Category Archives: SLP Collaboration

School SLP Collaboration in the Rear-View Mirror

In 1991 the American Speech-Language-Hearing Association published a “Relevant Paper” on school SLP collaboration, authored by the Committee on Language Learning Disorders, entitled, “A Model for Collaborative Service Delivery for Students With Language-Learning Disorders in the Public SchoolsCottage on the sea

(http://www.asha.org/docs/html/RP1991-00123.html).

The paper described the potential of school collaboration where SLPs work with other school professionals in assessing and treating at-risk children.  Members of the “team” function as equal partners in all phases of planning and intervention. The model is characterized as a supplement to pull out intervention.

How much impact did the model have?  Not much, for several reasons.

It did not recognize the full impact of IDEA 1997 on the horizon, increasing paperwork obligations and responsibility to relate clinical progress to the general curriculum. It did not anticipate growing numbers of complicated cases, expanding scope of SLP practice and burnout issues.  It did not anticipate the need for academics to test out the model as a set of standards and practices for implementation, especially for leadership to make collaboration happen in an education-dominated context.  It did not anticipate personnel shortages and high workload demands.  It stated school administrators were somewhat obliged to make time available for collaborative meetings and procedures throughout the phases of case management. It did not distinguish between voluntary collaboration among trusting colleagues, and mandatory collaboration such as that which is required for RTI programming.

In short, it badly underestimated time requirements and programmatic complexity of for SLPs and other special education personnel to make it work practically.

Twenty years later, collaboration is still a dream waiting to happen.

In a prior post (cf., 9. SLP Collaboration) we noted the Yoho study:

“Sarah E. Yoho of Ohio State University conducted a survey of Ohio speech-language pathologists investigating issues of caseload management related to selected practice issues (Ohio State, 2009).

….As expected, the large caseload of many school‐based Speech‐Language Pathologists and the broad scope of practice of the profession is the leading factor holding therapists back from adopting the emerging ideas of collaborative practice. The addition of literacy into that scope of practice is only one small factor contributing to the concerns of Speech Pathologists.”

Perhaps more interesting for some readers is the fact that a small panel of cloistered academic and clinical experts took it upon itself to generate and publish the advice without collecting survey data from working SLPs around the country. Had the panel taken this step to be empirical, it would have sent itself back to the drawing board.

Ultimately the model failed to make inroads because school administrators did not agree to freely provide more service time, as the model required.

Post Script

Ironically, the Association disavowed support of the document in the first place:

Disclaimer: The American Speech-Language-Hearing Association disclaims any liability to any party for the accuracy, completeness, or availability of these documents, or for any damages arising out of the use of the documents and any information they contain.”

February, 2015

We have tracked through to see why collaboration and other interventions have faltered. Simply, the ASHA Board of Directors is ineffective at guiding the development of curriculum for modern school practice. The CAA is allowed to function without direct Board study. Second-order change in practice requirements is impossible.

Furthermore we see efforts now to bring about collaboration in the medical setting without reference to school collaboration. ASHA in so many cases is incapable of long-term follow-through on critical practice issues. The BOD is a ceremonial body leaving our needs to the professional ASHA staff.

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True SLP Collaboration – Indiana’s Model Program

A report written in Urban Perspectives (winter 2006), ” Adapting Speech Therapy Service Delivery through Data-Based Decision- Making and Response to Intervention (Lori Carmichael-Howell and Jennifer Dezarn-Lynch, Metropolitan School District of Wayne Township, Indianapolis, IN)  gets at issues critical to the future of school speech-language pathology. 

The SLPs were frozen in a survival mode: “They were not satisfied with the progress in student achievement; services were delivered separate from the curriculum, and large amounts of time were focused on assessment and placement rather than intervention.” 

A district-wide improvement project was developed. “When data was examined during this project, a lack of consistency was found not only in identification of disabilities but also in service delivery methods, use of evidence-based practices, and SLP involvement in the general education curriculum.” 

Service delivery was made more flexible, adapted to children and SLPs, and RTI was interfaced with therapy services. Collaboration and generalization goals were important.  Aggregate data were collected to evaluate progress, and phonological process instruction was incorporated into the program.  The need for pull out therapy was reduced. 

The program has become a model for Indiana.

Comment

In one fell swoop the Indiana project demonstrates how SLPs can plan for systemic change addressing a wide range of issues including SLP overload and burnout.

http://www.urbancollaborative.org/sites/urbancollaborative.org/files/winter-spring-2010-issue.pdf

9. SLP Collaboration

Sarah E. Yoho of Ohio State University conducted a survey of Ohio speech-language pathologists investigating issues of caseload management related to selected practice issues (Ohio State, 2009). Collaboration, scope of practice and literacy were examined. Her faculty advisors were Dr.Rebecca McCauley and Dr.Wayne Secord. The study made it apparent little data are available on school practice issues in an era of rapid change in communication disorders and public education.

Results were consistent with current trends:

“As expected, the large caseload of many school‐based
Speech‐Language Pathologists and the broad scope of practice of the profession is the leading factor holding therapists back from adopting the emerging ideas of collaborative practice. The
addition of literacy into that scope of practice is only one small
factor contributing to the concerns of Speech Pathologists.”

The findings suggest school SLPs in the sample wanted to prepare themselves to do more collaboration and literacy but caseload size and time limitations constrained what they could do. They had too many pupils to see for direct service. The respondents spent 62% of their time in the therapy room and 38% in non-direct service activities including classroom programming.

Elsewhere (cf. RTI and Speech-Language Pathology) we commented:

“The momentum of RTI nationwide means SLPs are in the path of an avalanche without much warning. However, SLPs are competent school employees who have the ready talent to make RTI work. It depends on the flexibility of special education directors and individual SLPS. In many cases SLPs will be pushed to the side regardless of their willingness to collaborate…

It is unfortunate SLPs nationwide are tied down to moderately heavy caseloads at a time when they need flexibility to follow mandated educational trends. What happens to the traditional practice areas of voice, fluency and articulation?”

http://www.google.com/searchhl=en&source=hp&q=Yoho+ Ohion+State+Speech+Pathology&btnG=Google+Search

8. SLP Collaboration

In our posts we have addressed issues of RTI implementation and role implications for school personnel. Spectrum K12 School Solutions is continuing to survey national RTI adoption rates. For its 2009 report it found adoption rates are rising.

HIGHLIGHTS

“In April 2009, 71% of respondents indicated their districts are either piloting, in the process of district-wide implementation or have RTI in district-wide use vs. 60% in 2008 and 44% in 2007.

RTI is being increasingly implemented across all grade levels with a significant increase in high school implementation compared to 2008 (51% having some level of implementation in 2009 compared to 16% in 2008)……..

Academic implementation leads behavior implementation by a large degree with reading more prevalent than math…

A majority of districts continue to report RTI implementation is being led through a unified effort between general education and special education…. “

NEW SURVEY

Spectrum K12 School Solutions’ current survey is being cosponsored by:

NASDSE (National Association of State Directors of Special Education)

AASA (American Association of School Administrators),

CASE (Council of Administrators of Special Education)

CONCLUSIONS

Here, we emphasize two points for special education personnel participating in cooperative school programs for “struggling students” who might be considered for special education eligibility:

1. Survey data help practitioners prepare for abrupt and significant changes in their role functions.

2. RTI programmers should advocate for the reduction of initial and continuing special education placements.

7. SLP Collaboration

A new SLP joined an IEP team to discuss next year’s plan for an eight year old autistic girl. She was high functioning and verbal but with issues of pragmatics and social interaction. The SLP chimed in saying a collaborative plan might be a suitable approach to enhance essential communication and learning skills. The girl could spend more time in the classroom for natural peer interaction.

There was a moment of dead silence. The SLP went on to mention a few intervention ideas. No response.

Then the school psychologist spoke up and said he didn’t care for the idea much. “I’m a meat and potatoes man,” he said. The team settled on a plan for pull out services.

After the meeting, the director called the SLP to her office and asked shortly: “Now, what’s this collaboration thing you’re talking about?”

Three months later the director circulated a special education magazine to the staff. The cover announced that the whole issue was devoted to the topic of collaboration in special education.

There is no guarantee local school personnel will know about collaboration, have skills in it, or be receptive to it.

6. SLP Collaboration

The American Speech-Lanaguage-Hearing Association (ASHA) has published a survey study concerning “Role Ambiguity and Speech-Language Pathology” (The ASHA LEADER, December 15, 2009, pages 12-15) in which a number of issues are raised about SLP collaboration. A national sample of 4,708 members was used for the survey.
Sixty-five % were clinical service providers. Findings can be found online [http://www.asha.org/Publications/leader/2009/091215/RoleAmbiguity.htm]

The report documents the problems SLPs have participating in collaborative programs and offers eight general solutions.

A major concern was whether other specialists “encroached” on SLP practice. Half those surveyed said they had experienced it. Pinpointed were academic language therapists (89%), occupational therapists (65%), teachers (58%), nurses (55%) and reading specialists (50%). Encroachment centered around language/literacy (64%), autism (63%), learning disabilities (59%), early intervention (53%) and dysphagia/swallowing disorders (52%).

The SLPs thought other specialists did not know enough about SLP practice, and 71% thought ASHA should do something about encroachment, together with state associations (42%), state licensure boards (41%) and individual facilities (39%). Although ASHA recognized the challenges collaboration presents (time, money, information gaps, training, conflict), it took this position:

“It is ASHA’s position that SLPs do not “own” any aspect of their scope of practice, nor can they dictate what another profession can or cannot do. Clearly, speech-language pathology shares professional boundaries with related professions, and SLPs need to understand other team members’ expertise while articulating the value of their own unique knowledge and skills.”

Ellen Estomin (ASHA Leader, April 6, 2010) on behalf of the ASHA’s school-based SLPs said they agree with the part that says SLPs cannot dictate what other professionals do, or do not do, but they disagree with the part that says SLPs do not “own” aspects of scope of practice. Having an ethical code of conduct, extensive training, defined scope of practice and prescribed roles and responsibilities, SLPs should confidently communicate their strengths to the public.

It is clear the school-based SLPs are correct. ASHA properly certifies graduates in accredited institutions, and states add legal certification requirements. IDEA 2004 regulations and state statutes specify the legal foundations for SLP functions, functions in the past ASHA has lobbied for to Congress. School SLPs “own” articulation, whereas they do not “own” literacy:

“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” (Office of Special Education and Rehabilitation Services, Education: 34 Code of Federal Regulations, Section 300.8, Oct. 30, 2007).

It can be argued SLPs encroach on reading specialists when they assert rights to be accepted into literacy circles. Saying you have literacy expertise is not the same as Congress saying you have literacy expertise.

5. SLP Collaboration

Let’s say there are four kinds of collaboration.

DEFINITIONS

1. Inspirational. “Everyone-work-together-positively-for-the-good-of-struggling-children.” This type is quite idealistic but inspirational for young SLPs. It makes for a spirit of cooperation on the job. If collaboration opportunities crop up, SLPs are encouraged to join in and offer their expertise. Inspirational collaboration can lead to creative partnerships:

“Moving out of a pull-out therapy setting and into the classroom can prove to be beneficial for students, teachers, and speech-language pathologists (SLPs). Changing settings to provide therapy develops a relationship between the classroom teacher and the SLP. This relationship offers a creative solution to many…” questions of caseload management, peer interaction, and transference of learning to the classroom (Richmond, Super Duper).

2. Promoted. This type is where professional organizations promote types of collaboration thought to be important to the professions and school children. A 2001

Girl Scouts Marching on Main Street.

position statement by the the American Speech-Language-Hearing Association (ASHA) argued for SLP involvement in literacy programs:

“That document stated SLPs have a critical role in the development of literacy for students with communication disorders of any severity and that SLPs are to contribute to literacy efforts within their school districts and communities on behalf of other students. The ASHA document further stated those roles were to be carried out collaboratively with others who possessed expertise in the development of reading, writing, and related processes” (Hammond et al., Speech Pathology2).

3. Negotiated. This type concerns role relationships and assignments for cooperative projects. At issue is negotiating changes in job descriptions and school expectations. SLPs depend on pull out services, and administrators believe this is their proper role. They do not necessarily think of related service personnel functioning on educational teams.
SLPs must change expectations.

Weak negotiations can bring about diminution of role standing: “Ehren (2000) expressed a concern regarding collaborative SLPs becoming classroom teachers or aids. She asserted that determining the roles professionals take in spoken and written language-based skills is compounded by the pervasive and critical role language plays in school learning” (Speech Pathology2). It is normal for teachers to think language and literacy are the domains of educators and not SLPs.

4. Mandated collaboration. On the basis of national trends associated with IDEA 2004, local school districts are implementing prevention programs such as response to intervention. Administrators have money to train staff and the responsibility to develop plans for staff assignments. They can change job descriptions following program guidelines and employment agreements under “other duties as assigned.” SLPs might not want to participate in response to intervention but they are obliged to. They may prefer traditional direct service.

CONCLUSION

We see degrees of collaboration ranging from preference to obligation. The most provocative is mandated collaboration. Since 1997 SLPs have been integrated into special education in support of “progress in the general curriculum.” As IDEA has evolved, the law has moved toward imposing collaboration on SLPs regardless of their scope of practice. If someone says SLPs must be assigned to cooperative literacy education, it becomes a fact.

Here, we argue collaboration is simply best practice and should be adequately taught at the preservice level of SLP graduate education. Language and literacy should be within scope of practice as related domains and taught accordingly, if they are essential to the changing theories and legal foundations of public education. It should not be advisory and left to inspiration and creativity.

Neither should collaboration lose its direction: All programs should have as their general purpose to reduce the needless placement of at-risk children in special education. Why go to the trouble of creating expensive complicated service delivery plans if we lose sight of what is really important — to prevent over-identification of American school children.

4. SLP Collaboration

In 2002, now eight years ago, the President’s Commission on Excellence in Special Education made this comment about the problem of the preventing special education over-identification:

“The Commission finds that the IDEA establishes complex requirements that are difficult to effectively implement at the state and local level. Nowhere in IDEA is this more complex than in the eligibility determination process. Improving this process, coupled with research-based early intervention programs, may reduce the number of children who are identified as having a disability, particularly when early identification and intervention are in place and research-based interventions are provided before referral” (Commission).

The Commission recommended improving the “eligibility determination process” saying it “…may reduce the number of children who are identified as having a disability…” Suggested was the solution of “research-based early intervention programs.”

Key here is that U. S. school SLPs are partners in improving the eligibility process. Our posts recommend “Strategic Eligibility Management.” Part of the solution must be reached through collaboration. Programs should be started by SLPs to provide school leadership. Collaboration should be a skill learned in college practicum prior to school employment. Educational speech pathology is too important to leave to on-the-job training.

There is moderate evidence that response to intervention and similar prevention programs are being implemented long-term in U. S. schools. There are models, pilot programs, and scattered efforts, but protracted development is surprisingly uneven even though hopes ran high after the authorizations of IDEA in 2004.

SLPs must step forward and help to reduce the over-identification of at-risk children. They must see it as AN ETHICAL PROBLEM. They must move away from pull out services and begin to manage their caseloads with a broader perspective. They can also help themselves reduce caseload demands.

3. SLP Collaboration

We argue that SLP collaboration — indeed, special education collaboration — is best practice and not a fad. It appears to be a fad because it is hardly in use. For eligibility management, it is one strategy for reducing over-identification of at-risk children and reducing caseload management problems.

Consider the work of SLP Claudia Dunaway on innovative service delivery (Dunaway, 2007). One program was a collaborative school articulation clinic. She reports:

“The Articulation Resource Center sponsors the speech improvement class, which is a response to intervention (RTI) approach to working with kids with articulation differences. We use the latest methodologies, we collect data, and we’re able to provide short-term effective intervention. Most of our kids are in and out with corrected articulation errors within 20 hours….”

Additionally, the Center serves a larger purpose, to reduce the number of children placed in special education:

“We’ve significantly reduced the number of kids on IEPs and saved the district a lot of money and we’ve done it in a way that benefits students. That’s always our first goal—our first concern—what can we do to serve our students.”

The Center also supports early dismissal. Prior cases had been receiving SLP services for 3 years.

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.”

“We discovered that we could shorten that time—we were able to get it down to under 20 hours. I think 75 percent of the kids are done within 15 hours.” Hence, caseload size was controlled through quick dismissals.

Collaboration is a method for Strategic Eligibility Management and educational speech-language pathology. It is best practice and a good practice.

2. SLP Collaboration

School speech therapists were obliged to accept collaboration with IDEA 1997. At that juncture, they had to support “progress in the general curriculum,” resetting standards for speech and language disability along legal lines. Here is an overview from 2002:

“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).

QUESTIONS

It’s been 13 years since the general education requirement was set forth explicitly. Still, a good many questions come up:

What data do we have on school SLP collaboration? What percentage of the nation’s school SLPs routinely use collaboration as an intervention? In contrast, how much pull out is used? Are school SLPs setting up collaborative programs on their own, or are they waiting for school administrators to take the lead? Are SLPs trained in collaboration in the university clinic? What research is going on as to effectiveness? Does collaboration produce good results compared to direct intervention? Are annual IEP goals being met through collaboration? What communication goals are being achieved through collaboration? Does collaboration invalidate standard methods of asssessment? Is pull out still seen as the essential service delivery model, or has there been a change in outlook to move out of the therapy room? Are collaborative speech and language methods being replicated on a large scale? Is collaboration a part of the university preservice curriculum? Do state agencies vary in their requirements for SLP collaboration? Are university clinical supervisors teaching it on and off campus? Are SLPs involved in reducing special education over-identification through collaboration? Are they involved in RTI efforts and preschool programs designed to reduce the numbers of at-risk children placed in special education? Do school SLPs collaborate with each other? How do SLPs collaborate for LD prevention, when reading programs are entailed? How is collaboration being used from preschool to high school? Is collaboration saving time and reducing load demands? Is collaboration taking SLPs into general education programs? Are administrators freeing up time for collaboration? Are children receiving services through collaboration dismissed earlier?

BOUTIQUE SPEECH PATHOLOGY

Girl Scouts Marching on Main Street.

The impression one gains since 1980 is that we have created “boutique speech pathology.” Publications, commercial catalogs, and workshop experts throw out “exciting possibilities” on a “try- this-and-try-that” basis, as though we are trying to accessorize best practice. “This year try a blue shirt and a pink tie! You’ll like it!” Scope of practice is expanding like an overlarge wardrobe.

At the same time SLPs are admonished in the most serious tones to “follow evidence-based practice,” forsaking fads and invalid methods, and adhering to IDEA standards. The schizophrenia is obvious, and confusing.

SLP COLLABORATION

Here is what we have to confront:

Collaboration is now best practice, and not just another technique.