “speech therapy” to refer to speech-language pathology.   The following search hit rates were presented:

Speech therapy—–8,320,000

Speech pathology—–1,222,000

Speech-language pathology—–943,000

Speech therapy reflects medical- diagnostic and programmatic thinking rather than scientific.  The speech therapy era effectively ended in 1960 when the field of communication disorders experienced a burst of scientific activity and moved toward language foundations.

A Parallels Universe exists.   For example, across clinical service domains phonology, articulation and oral motor training are regarded as separate treatment foci.  Hence, theory integration is being held back by the misuse of terminology.

A lack of integration is also blocking the proper growth of “educational speech-language pathology,” wherein hybrid school criteria are developing for special education placement and intervention models tied to IDEA 2004.

“Speech therapy” notions are not suitable for school settings.  The most obvious failing is that modern language theory is excluded and there is no concern for the overidentification of  non-disabled minority children and the stigma of going to “speech therapy” as a factor in high school success.

More subtle are the effects of social expectations for types of treatment.  Those who speak of “speech therapy” come to expect oral-motor practice and sound-by-sound content, i.e. “bottom up” methods.  Administrators and teachers believe they know what good “speech therapists” do.  They anticipate seeing “therapists” in a small room guiding clients to produce sounds accurately.  Administrators advertise for “speech therapist”   employment.  State and federal government documents mention “speech therapy.”

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

Needless fragmentation of the discipline occurs when “Speech Therapy” holds sway over “Speech-Language Pathology.”

Post Script

A reader writes in to provide this experience:

“Our school district’s IEP computer based program defaults to Speech Therapist. After many requests the tech dept added Speech Pathologist. Getting close aren’t we? Now I am trying to get the original request of Speech/Language Pathologist. I have to routinely go into this computer based program and change Speech Therapist to Speech/Language Pathologist.”

Update

We have since noticed that 11,900,000 pages are  found for “MEDICAL SPEECH PATHOLOGY.”  A further sign of fragmentation of the field of speech-language pathology?

Another interpretation is the field is naturally evolving with sub-specialties whose missions are tied to unique contexts, thereby stretching “one-size-fits-all” certification pushed forward from the 1930s.  Is the medical model obsolete?  Or is it perfect for “medical speech pathology” and imperfect for school speech-language pathology?

What kinds of organizational structure is needed to accommodate expanded  knowledge, policy formation, standards and communication?  Does the non-profit model under a single umbrella function to support mature  growth in the school setting?  Does  the pattern of conflicting terminology reflect a breakdown in the model?

July 2012 update

One of our most popular posts.  It  is more than just a terminology issue.

Dr. John Muma adds a scientific perspective to the problem (ASHA Leader, June 5 2012).  Whereas academic programs have settled on “communication disorders” to refer to the specialty, ASHA continues to cling to an “arcane” modalities approach.  Language theory makes this approach obsolete.  “Just as professionals are charged by the ASHA Code of Ethics to be up to date with developments in the field, the professional association (ASHA) should also reflect an up-to-date perspective.”

 http://journals.asha.org/misc/ifora.dtl#mission

Dr. Muma’s comment is confirmed looking at ASHA’s research mission statement:

“ASHA’s mission is to promote the interests of and provide the highest quality services for professionals in audiology, speech-language pathology, and speech and hearing science, and to advocate for people with communication disabilities. To help fulfill our mission and support science and research in the discipline of communication disorders, we publish four peer-reviewed scholarly journals” (my emphasis).

School speech pathology is buried another level down in “speech-language pathology.”

The more one parse this topic, the more one wants to ask, “Who’s in charge of ASHA to fix these things?  Doesn’t this confuse our publics?”

http://journals.asha.org/misc/ifora.dtl#mission

Mission Statement

ASHA’s mission statement   places emphasis on communication:

“Empowering and supporting speech-language pathologists, audiologists, speech, language and hearing scientists by:

Advocating on behalf of persons with communication and related disorders;

Advocating communication science;

Promoting effective human communication.”

Sloppy Administration

Another explanation of a confusing and obsolete  professional nomenclature as promulgated by the American Speech-Language-Hearing Association is sloppy management of ASHA information systems, especially on the ASHA website.  There should be a clear  and valid conceptual model for professional programs and terminology, and consistent usage across all platforms of public communication.

In May of 2012 at the ASHA Board meeting a proposal which would strengthen the medical outlook was made and approved:

“A group of members, who are board-recognized swallowing specialists, asked the Board to consider changing ASHA’s mission statement to include swallowing. President Chabon led the Board in a discussion concerning altering the mission statement. Following discussion, it was decided that ASHA should consider adding the words swallowing and balance to ASHA’s mission statement, while maintaining the original sense of the mission. A team, including Vice President for Planning Barbara Moore and ASHA staff, will draft language for the Board to discuss at a future meeting.”

This provides more evidence of how terminology is fractionated as Dr. Muma’s model predicts.  When medical thinking is elevated as a mission focus we are keenly aware of how school practice languishes in the backwaters of the field.

Notes on ASHA Organizational Bias

Yes, clearly “school-based” speech-language pathology is buried in an organizational system to be compared to “prison-based” speech-language pathology. We repost the “Events” post to document concerns:

History

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 professors 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.

Please give us feedback on this post? Far fetched? On target? Revealing? Useless?

American School Speech-Language Pathology Buried in ASHA Hierarchy!

Management experts believe the lower a program is in an organizational hierarchy the lower the administrative priority of that program. Referring to a current car safety issue, “Yale University management and law professor Jonathan Macey, author of a book on corporate governance [states} “The organization chart does obviously reflect a company’s priorities.” We argue school speech-language pathology is a low-priority program reflecting ASHA bias. It is buried far down in the organizational hierarchy even though half the membership is school based.

Summer day, Canal St. Martin, Paris

Summer day, Canal St. Martin, Paris

ASHA

–Administration

—-Audiology
—-Speech Science
—-Speech-Language Pathology

——-Medical Speech-Language Pathology
——-School Speech-Language Pathology

Le Procope. 13 rue de l'Ancienne Comédie - 75006 PARIS

Le Procope. 13 rue de l’Ancienne Comédie – 75006 PARIS

Medical Speech-Language Pathology has enjoyed priority dating back to the 1925 founders of the modern ASHA.

One can add in the Schools Office at ASHA to further illustrate the depth of embedding hypothesis. Since it was founded in 1970 peaking in 1995 it has almost no status at all considering over half the members work in education.

http://www.theepochtimes.com/n3/713880-organization-charts-are-boring-but-here´s-one-that-could-save-your-life/

The Legal Status of the CAA?

What is the The Legal Status of the ASHA CAA?

ASHA attorneys should publish to the membership a position paper on the legal foundations for The Council on Academic Accreditation in Audiology and Speech-Language Pathology.

Window looking out.

Window looking out.

The CAA claims to be “autonomous” though it receives staff and financial support from ASHA members.

The CAA claims to be “autonomous” though the Bylaws say it is authorized and sustained by the ASHA Board of Directors.

The CAA claims to be “autonomous” though the Bylaws (8.2) do not confirm such claims:

“…The Association, by action of the Board of Directors, shall establish and maintain a program of academic accreditation. The Association shall establish the Council on Academic Accreditation in Audiology and Speech-Language Pathology (CAA), which shall define the standards for the accreditation of graduate education programs and apply those standards in the accreditation of such programs.”

CAA accountability to the membership is diminished by ambiguous claims of autonomy, complicating roles and responsibilities.

Even members of the Board of Directors speak of “collaborating” with CAA when no collaboration is necessary. BOD must assert its legal authority to have critical issues addressed, particularly, curriculum development for school speech-language pathology.

Deference to CAA goes back to the days of Director Kenneth Johnson who ran ASHA as a fiefdom on behalf of the founders.

CAA Leading ASHA Curriculum Change is Better!

We have documented the bunker mentality of the The Council on Academic Accreditation in Audiology and Speech-Language Pathology. It needs to be transformed into a catalyst for curriculum change serving school SLPs and the school children of America. It is recognized by the U. S. Department of Education and should represent a high standard for innovation and imagination in education.

The CAA conveys the impression it wants to be an exclusive private club separated from the paying voting membership of school SLPs by a policy of self isolation called “autonomy.” Where are the glossy can-do articles in the ASHA Leader? It should be a resource for modernizing graduate education for students, faculty and clients.

Post

Below we repost an overview of progressive changes,
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 pragmatic 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.

Library of Congress, via CBS News: "Child labor photos from 1911 The child labor photos Lewis Hine took in the early 1900s were meant to shock Americans into reforming child labor laws. Decades later, many of these photos are getting a fresh look, thanks to one man's efforts to link the subjects to their living relatives. This photo taken in Winchendon, Mass., in Sept. 1911, shows Mamie Laberge at her workstation. She is under the legal work age. 

Caption information from "The Library of Congress."

Library of Congress, via CBS News: “Child labor photos from 1911
The child labor photos Lewis Hine took in the early 1900s were meant to shock Americans into reforming child labor laws. Decades later, many of these photos are getting a fresh look, thanks to one man’s efforts to link the subjects to their living relatives. This photo taken in Winchendon, Mass., in Sept. 1911, shows Mamie Laberge at her workstation. She is under the legal work age. 

Caption information from “The Library of Congress.”

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 it that they are 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.”