Category Archives: SLP School Policy

Public policy

ASHA Board of Directors Supports Practice Portal

Old house in small town

Old house in small town

The Portal: September, 2014

The American Speech Language Hearing Association represents a modern field providing clinical communication services to adults and children in all settings of service delivery. Accordingly, it has initiated a project to describe the many help services speech language pathologists provide to their clients. The Portal project is a long-term program approved by ASHA Board of Director:

“BOD 32-2013…. RESOLVED, That the Board of Directors (BOD) of the American Speech-Language-Hearing Association (ASHA) continue to support the development of ASHA’s Practice Portal, and further;

RESOLVED, That the BOD approve use of the Special Opportunities Fund to provide such support in an amount not to exceed $550,000 per year for the years 2015, 2016, and 2017.”

http://www.asha.org/PRPDefault.aspx?utm_source=asha&utm_medium=email&utm_campaign=pp092214

http://leader.pubs.asha.org/article.aspx?articleid=1854281

Internet Connectivity

The TerpSys company has designed the Portal program for easy online use:

“TerpSys worked with ASHA to create a responsive site that makes navigating through large amounts of scientific information easy on any device:

Responsive – ASHA can create and maintain one set of content, but know that it looks custom-tailored on all of their users’ devices

Brand Extending – The Practice Portal fits the overall ASHA brand, but with a fresh, forward-looking feel
User-centered – Content expands and contracts to give users quick access to just the information they need in the moment

Consistent – Ektron, a .NET-based content management system (CMS), allows new content to be created in a consistent way as the Practice Portal grows”

http://terpsys.com/success-story-asha/kkk

According to a current public information release, the Portal is being well received and is pushing forward on new topics:

“Currently, the Portal site features detailed content on 20 clinical and professional issues for audiologists and speech language pathologists, including pages on autism, dementia, bilingual service delivery, classroom acoustics, and newborn hearing screening. New pages are added on a regular basis and announced on ASHA’s Facebook, twitter, and community sites.”

“The goal of ASHA’s Practice Portal is to assist audiologists and speech-language pathologists in their day-to-day practices by making it easier to find the best available evidence and expertise in patient care, identify resources that have been vetted for relevance and credibility, and increase practice efficiency. Our goal is not to provide a practice ‘recipe’ but to make available to you the information and resources you need to guide your decision-making…”
http://www.asha.org/Practice-Portal/About/

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2. Does the American Speech-Language-Hearin g Association Have a Curriculum Process?

In our last post we raised questions about ASHA’s curriculum process. It is correct to say we are flummoxed by it.

Take the example of collaboration in schools. Collaboration is an old topic in the field. Sylvia Hanna and I as clinical supervisors at Ohio University in 1967 were part of an interdisciplinary team sent out on Saturdays into Appalachia to help with free diagnostic clinics. We organized our notes, had pictures taken and published an article in Rehabilitation Literature on the positive outcomes observed. It was selected as the featured article of the month. Since that experience many projects in collaborative programming have been carried out around the country. I have been a part of several collaborative programs on campus.

In 1975 Public Law 94-142 was enacted by congress. The courts upheld procedures obliging school speech pathologist to collaborate in the planning process for special education children. IDEA legislation later promoted response to intervention where for SLPs were asked to collaborate with general educators.

The ASHA Model

In a report received by the ASHA Executive Board in October of 1990, called “A Model for Collaborative Service Delivery for Students with Language-Learning Disorders in the Public Schools,” the idea of collaborative education in schools was thoroughly developed by the Committee on Language Learning Disorders. The report covered the topics of collaborative service delivery, collaborative teams, administration, planning programs, assessment, intervention, accountability and references (74 items). The report was authored by an expert ASHA panel of administrators, clinicians and academics. Research was described as a basis for collaborative practice. The report was highlighted in PubMed.gov in 1991: Collaboration…”holds great promise for providing services to maximize the functional potential of students with language-learning disorders.”

In 2002, Kathleen Whitmire, ASHA’s Director of School Services, promoted flexible SLP service delivery: “When developing the intervention plan, the team should take into consideration the full spectrum of service delivery options when deciding which options are appropriate for meeting the individual needs of the child. It may be appropriate to provide a mix of options, e.g., classroom-based, individual pull-out, and consultation, to help the child establish basic speech-language skills, examine attitudes and beliefs, and apply skills in various contexts.”

Continued Support

In 2009, in the ASHA Leader (December), President Sue Hale advocated for partnerships: “The opportunities for collaboration are limitless, and will help create more clinical outcomes and better science to enhance both professions.”

In the same edition, the Coordinating Committee of the Vice President of Speech-Language Pathology Practice report on page 12 on the collaborative role of speech-language pathology and changes on the horizon: “A key component of these changes has been the increased use of collaborative models for care that require speech-language pathologists to learn new skills related to team dynamics and conflict resolution.” Further: “A potential response to environmental changes in education and health care is to increase collaboration and teaming to enhance functional outcomes.”

In 2010 ASHA published its professional position statement on the “Role and Responsibilities of Speech-Language Pathologists in Schools.” The word “responsibility” signalled school SLPs now had a professional obligation to adopt the practices described. A section was devoted to collaboration where SLPs must work cooperatively with general education and special education. SLPs must also cooperate with university programs, communities, families and students. “Work within the larger context of education, such as with literacy, curriculum and RTI, require close collaboration with other educators.”

In the June, 2013 edition of The ASHA Leader, articles were presented on the status and potential of collaborative SLP practice. Instead of talking about collaboration Interprofessional education (IPE) is referenced. Aruna Hari Prasad, ASHA’s associate director of school services, writes on the value of collaboration in schools. Collaboration engenders a broader view of special education, more coordinated services, more creativity, more efficiency and easier parent involvement.

Comment

Since ASHA published its seminal collaboration model in 1990, clinicians are now middle-age and older SLPs have retired. School office leadership has turned over, another executive director is in place, and countless presidents and directors have come and gone. And still no action on bringing collaboration into graduate programs of America’s academic programs.

If collaboration is such a good idea, why hasn’t ASHA acted on it? Is there no orderly process to address new curriculum topics?

“But do communication sciences and disorders graduates have the skills they need for successful collaboration with other professionals? The fact is that formal training in this area has lagged dramatically behind practice expectations” (Judith L. Page &  Donna S. Morris, ASHA Leader, May 15, 2012)

Sisyphus, Poster Child for American Education

I went to Barnes and Noble bookstore the other day.  It seemed time to look over their shelf on “Education” to find trending books.  I bought Diane Ravitch’s, The Death and Life of the Great American School System (Basic Books, 2010) because it was on my read list.  The shelf was like the many I had seen before in bookstores across the country.  It was loaded with brightly colored “how to” books.

Most of us in education never reach the mountain top because we are too busy searching for the perfect method.

According to Ravich, at the top of the mountain is the pantheon of politically inspired non-educators seeking to make changes in things they do not understand.  We keep  climbing hoping we find the perfect method.

Diane Ravitch’s blog

Diane Ravitch Defends Education on youtube:

http://www.youtube.com/watch?v=Qb1Lsod2nts

5. The Future of School Speech-Language Pathology

Last year we  began to argue for the “overhaul” of American school speech-language pathology.  Responsibility rests with the Membership of the American Speech-Language-Hearing Association (ASHA) and particularly the elected Board of Directors. The appearance is the Board dwells more on the health of the non-profit organization than it does on school reform.  Overhaul must be from top to bottom, from undergraduate education through to continuing education.  Reform is needed to eliminate historical bias against the “speech correction teachers.”

Here is the earlier post:

“Reform

The administrative management of educational speech-language pathology needs a total overhaul.  That means fresh thinking and reform.  The last generation of school SLPs didn’t get crucial and timely assistance.

a. To examine or go over carefully for needed repairs.
b. To dismantle in order to make repairs.

“Overhaul” defined by the FREE DICTIONARY points us toward (a) and the view that school speech-language pathology should retain good measures and good practice but it should be examined carefully for Needed Repairs.  

A starting place is recognition one cannot talk about school practices as disembodied techniques and skills apart from how ASHA policies impact the processes of educating and informing SLPs.  The medical model bias is a problem.”

Stairs to the river, Paris

New Division 

We are now recommending a new Division of School Speech-Language Pathology as a separate administrative unit apartment from “Speech Therapy.”

COMMENT

Janet Ness On September 1, 2012 at 2:33 am

It is so funny to me because my training included everything that SLPs licensed for hospitals and clinics had. I chose to take MORE classes so that I could be certified to work in the schools.

  • schoolspeechpathology On September 1, 2012 at 2:56 am

    For many years, at least 50, this has been the case. There is no logical reason for this except historical preference expressed by those favoring the medical model over educational speech pathology. The programs should be the same length and the same cost. Or hospital SLPs should take more language so as to embrace cognitive linguist models. In the U.S. all children who go to hospitals are subject to IDEA law and school intervention. Hospital SLPs should ask for IEPs within scope of practice. They should support school SLPs and participate in IEP meetings. IDEA trumps hospital assessment. Thanks. JMP

ASHA Studies Mission in 2012

The Board of Directors of the American Speech-Language-Hearing Association has announced for its August 2012 meeting interest in soliciting input on the Mission of the Association. The current mission:

“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.”

“A mission statement is a statement of the purpose of a company or organization. The mission statement should guide the actions of the organization, spell out its overall goal, provide a path, and guide decision-making. It provides “the framework or context within which the company’s strategies are formulated.”[1]  Wikipedia”

http://en.wikipedia.org/wiki/Mission_statement

Kids stuff for school.

In May of 2012 the Board considered a proposal adding a medical  component to the mission statement: ”

A group of members, who are board-recognized swallowing specialists, asked the Board to consider changing ASHA’s mission statement to include swallowing…. 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….”

 

2014 Update

“We are happy to see the Board of Directors has shifted the ASHA mission to include accreditation and educational preparation. The CAA (Council on Academic Accreditation) should be drawn out of its silo to address school speech-language pathology curriculum development.

The new mission includes “setting standards” and “fostering excellence in professional practice, and advocating for members and those they serve.”

ASHA Governance and School Speech Pathology Practice

Tracing through the history of  The American Speech-Language-Hearing Association gives one ideas and impressions about governance and organization shaping school practices in American schools.

Governance is the act of governing. It relates to decisions that define expectations, grant power, or verify performance. It consists of either a separate process or part of management or leadership processes…In the case of a business or of a non-profit organisation, governance relates to consistent management, cohesive policies, guidance, processes and decision-rights for a given area of responsibility… ” (Wiki)

“The duty of decision-making is a cornerstone of professional associations, entrusted to the those elected to the organization’s governing body — in ASHA’s case, the Board of Directors” (Chabon & Pietranton, ASHA Leader, 2012, March 13).

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

Over more than 100 years of organizational activity, capture of  school speech pathology by a small group of academic speech therapists in 1925 established organizational bias against those who did not want to work in hospitals and clinics, and who wanted to work with school children. School practice was flourishing up to 1925, whereas speech therapy practice was almost non-existent. Medical-model thinking was imposed on school speech pathology by the careful selection of executive directors, central organization in Washington, D. C., and non-profit status. Medical model leaders used the rapid growth of school speech pathology as a revenue base for continued funding of narrow and often arcane speech therapy research, teaching and practice.  It took until 1970 for ASHA governors to take even a modest step toward supporting school functions by way of a small office for school issues and programs, an office which remains virtually the same today even though more than half of ASHA members work are in education.

The production of doctoral graduates preparing for leadership in schools  was  nil. Doctoral education was heavily invested in medical-model research and coursework.  The rapidly growing school section of ASHA went without leadership in school speech-language pathology.

In the meantime ASHA was flat-footed when it came to addressing the effects of the civil rights movement and federal legislation on school practice, beginning especially in 1975.  The small office struggled to address issues but was overwhelmed and under staffed.  ASHA governance continued to be biased toward medical model thinking, leaving preservice training in status quo.  A whole generation of graduates completed their careers with insufficient background with respect to the massively changing school environment.  The  deep bias favoring medical-model thinking blinded governors as to trends in school practice..  It is difficult to govern something one does not understand, if one has not practiced in schools.

Executive Director Position:    Speech correctionists were excluded a priori from the position of Executive Director of ASHA. A direct chain  from the male founders to the present day promulgated medical model thinking: Wendell Johnson (1931-1941, Iowa, de facto);  D. W. Morris (1941-1948, Ohio State):  George A. Kopp (1948-1957, Wayne State University); Kenneth O. Johnson  (1958-1980, Stanford Medical);  Frederick T. Spahr (1980-2003, Pennsylvania State). The last in the chain is a woman but no language specialist has ever  been selected, nor a doctoral-level professional with extensive school background.”  (Women Lost)

A clown on mainstreet.

Adopting the non-profit  structure imposed greater inflexibility on ASHA.  Whereas universities up to 1970 provided the fire power for organizational growth of the young profession, executive directors put their energies into the non-profit mission.  University programs lost their influence while sustaining “speech therapy” training.  ASHA became less nimble because it was investing both in gaining control of credentialing and establishing the non-profit base in Washington.  Becoming a strong national cartel for speech therapy services was the larger agenda.  From the beginning, the school  segment of the profession was the profit center to fund organizational growth.

With status quo operating unquestioned, and academic control diminished, ASHA governance took professional leadership in the direction of service to the non-profit medical model credential-control mission, a mission heavily influenced by director Kenneth O. Johnson, 1958-1980. The role of president of the association continued to be eroded giving executive directors greater de facto power and influence.  Presidents rotated through on one year appointments, insufficient time to produce lasting results, while allowing the one-size-fits-all training plan to carry on with little or no innovation to support school clinicians.  To bring the cognitive-linguistic model into training in the 1970s, no small amount of resistance operated.  Even now the literacy domain as an extension of language pathology has fallen years behind in development though it is central to emerging school practice demands.  Attention to literacy training in the university programs languishes. Upon his retirement Frederick T. Spahr, 1980-2003, admitted language had been a vital step forward for the profession although the movement had not received wide support.

For school speech-language pathology to receive full support for its changing mission,  it needs to be a separate ASHA division with separate graduate school major to rectify the historical mistakes by ASHA governors and to break away from cartel strategies.  We have developed here the rationale for  “educational speech pathology” parallel to educational audiology, pointing out repeatedly that school pathologists are half the ASHA membership.

Yet school speech-language pathology continues to be submerged in current institutional thinking: “ASHA exists to enhance the professional lives of audiologists, speech-language pathologists, and speech, language and hearing scientists, and through us, the lives of individuals with communication disorders”   (Chabon & Pietranton, ASHA Leader, 2012, March 13).  Science and  audiology get separate billing following old-line preferences dating back to D. W. Morris, 1941-1948 and George A. Kopp, 1948-1957.  These narrow technical areas receive support from the school SLPs who provide the force behind the profession. Under the present structures, there is not way to give full billing to school SLPs. School practice is just another practice area, “school-based” versus “prison-based” for example.

The Board of Directors should seek to overhaul speech-language pathology to include a separate ASHA division, properly supported in concept, advertising and funding. Policy should reflect changes in curriculum knowledge unique to educational settings.  Students going into school work should all have the background described in the course description developed at the Brooklyn College (New York):

Educ 7672T Teaching in Least Restrictive Environments

30 hours plus conference; 3 credits

Strategies to integrate and support students with special needs in least restrictive environments. System and organizational change theories and strategies for developing models of inclusive education. Focus on curriculum and collaborative processes with other professionals including co-teaching, consultative, and itinerant models. Engagement of family members in collaborative efforts. Students will implement a consultative/collaborative project. Field experiences in a variety of school and community settings.

Such preparation should be incorporated into clinical clock hour experiences in university speech and language training centers.  IDEA -2004 procedures should become a part of the work with those school children who have educational plans (IEPs). Proper diagnostic experience should  reinforce educational principles, and CCC training hours should be granted for such training.  One way or another, the Board of Director must make sure preservice training is appropriate for school clinicians.  One cannot count on colleges of education to provide linkages to IDEA requirements.

Window looking out.

The ASHA Board of Directors is soliciting input. President  Chabon has approved input to the Board, using an InTouch form for this purpose.

We advocate an overhaul of school speech-language pathology to remove historical bias favoring medical speech pathology.  The bias started in 1925 with the capture of school speech correction, and the “FOUNDER’S SYNDROME’ has operated ever since:

Founder’s syndrome is an issue organizations face as they grow. Dynamic founders with a strong vision of how to operate the project try to retain control of the organization, even as new employees or volunteers want to expand the project’s scope or change policy.”  (Wiki)

The cognitive-linguistic model was eventually accepted in the 1970s but never allowed to blossom fundamentally in support of language, culture and learning in schools.

Prior  comment:  “Consider the size of the National Association of School Nurses.  In 1968 NASN started with NEA as a department. In 1979 it became a separate non-profit organization.  Today it lobbies in Washington, has a national network of state organizations, advertising plans, board members, annual conference, two publications, radio service, bookstore, national president, and a full-service web site.  All of this is accomplished with 14,500 members.”

http://nasnupgrade.nasn.org/”

John M. Panagos

Proof of School Speech Pathology Over-identification?

One of our SLP visitors posed a critical science question for all of us to consider.  Here is the comment:

“I wonder where you get your data. SLP’s have to substantiate eligibility with standardized tests and data of progress. With our caseloads, there is no way we would take on a child that didn’t need it! That said, new regulations require language services that formerly were not covered if it could be shown that a child had a concommittent intellectual disorder. The result of that regulation is that practically any intellectually disabled child also receives language services.”

Kids stuff for school.

Our quick answer was designed to touch on some “evidence” on the matter:

“Take a look at “About Us” for the premise, and consider the many posts covering disproportionality, over-identification, least restrictive environment and failure to dismiss. Consider actual clinical examples and the use of aggregate data. For IDEA 2004 renewal, consider how the law was changed to reduce LD over-placement because of issues of construct validity for test interpretation. We argue for improved skill development. Consider the content of “Themes of Interest II.’ Look at, “SLPs Can Lead Over-identification Preschool Prevention Programs.”

Yes, the question posed is excellent and the right one.  It goes to the question of what constitutes proof.

Dr. Jay Greene and his colleagues demonstrated the influence of a macro variable on the over-identification of at-risk children for special education placement and retention, financial incentives for local superintendents  to increase the population:  “There is a statistically significant positive relationship between bounty funding systems and growth in special education enrollment. Bounty funding results in an additional enrollment increase of 1.24 percentage points over ten years.”  2002  (Congress did address the problem.)

http://www.manhattan-institute.org/html/cr_32.htm

School SLPs are instrumental in placing children nationwide, and therefore we can say they have made decisions influenced by financial patterns in their districts.  Likewise, they are influenced by state policies: “An analysis of U.S. Department of Education data shows that the percentage of students in special education varies widely among states. While Rhode Island tops the country at 18 percent, Texas, at 9 percent, is at the bottom. The average percentage across all states is 13 percent, and two-thirds of states are above that number, according to the data.”  Thus in Rhode Island  SLPs are part of a pattern making them more likely to recommend children than SLPs in Texas, and so forth.

http://ed.gov/about/offices/list/ocr/504faq.html

We infer working school SLPs are not aware of the patterns of over-identification in their caseloads, while the known problem is older than the SLPs:

“Concerns about the overidentification of ethnic and culturally diverse students in special education first gained national attention in the 1960s as civil rights advocates, educators, administrators, and policy makers began raising questions about the overrepresentation of minority students in classes for the mentally retarded. To a great extent, disproportionate placement still remains today. Although the problems varies from state to state and region to region, it is seen as an ongoing national problem which may result in students who are unserved, misclassified or inappropriately labeled, or receive services that do not meet their needs. Disproportionate placement of these students into special education classes may be seen as a form of discrimination.”   Amy Zirkelbach, 2002

Recommended is the following post  for the practical implications of managing identification:

How One SLP Manages Caseload and Eligibility

SLPs need to take heed of the  conditions around them:  “

“While African Americans make up approximately 17 percent of public school enrollment, they account for 31 percent of students identified as having mental retardation or intellectual disabilities, 28 percent of students labeled as having an emotional disturbance, and 21 percent of students who have learning disabilities. Some of these categories aren’t pure medical diagnoses, calling judgment, and perhaps bias, into play.”

http://blogs.edweek.org/edweek/speced/2012/01/a_new_initiative_hopes_to.html