School SLPs Fight Caseload Size! Why?

We have presented ample evidence that U. S. school SLP caseloads are large partly because of poor caseload management strategies.

National evidence indicates too many at-risk children are put into special education when school SLPs are chief evaluators in the process.  There is mis-evaluation allowing children to be placed in the wrong categories.  Mis-use of standardized tests is a factor.

National evidence indicates clearly that non-disabled children are placed in special education, particularly  black 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.

Special education and regular classroom teachers share in the responsibility of  special education over-identification.  Special education teachers also complain about having too many children.

We respect the public service of Linda Schrock Taylor:

 ”Recent news articles have discussed the possibility that two black holes might collide in a few million years. Although an interesting concept, this potential danger pales in the face of a real ‘black hole’ – that of SPECIAL EDUCATION. Every year, thousands of our children disappear into the vagueness of special placements, never to be released from the labels and stigma; never to escape and again be seen as ‘normal.’ Many teachers must notice this engulfing, this entrapment, of our children; some teachers must surely strive to defeat this grave and senseless closure on potential; but the problem is rarely mentioned or discussed.”

6. Educational Speech Pathology: Assessment

A hybrid model of school-based speech-language assessment for the placement and dismissal of at-risk children in special education under IDEA 2004 is two-fold:

1. Assessment of communication adequacy (speech, language, pragmatics) to determine whether a communication disorder exists.  This is a traditional practice suitable for any setting including private practice.  To put it simply, anything learned in graduate school can be brought into play in support of clinical decision-making.  

2. Assessment of the impact of a communication disorder on progress in the general curriculum.  This is a non-traditional practice often conducted in collaboration with educators who contribute information to the assessment process (such as RTI data), arbitrated by members of the IEP team.

A child who meets both sets of criteria can be legally recommended by the SLP for special education placement as an SLI (Speech-Language Impairment) pupil.  IDEA 2004 requires: “A communication disorder such as stuttering, impaired articulation, a language impairment, or a voice impairment that ADVERSELY AFFECTS A STUDENT’S EDUCATIONAL PERFORMANCE.”

The communication competence model is powerful (unconstrained) and in principle when applied to at-risk school children can yield judgments in any of the 14 IDEA eligibility categories:  

Autism, Deaf-Blindness, Deafness, Developmental Delay, Emotional Disturbance, Hearing Impairment.  Mental Retardation,  Multiple Disabilities, Orthopedic Impairment, Other Health Impairment,  Specific Learning Disability, Speech or Language Impairment, Traumatic Brain Injury,Visual Impairment Including Blindness.

For intervention, SLPs can have children from any of these categories as either the primary IEP service provider or the secondary. Unlike school psychologists and medical doctors, SLPs provide direct educational treatment and therefore are principal case managers in America’s  100,000 schools.

Therefore, school speech-language pathologists are key to whether America’s at-risk school children are placed and retained in special education.  No other specialty is more central to issues of SPECIAL EDUCATION OVER-IDENTIFICATION AND MINORITY DISPROPORTIONALITY. 

SLPs to be properly prepared for school service must be well-informed on all eligibility criteria and take into consider a legal responsibility to help protect FAPE rights.  They must recognize the kinds of errors being made in the respective IDEA categories and avoid making them.  They cannot rely solely on clinical criteria for decision making.

School SLPs must be exceptionally strong with regard to cultural and linguistic variations associated with different types of disability and learning styles.

In 2011, there is not much evidence school SLPs are aware of current U.S. FAPE issues and sort them out as they consider eligibility criteria and determinations.

5. Educational Speech Pathology

We have identified a hybrid model of school speech pathology assessment, where clinical and educational criteria are combined for judgments about special education eligibility.  It applies to the emergent population called “struggling children.”  Such children show academic delay but are not placed in special education.  Programs like Response to Intervention grade learning remediation to prevent placement in special education.  SLPs are put in the position of assessing  a broader range of speech,  language and learning skills.  For example, “poor children” is not a clinical population but poor children can be different in communication development.

We have already pointed out an array of labels applied to “struggling children.”

“diverse learners
struggling students
at risk
special needs
special education
disabled
disadvantaged
hard-to-teach
impaired
culturally and linguistically different
handicapped (historic)
slow learners (historic)
migrant
neglected
English language learners
minority
poor

PEJORATIVE

disruptive
problem
difficult
lazy (historic)”

4. Educational Speech Pathology

In prior posts, we described a hybrid model of school assessment, derived from both medical and educational criteria.  “Assessment based on the traditional medical model brings forth a rich history of research and best practice. Assessment based on an academic performance brings forth the learning implications. A hybrid assessment model creates a valid framework for disability assessment in schools for the prevention of over-identification” (cf. SLI Definition for Eligibility).

Assessment should change to reflect the hybrid perspective.  One must consider the population of “struggling children” which includes both disabled and non-disabled children. The first aim is to sort out children who should not be placed in special education. The second is to support general education remedial services associated with RTI tiers, especially Tier 3.

For RTI, “dynamic assessment” comes into play, determining special education status through repeated measures of performance.  This procedure lessens dependency on “one-shot” assessments made with norm-referenced tests.  “Dynamic asssesment is an interactive approach to conducting assessments within the domains of psychology, speech/language pathology, or education, that focuses on the ability of learner to respond to intervention. Dynamic assessment is not a single package or procedure, but is both a model and philosophy of conducting assessments” (Peabody, 2010). 

Classroom evaluations can take on greater importance. 

For RTI, collaborative assessment is more likely.

Assessing phonology with respect to language and reading is a new direction.  RTI has a reading focus in most schools.

Prevention is more critical to hybrid approaches.  It starts with the question, “How do I evaluate speech, language, and literacy needs within a collaborative framework to keep children out of special education?”

3. Educational Speech Pathology

In 1997, the authorization of IDEA changed school speech-language pathology fundamentally. It set forth the argument that the proper assessment of speech and language impairments should entail components of academic performance: “The 1997 law required that the individualized education program of each child with a disability relate programming for the child to achievement in the general education curriculum” (IDEA Committee).

Prior, a kind of parallel universe existed between education and speech-language pathology as a “related service.” Now a merger of models took place, engendered initially by public policy rather than science.

Up 1997, the medical model prevailed in the preservice education of SLPs. At the heart of assessment was the classic definition of Charles Van Riper: “Speech is abnormal when it deviates so far from the speech of other people that it calls attention to itself, interferes with communication, or causes the speaker or his/her listeners to be distressed” (Sevier County). Not only was the quality of communication involved but also speakers’ emotional adjustment to their abnormal speech. The definition was generic in that it could apply to any setting including schools.

IDEA 1997 linked disability to “progress in the general curriculum.” The SLI definition became: “a communication disorder, such as stuttering, impaired articulation, a language impairment, or voice impairment which ADVERSELY AFFECTS EDUCATIONAL PERFORMANCE” (my emphasis, Sevier County). Thus a hybrid model of speech and language evaluation was created with no fanfare at all. We say:

“Dual use of disability and academic performance criteria is a powerful tool for school SLPs managing special education eligibility to reduce over-identification. Assessment based on the traditional medical model brings forth a rich history of research and best practice. Assessment based on an academic performance brings forth the learning implications. A hybrid assessment model creates a valid framework for disability assessment in schools for the prevention of over-identification” ( cf. SLI Definition for Eligibility).

Let’s look at an example, dyslexia. It is a well known medical condition that says a lot about how young disabled school children might process print material. The same for dysgraphia. However, not all dyslexic children have the same literacy problems learning to read and write, if at all, and not every dyslexic child should be automatically placed in special education as a learning-disabled child. Some types of instruction might forestall the onset of symptoms. The orthography of a particular language (e.g. Italian) can block or minimize the manifestation of an underlying abnormal brain condition.

Hence in dyslexia there is a relationship between medical conditions and education, the nature of which defines the disability. Assessment is a relational judgment in the final analysis. The same can be said for SLI, where the “syntax gene” affects learning influenced by education.

Another example is generalization of learning. It is believed by SLP researchers that phonological intervention should generalize to classroom literacy but no hypotheses are stated about the reverse. When formal literacy instruction starts up, phonological performance in the therapy room should improve as a result.

2. Educational Speech Pathology

We can think of educational speech-language pathology starting with IDEA 1997, with special references to “progress in the general curriculum.”

ELIGIBILITY

We can pinpoint one critical 2007 change concerning the federal regulatory definition of speech and language impairments:

“(11) Speech or language impairment means a communication disorder, such as stuttering, impaired articulation, a language impairment, or a voice impairment, that adversely affects a child’s educational performance” (Federal Category Codes, 34 Code of Federal Regulations section 300.8, 2008).

It is critical because it brings into focus the eligibility criterion – “that adversely affects a child’s educational performance.”

Children with communication disorders who are at grade level in academic achievement are not necessarily eligible for special education.

1. Educational Speech Pathology

Trends in school practice are stretching generic university preservice models in speech-language pathology (speech therapy) to their limits!

Steppling, Quattlebaum and Brady have authored an important article (Toward a Discussion of Issues Associated With Speech-Language Pathologists’ Dismissal Practices in Public School Settings) that shows intellectual points where preservice clinical models do not accommodate school decision making. They focus in on dismissal for discussion (Dismissal).

A shift in federal law in 1997 changed the picture as to whether SLPs work in isolation or work to reinforce the general curriculum:

“Contemporary standards-based reforms emphasize that every student must work toward the expectations set for each academic content area. As the mandates of the Individuals with Disabilities Education Act (IDEA, 1997) become fully implemented (ASHA, 1996; ASHA, 1999; Mead, 1999), more school speech-language pathologists (SLPs) will assess students’ abilities to meet curricular demands, design curriculum-based goals and objectives for students, and provide interventions designed to help students meet curricular requirements. This will apply whether the least restrictive environment for therapy is a classroom or a pullout setting” (Goliath).

Prevention is an often-stated aim of SLP practice but the use of evidence-based programs in schools to reduce special education overidentification is not a feature of prevention.

Do preservice programs cover misidentification as an ethical question?

Take another example, generalization of intervention to “progress in the general curriculum.” Intervention models do not address such topics, and the interesting possibilities thereby arising.

When phonological intervention is set up, is there any concern for how it generalizes to classroom literacy? Or, how classroom literacy instruction generalizes to phonological intervention?

One-on-one direct intervention is emphasized in preservice university clinics, implicitly validating pull out service delivery in school settings. However, one must consider that pull out is not necessarily more effective in schools where collaborative programs are gaining ground.

Educational speech-language pathology should be judged on its own terms and should be researched in schools to validate any claims made.