School Speech Therapy and Special Education Overidentification

American school speech-language pathologists continue to make placement recommendations for a large percentage of all special education children, second only to Specific Learning Disability.  The number has been growing, and many of the children placed and retained are incorrectly identified.  Many are non-disabled minority children.  An effect never considered is how speech and language designation reduces chances for academic success.  While the costs of special education grow, SLI children and others are not receiving the academic support they need to graduate with peers.  A recent report from the Center for Public Education makes these clear.  In 2006 the diploma graduation rate for SLI children 67.45, slightly higher than SLD pupils[www.centerforpubliceducation.org].

SOLUTIONS

The Center for Public Education sets forth recommendations for reducing the overidentification of at-risk children for special education placement:

“The vast majority of students today who are identified with disabilities might have been classified as simply “low achieving” just a few years ago. However, their achievement still lags behind that of non-disabled students. The booming growth of special education—along with the accountability measures of NCLB—makes the achievement of students with disabilities something educators cannot ignore. While specific solutions are elusive due to the lack of research, when schools and districts target resources and support, the achievement of students with disabilities does increase.

In order to accurately evaluate your district’s needs and goals, you should consider the following questions:

1. What is the special education population in our district? How does it break down by disability? By racial/ethnic group? By family income?

2. How are our district’s special education students performing relative to other students? Has this performance changed over time?

3. What goals could we reasonably set for special education students, keeping in mind the group’s diversity?

4. How much of our special education dollars are federal? State? Local?

5. Do we have enough special education teachers? Do they meet the “highly qualified” definition? Do they have enough resources and support?

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School SLPs and Over-identification

The recent history of American special education is that too many children have been placed. Here are assorted reasons mentioned in policy debates.  SLPs and special eduction teachers can begin to address issues of eligibility placement and retention with a better appeciation of the powerful factors pushing on them to over-subscribe children who should not be in special education.  Certainly this applies to the placement of  non-disabled minority children.

Professional organization such as the National Education Association should take the lead in mitigating factors leading to the over-identification of at-risk children.

1. There were federal financial incentives to enroll children in special education.

2. Professional misdiagnosis.

3. Variations of state and local policies and regulations.

4. General education deficiencies in providing programs for at-risk children.

5. Use of special education as a remedial service for general education.

6. Over-use of the learning disability category.

7. Placement of more males than females.

8. Over-placement of minority pupils.

9. Limited special teaching skills of general education teachers.

10. Lack of pre-referral early intervention programs.

11. Over-lapping disability symptoms.

12. Referral of hard-to-teach children to special education.

13. Attorneys assisting parents with placement decisions.

14. Lack of variety of valid testing procedures.

15. Over-use of the IQ-discrepancy model.

16. Under-identification of of some disabilities.

17. Administrative pressures to place.

18. Late identification of children with learning disabilities.

19. State-to-state variation in eligibility criteria.

20. Special education placement of limited English pupils.

21. Parent pressures for special education services.

22. IEP bias toward MOST RESTRICTIVE ENVIRONMENT.

23. Changing program criteria from early intervention to preschool to elementary.

24. Misevaluation of poor, health-at-risk and migrant children.

25. Inadequate personnel preparation for linguistic and cultural differences.

26. Failure of states historically to reduce misidentifications.

27. Continuing misidentification of children already placed in special education.

28. Inadequate school programs for limited English children.

29. Over-concern of administrators with procedural compliance.
    
30. Shifting intellectual, social, emotional, linguistic and cognitive symptoms over the first eight years of life.

31. Inadequate early reading instruction for at-risk children.

32. Inadequate school-based training programs for teachers and special education specialists.

33. Prejudice against children with racial, linguistic and cultural differences.

34. Lack of strong advocacy by professional organizations to reduce over-identification.

35. A lack of local leadership to reduce over-identification.

35. Insufficient monitoring of transfer IEPs for incomplete, out-of-date and incorrect records.

36. No Child Left Behind pressures for high performance.

37. Bias operating in IEP teams.

38. Poor communication with parents to disclose the risks of special education placement.

39. Over-placement of Attention Deficit Hyperactivity Disorder children.

40. Misplacement of emotionally disturbed children.

41. Need for remedial reading specialists to evaluate for early disabilities.

42. Inadequate numbers of specialists to make proper evaluations.

43. Inadequate long-term local record-keeping on the characteristics of at-risk and special education pupils.

44. More research on how eligibility determinations are made at the local level.

45. Inadequate staff training for the proper use of eligibility criteria.

46. Quick referrals (45 days) to special education without prior child study.

47. Classifying children too early without trial intervention.

48. Inadequate advocacy by state agencies to reduce over-identification.

49. Inadequate resources targeted at reducing over-identification.

50. Inadequate data on how placements are made, how they vary, and what persons are involved.

 

Prevention: SLPs Must Screen Out Non-Disabled Pupils

During college SLPs learn about cultural and linguistic differences.  Yet SLPs are still mis-placing non-disabled children.  

The American Speech-Language-Hearing Association has published a school position statement on the Role of Speech-Language Pathologists:

“Providing Culturally Competent Services.  With the ever-increasing diversity in the schools, SLPs make important contributions to ensure that all students receive quality, culturally competent services. SLPs have the expertise to distinguish a language disorder from “something else.” That “something else” might include cultural and linguistic differences, socioeconomic factors, lack of adequate prior instruction, and the process of acquiring the dialect of English used in the schools. This expertise leads to more accurate and appropriate identification of student needs. SLPs can also address the impact of language differences and second language acquisition on student learning and provide assistance to teachers in promoting educational growth.”

http://www.asha.org/docs/html/PI2010-00317.html#sec1.2

The implications of …”more accurate and appropriate identification of student needs…are not spelled out, when they are critical for reducing the misplacement of non-disabled children. Evidence adduced in this blog indicates non-disabled minority children continue to be over-placed.  The rationale for action is found in States Monitor School Disproportionality:

Posny summarized the problem: “Excerpts from findings in the Individuals with Disabilities Education Act (IDEA) 2004′s statute note that: (1) greater efforts are needed to prevent the intensification of problems connected with mislabeling minority children with disabilities; (2) African-American children are identified as having mental retardation and emotional disturbance at rates greater than their white counterparts; (3) more minority children continue to be served in special education than would be expected from the percentage of minority students in the general school population; (4) in the 1998-1999 school year, African-American children represented 14.8% of the population aged 6 through 21, yet comprised 20.2% of all children with disabilities served in our schools; and (5) studies have found that schools with predominately white students and teachers have placed disproportionately high numbers of their minority students into special education.”

Matthew Deninger’s data (cf. School Speech Therapy, Pull Out, and LRE) indicated SLPs display a tendency to over-place a disproportionate number of black children in the SLI category.  Our other posts reinforce the fact that SLPs are inclined to over-place minority children — Native Americans, black children and Hispanics.

School speech therapists are not alone in misidentifying at-risk children. It is a widespread problem among related services personnel and special educators.

There are three reasons for preventing the misplacement of non-disabled children displaying cultural and linguistic differences: 

It is NOT Best Practice.

It is NOT Ethical.

It is NOT Legal.

SLP Perspective on Overidentification

Why are there so many children in special education?

Before 1950 special needs children were underrepresented in schools. IDEA legislation pressured teachers into taking and “mainstreaming” greater numbers of handicapped pupils. Federal financial incentives helped inflate enrollments. Numbers grew faster than predicted by underlying social and medical disability. Unknown is the extent to which local administrators advanced enrollments for financial gain.

Poor coordination of federal, state and local regulations produced variation of eligibility standards across the country. Eligibility decisions as determined by local IEP teams drifted in many directions. Confusing and costly divisions between general education and special education for remedial and special education services contributed to the fragmentation of educational programs. It created the necessity of “referring” to special education to access types of instruction unavailable in general education.

Misidentification of special education children accounted for flawed placements of disabled and minority children. Learning disability placements grew wildly, suggesting a “waste basket” category in which non-disabled children were placed. Inexplicably, males were placed more often than females. Black and “disadvantaged” children the same. Children who simply had no means of learning English were identified as learning disabled.

Regular classroom teachers began to drive eligibility. One explanation is that they are ”bothered” by by distractible learners in the classroom (Congress Report).

Parents and parent advocacy groups insisted on having their children placed in special education with little regard for the stigmatization of such placements. Attorneys gave assistance. Administrators became afraid of parent complaints and potential legal setbacks. Their focus was on school record-keeping to ward off state auditors.

School psychologists placed the majority of America’s special education pupils. Public policy debates did not address the influence of any one profession on admissions. Psychometric standards for the placement of learning disabled children are now in dispute – i.e, the “discrepancy model.”

School speech-language pathologists have made certain “grassroots” efforts to reduce their caseloads but no similar effort to take responsibility for over-placing children in special education. In the school hierarchy, they accepted a minor policy role in eligibility determination. SLPs help place 20% of special education students nationwide, so they have ample opportunity to address off-target placements within their job category.

An ASHA panel describes how SLPs should exercise leadership in the school setting: “In the context of educational reform it is important for SLPs to assume a leadership role in defining and articulating their roles and responsibilities and in ensuring that students’ educational needs are met…They must themselves keep abreast of the changes reform brings” (ASHA Policy, 2009). Eligibility reform is needed to make sure the right children get the right services.

Speech Pathology Prevention in Schools

Prevention is a long-held professional goal of speech and language pathology.  In schools, the best opportunity is to reduce the number of pupils needlessly placed and retained in special education.  Even though special education personnel, including SLPs, complain about having big caseloads, most do not take responsibility for aggressively screening out non-disabled minority children.

SLP Caseload Eligibility

As a part of Strategic Eligibility Management (SEM), the alert SLP must start off whittling away at his or her individual caseload to reduce size and misidentifications in an ethical manner. Beyond this, the SLP is interdependent with other SLPs who might be creating placement “leaks” in the special education system. Caseloads are passed on from preschool to high school, and one can inherit the shaky eligibility judgments of others. Some SLPs also exit children rarely because of the difficulties of doing so. Sometimes SLPs do find themselves cleaning up a poorly managed caseload. Chances are new graduates do not know about the over-identification of at-risk children because it didn’t come up in their graduate programs and because of the stigma associated with it (cf. Why Over-identification). They are working strongly for compliance, getting along and keeping their jobs.

Placement “leaks” in the system must be diagnosed. Where and how are they occurring? Who is involved and how can they be gently influenced to make better professional judgments? How does peer pressure come into play? Where is judgment breaking down?

POINTS OF ENTRY

Child find. According to IDEA, schools must advertise in the community for referrals of at-risk children. They must arrange for screening sessions open to the public. Which SLPs are involved with this? Are they influenced by staff opinions?

Parents. Any parent can within a district (LEA) refer his or her child directly to the office of special education. The school by law must respond. Pressure is placed on the school for quick action, action that usually entails placement. “Rush to judgment” must be controlled.

Transfers. Children who bring active IEPs into the school district transfer their eligibility. The school may review the adequacy of the plan and how it will be carried out. It can review the disability judgment. Too often special education placement is automatically accepted. SLPs should flag questionable IEPs.

Home schooling. Parents who home school within the LEA are entitled to special education services. They must go through the standard eligibility procedures. One must watch for short-cuts in standard procedures.

LEA schools. Private and charter schools within the LEA can refer their pupils via parents to special education. The LEA must take the referral. Such referrals sometimes come in during the summer, when SLPs are on vacation.

0-3 years. Children who are made eligible for remedial support services must transfer into the LEA shortly before age 3 years. They bring an eligibility determination with them. The determination can be based on various disability criteria, and SLPs might believe they are obligated to accept the transfer information as is. Medical opinions must be translated into educational categories.

3-6 referrals. Kindergarten teachers and sometimes Headstart teachers can refer children to special education. Some at-risk children are identified through screening programs. Special education criteria change with regular school placement. How do developmental criteria translate into educational criteria?

6-21 referrals. At-risk children are often referred by elementary teachers as their academic learning patterns become evident. Referrals can be made throughout the school years, as, for example, in cases of traumatic head injury (TBI). Some teachers make questionable special education referrals. Pre-interventions must be considered, too.

Eligibility criteria vary with age, program and disability. Misidentifications can occur at any step. For example, migrant children sometimes bring out-of-date IEPs to their next school. Hurried acceptance can sustain misidentification.

SLPs, RTI and Over-identification

Speech Pathology Group advocates for school collaboration to reduce time demands on SLPs. Collaboration takes place through Response To Intervention programs and can prevent SLI over-identification:

“The purpose of implementing a response to intervention (RTI) program is to not only reduce the number of special education referrals and evaluations, but to also prevent inappropriate placement of students in special education” (SpeechPathologyGroup2).

This applies to SLPs who would normally evaluate to place speech and language impaired children directly into special education and their caseloads. RTI can screen out non-disabled children with weak communication skills. There are Hispanic children who have limited English. There are poor children who are not used to structured tasks used in norm-referenced tests. There are phonologically delayed children who show they are stimulable for accurate production and can quickly begin to produce high intelligible speech with cues. In RTI they get a chance to show they need only interactive stimulation in the regular classroom.

Also, SLPs contribute to school success operating outside the structure of the therapy room:

“RTI yields major cost savings to the education system by preventing over-identification of speech and language impairments, reducing long-term costs of educating struggling learners and allowing special education resources to be allocated on the basis of highest need. In addition, IDEA 2004 permits school districts to use as much as 15% of special education monies to pay for qualifying early intervening services, including professional development for teachers.”

This post suggests SLPs have more control over caseload size and workload than they realize. They need to focus on the goal of reducing over-identification using whatever school programs support that goal.

http://www.speechpathologygroup.com/html/contract/interventions.html

October, 2014

This post was made in 2011. Here is another area of school concern ASHA and the CAA manage to avoid.

Monitoring Misidentification for SLPs

SLPs want to manage special education eligibility correctly and in this way ethically keep caseload size and workload under control. IDEA 2004 regulations provides the legal basis to reduce overidentification and disproportionality in all private and public U. S. schools.

idea.ed.gov (Legacy 2007) provides a summary of what state and local school districts “must” do to monitor incorrect placements in special education. Here is the basic requirement:

“The State must have in effect, consistent with the purposes of 34 CFR Part 300 and with section 618(d) of the Act, policies and procedures designed to prevent the inappropriate overidentification or disproportionate representation by race and ethnicity of children as children with disabilities, including children with disabilities with a particular impairment described in 34 CFR 300.8 of the IDEA regulations.[34 CFR 300.173] [20 U.S.C. 1412(a)(24)]”

PREVENT is the operative word. When an SLP avoids an inappropriate placement, a measure of prevention is taken and caseload is reduced by one.

Moreover, the state must monitor local school districts to see they are doing their jobs to reduce overidentification and disproportionality:

“…in accordance with §300.646(a) of the IDEA regulations, the State or the Secretary of the Interior must…require the LEA to publicly report on the revision of policies, practices, and procedures described under §300.646(b)(1) of the IDEA regulations.”

These prevention measures assume background knowledge of the fact that too many American school children are placed in special education via misdiagnosis, and many of these children are from minority groups.

SLPs in their schools should feel free to explore this topic with administrators. They are in the same lifeboat.

SLI Definition for Eligibility

IDEA 2004 says SLPs are supposed to ensure at-risk children are properly placed in special education. “Proper” involves accurately following statutory criteria for “speech and language impairment” (SLI). Otherwise, there can be under-, over- and misidentification of SLI students and this works against their FAPE rights.

Here is an example of how inconsistency can come into play.

ARIZONA CASE

1984: School SLPs used the widely quoted definition of speech disorder authored by Dr. Charles Van Riper (Sevier County): “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).

1997: IDEA established links with with the general curriculum: “a communication disorder, such as stuttering, impaired articulation, a language impairment, or voice impairment which ADVERSELY AFFECTS EDUCATIONAL PERFORMANCE” (my emphasis, Sevier County).

2003: Arizona followed a modified Van Riper definition: “Speech/Language impairment means a communication disorder such as stuttering, impaired articulation, severe language skills, or a voice impairment… to the extent that it calls attention to itself, it interferes with communication or causes a child to be maladjusted.” There is no mention of IDEA 1997 ADVERSELY AFFECTS EDUCATIONAL PERFORMANCE.

(ARS 15-761, 34, Management Information Systems; http:/www. ade.state.az.us/ess/ChildFind/CfStateEligibility.asp)

2004: IDEA retained SLI links with the general curriculum:

2007: IDEA-2004 regulations: “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).

Main road in Lakeside, Arizona, in the White Mountains

2008: The Arizona State Legislature aligned SLI with IDEA 2004: “For a child who has reached the required age for kindergarten, means a speech or language impairment as defined in 34 Code of Federal Regulations section 300.8” (Section 15-761, 34, Arizona Legislature).

2008: The Arizona House of Representatives aligned SLI with IDEA 2004: “Speech/language impairment” means a speech or language impairment as DEFINED in 34 Code of Federal Regulations section 300.8.2″ (HOUSE BILL 2278, amending 15-761).

(www.azleg.gov/legtext/48leg/2r/bills/hb2278h.pdf)

(Again IDEA 2004: “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.”)

2009: The Arizona Department of Education (“Evaluation and Eligibility, Processes and Procedures From Referral to Determination of Eligibility”) used the 2003 definition: “The student has a communication disorder such as stuttering, impaired articulation, severe disorders of syntax, semantics or vocabulary, functional language skills, or voice impairment to the extent that it calls attention to itself and interferes with communication or causes the child to be maladjusted.” There is no reference to ADVERSELY AFFECTS A CHILD’S EDUCATIONAL PERFORMANCE.

(http://www.azed.gov/ess/publications/AZ-TASEvaluation.pdf.)

2010: Arizona Exceptional Services uses the 2003 definition: “The student has a communication disorder such as stuttering, impaired articulation, severe disorders of syntax, semantics or vocabulary, functional language skills, or voice impairment to the extent that it calls attention to itself and interferes with communication or causes the child to be maladjusted” (Arizona Exceptional). There is no reference to ADVERSELY AFFECTS A CHILD’S EDUCATIONAL PERFORMANCE

(https://www.ade.state.az.us/ESS/ChildFind/CfHome.asp)

2010: Apache Junction Schools uses the 2003 definition: “a communication disorder such as stuttering, impaired articulation, severe disorders of syntax or vocabulary or functional language skills,
or a voice impairment, as determined by evaluation, to the extent that it calls attention to itself, interferes with communication or causes the child to be maladjusted” (Apache Unified). There is no reference to ADVERSELY AFFECTS A CHILD’S EDUCATIONAL PERFORMANCE.

2010: With reference to IDEA, The State of Texas defines SLI this way: “A communication disorder such as stuttering, impaired articulation, a language impairment, or a voice impairment that ADVERSELY AFFECTS A STUDENT’S EDUCATIONAL PERFORMANCE  (Texas Report).

LESSON

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.

Speech therapists, occupational therapists, physical therapists and psychologists should verify the eligibility criteria used in their states to make sure they are clerically accurate and consistent.

Post Script

You may have noticed that the phrase “adversely affects educational performance” appears in most of the disability definitions. This does not mean, however, that a child must be failing in school to receive special education and related services. According to IDEA, states must make a free appropriate public education available to “any individual child with a disability who needs special education and related services, even if the child has not failed or been retained in a course or grade, and is advancing from grade to grade.” [§300.101(c)(1)]  National Dissemination Center for Children with Disabilities

This statement shows school SLPs must make judgment the heart of all placement decisions.  All criteria and IDEA law must be considered on a case-by-case basis.

4. SLP Misidentification

We wonder who puts the so many children in special education? Who are the key decision-makers? SLPs play a key role.

IDEA 2004 regulations address the thorny problem of decisions to place learning disabled children, a category that by all sources has run wild over the last 35 years.

“The determination of whether a child suspected of having a specific learning disability is a child with a disability as defined in 34 CFR 300.8, must be made by the child’s parents and a team of qualified professionals…”

The decision to place is a team decision approved by the child’s parents. Final responsibility rests with the parents. It is unclear where responsibility resides when it comes to indefinitely large IEP teams. However, the team under IDEA regulations must include:

1. “The child’s regular teacher; or if the child does not have a regular teacher, a regular classroom teacher qualified to teach a child of his or her age; or for a child of less than school age, an individual qualified by the State educational agency (SEA) to teach a child of his or her age…”

We see the importance of the educational perspective in the composition of the IEP team. This can include the teacher who made the referral for services.

2. “At least one person qualified to conduct individual diagnostic examinations of children, such as a school psychologist, speech-language pathologist, or remedial reading teacher.”

This requirement confirms that school psychologists and speech-language pathologist provide much of the critical diagnostic information used for SLD placements. Remedial reading teachers, one surmises, play a lesser role nationwide.

Weight of opinion is not addressed by the IDEA regulations. Parents, psychologists, teachers and SLPs offer opinions carrying more weight than some of the other participants. Related services personnel add weight when their professional opinions fit the recommendation of LD eligibility.

Final determinations are still cast in the dim light of the group dynamics of the IEP team plus local customs (cf. Micro Level).