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School Programs in Speech-Language Pathology Organization and Service Delivery SIXth Edition School Programs in Speech-Language Pathology Organization and Service Delivery SIXth Edition Jean Blosser, EdD, CCC-SLP Jennifer W Means, SLP.D, CCC-SLP 5521 Ruffin Road San Diego, CA 92123 e-mail: information@pluralpublishing.com Website: http://www.pluralpublishing.com Copyright © 2020 by Plural Publishing, Inc Typeset in 11/14 Palatino by Flanagan’s Publishing Services, Inc Printed in the United States of America by McNaughton & Gunn, Inc All rights, including that of translation, reserved No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, recording, or otherwise, including photocopying, recording, taping, Web distribution, or information storage and retrieval systems without the prior written consent of the publisher For permission to use material from this text, contact us by Telephone: (866) 758-7251 Fax: (888) 758-7255 e-mail: permissions@pluralpublishing.com Every attempt has been made to contact the copyright holders for material originally printed in another source If any have been inadvertently overlooked, the publishers will gladly make the necessary arrangements at the first opportunity Disclaimer: Please note that ancillary content (such as documents, audio, and video, etc.) may not be included as published in the original print version of this book Library of Congress Cataloging-in-Publication Data: Names: Blosser, Jean, author | Means, Jennifer W., author Title: School programs in speech-language pathology : organization and service delivery / Jean Blosser, Jennifer W Means Description: Sixth edition | San Diego, CA : Plural Publishing, [2020] | Includes bibliographical references and index Identifiers: LCCN 2018054951| ISBN 9781635501179 (alk paper) | ISBN 1635501172 (alk paper) Subjects: | MESH: Speech-Language Pathology organization & administration | School Health Services organization & administration | United States Classification: LCC LB3454 | NLM WL 21 | DDC 371.91/42 dc23 LC record available at https://lccn.loc.gov/2018054951 Contents List of Tables xi List of Figures xiii Preface xv Acknowledgments xix Evolution of Speech-Language Pathology Programs in Schools Early History The Michigan Story Early Growth Expanding Our Scope of Practice The “Quiet Revolution” Federal Legislation The PARC Case Mainstreaming 8 United States Department of Education Education Reform and Federal Legislation Terminology: What’s in a Name? 12 The Emerging Role of the School SLP 13 Future Challenges 17 Becoming an Ethical Professional 19 The Code of Ethics Principles of Ethics Ethics Issues in the School Setting Personal and Professional Qualifications Becoming a “Professional” Professional Agencies and Organizations Professional Credentials Program Accreditation Professional Associations 20 21 22 22 24 24 25 27 27 Foundations of the School Speech-Language Pathology Program 31 Organizational Structure of the School System 32 Public Laws Affecting Speech-Language Service Delivery 36 Accountability 45 Inclusive Education 46 Parents Are Important Team Members 47 Public School Reform: Issues and Trends 48 Priorities and Goals for Schools 48 v vi School Programs in Speech-Language Pathology: Organization and Service Delivery Ongoing Improvement: Raising Standards Core State Standards for Education Why Should SLPs Care About Education Goals and Academic Standards? Numbers Count! Prevalence and Incidence Number of Students Who Receive Speech-Language Services Caseload Composition Public School Funding Funding for School Speech-Language Services How Does the Funding Allocation Work? 49 51 53 54 56 58 58 59 61 The Speech-Language Pathologist as a Leader and Manager 63 Leaders Create Change Management: Basic Principles The SLP’s Roles and Responsibilities Organizing and Managing for Success The Many Faces of Management Managing Program Development and Change Develop Program Goals and Objectives Managing Workload and Time Professional Development Plans Quality Improvement 64 66 67 68 69 72 79 81 85 85 Tools of the Trade 95 Physical Facilities Minimal Standards for Facilities and Space Pleasant, Comfortable, and Functional Space Designated Space for SLP Services Special Considerations for Special Populations Facilities for Observation Tools: Technology, Equipment, Professional Materials, and Supplies Integrating Technology into All Aspects of the Program Technology in Service Delivery Augmentative and Alternative Communication Systems (AAC) Demonstration Centers Coaching Teachers to Maximize the Potential of AAC Telepractice as a Service Delivery Option Intervention Materials Educational Materials Integrating Multimedia Materials into Treatment Surfing the Web Assistive Listening Devices Evaluating Materials to Determine Quality and Applicability Organizing Materials and Intervention Activities Expendable Materials Budgeting for Technology, Equipment, Materials, Supplies, and Professional Development Inventory Records 96 96 99 100 100 101 102 102 104 104 106 106 107 112 112 113 113 113 114 115 116 116 118 Contents vii Accountability, Documentation, and Outcomes 121 Documenting and Reporting Consistent Decisions and Comprehensive Record Keeping Legally Defensible Records HIPAA and FERPA Periodic Reflection on Your Program and Services Written Reports Outcomes in Schools A Unique Framework for Measuring Outcomes of Speech-Language Pathology Programs Student Outcomes Measuring Student Outcomes Reporting Progress Partnership Outcomes Program and System Outcomes Training and Buy-In Can Lead to Success Risk Management Plan 122 123 125 126 132 133 133 134 Establishing the Workload and Caseload 147 134 135 137 140 142 142 143 A Philosophy: The Basis on Which to Build the SLP Workload and Caseload 148 The SLP’s Workload 149 Laying the Foundation: Process and Terms 150 The Prereferral Process 151 Identifying Students with Disabilities 152 Referrals for Speech-Language Evaluation 152 Screening 157 Assessment 168 Multifactored Evaluation 170 The Speech-Language Pathologist’s Responsibility 172 Scanning and Analyzing the Environment and People in the Environment 172 Eligibility for Speech-Language Services 180 Classification of Procedures and Communication Disorders 186 Caseload Composition and Size 188 Describing Functional Communication 198 Clinical Judgment 199 Matching the Right Student with the Right Services and Interventions 199 Service Completion: Exiting Students from Therapy 200 Who Determines Eligibility or Dismissal? 202 The Placement Team’s Purpose 204 Ethics and Responsibilities 204 Service Delivery Options 207 Classification of Procedures and Communication Disorders 209 Inclusion 209 Typical Service Delivery Options 211 A Menu of Service Delivery Options 213 Key Service Delivery Variables 213 viii School Programs in Speech-Language Pathology: Organization and Service Delivery Matching Service Delivery Options to Individual Student’s Needs Determining Dosage: the Amount, Frequency, and Duration of Intervention Services Taking a Different Perspective for Planning Services: The PAC Framework for Determining Appropriate Models of Service Delivery Multi-Tiered System of Support (MTSS) Service Coordination Specialized Services Scheduling Services Working with Teachers and Administrators to Plan Schedules 220 221 222 Educationally Relevant Services 245 228 233 234 237 241 Educational Relevance — What an Important Concept! 246 Planning Individualized Programs 247 An Approach to the Planning Process 248 251 Developing the Individualized Education Program The IEP Team 257 The Individualized Education Program (IEP) 258 IEP Forms and Content 258 Individualized Family Service Plan (IFSP) 266 Individualized Transition Plan (ITP) — After Age 14 268 Identifying the Appropriate Assessment and Treatment Approach 271 Core Curriculum Standards 271 Modifying the Instructional Environment 273 Making Speech-Language Intervention Relevant to the Students’ Educational Needs 273 Universal Design for Learning 277 Planning and Evaluating the Treatment Session 278 Motivation 279 Evaluating the Effectiveness of the Intervention Approach and Therapy Session 281 Considerations for Special Populations 281 Literacy (Reading and Written Language Disorders) 282 Cultural and Linguistically Diverse Populations 284 Attention Deficit and Central Auditory Processing Disorders 286 Severe Communication Disabilities 287 Autism Spectrum Disorders (ASD) 289 Hearing Impairments 289 Traumatic Brain Injury (TBI) 291 Behavior Problems and Disorders 292 Abused and Neglected Children 292 Working with Adolescents 294 Working with Groups of Children 294 Counseling 295 Prevention of Communication Problems 295 Effective Team Engagement 296 10 Interprofessional Collaboration: Creating Strong Partnerships Benefits of Collaborating and Consulting with Others 301 302 Contents ix Interprofessional Education, Practice, and Collaboration (IPE, IPP, IPC) School Culture Foster Effective Involvement Through Mentoring Specialized Instructional Support Personnel (SISP) The Principal The Classroom Teacher Special Education Teachers The Educational Audiologist Speech-Language Pathology Assistants The Psychologist The Social Worker The Bilingual Educator and/or English-as-a-Second Language (ESL) Teacher The Guidance Counselor and Vocational Rehabilitation Counselor The School Nurse The Occupational Therapist (OT) The Physical Therapist (PT) The Board Certified Behavior Analyst (BCBA) The Health and Physical Education Teacher Vocational Counselors and Employers Nonteaching Support Personnel Working with Physicians in the Community Working with the Dentist Working with Family Parent Groups Involving Siblings Changing Family Patterns Involving the Student Satisfaction with Services Maintaining Ongoing Communication with Collaborative Partners Community Information Program 302 304 310 316 316 318 322 324 325 331 331 332 333 333 335 336 337 338 338 338 339 339 340 343 343 343 344 345 349 350 11 The School Experience 353 12 Life as a Professional SLP 365 The University Externship Program Goals of the School-Based Extern Experience The School Externship Team Laying the Groundwork for Success Recommendations for Making the Most of Your School Experience Competency-Based Evaluation of University Student Externs ASHA Certification and State Licensure Requirements A Word of Advice to Student Externs Access Support and Resources Build Your Expertise Investigate and Research Influence Decision-Makers 355 356 356 360 360 362 363 363 366 367 367 369 192 Date of Rating Age SLP Sentence length/complexity Word order/syntax Vocabulary/semantics Word finding Word form/morphology Auditory comprehension Two of the following areas are deficient Determination of eligibility as a student with a Speech and/or Language Impairment is made by the Eligibility Committee *Standard scores are based on a mean of 100 and a standard deviation of 15 The standard score can be a receptive, expressive or total language quotient/composite score August, 2018 The student does not perform effectively most of the time, despite the provision of general education modifications and supports Sentence length/complexity Word order/syntax Vocabulary/semantics Word finding Word form/morphology Auditory comprehension At least three of the following areas are deficient >2 SD below test mean Between 1.67 to SD below (standard score below 70) or test mean (standard score nd between 70-75), from the 2nd to below the Percentile the 5th Percentile DOB The student performs effectively The student needs more cues, most of the time with little or no more explanations, and checks on assistance required progress or assistance than the typical student in class Sentence length/complexity Word order/syntax Vocabulary/semantics Word finding Word form/morphology Auditory comprehension One of the following areas is deficient Between 1.33 and 1.67 SD below test mean (standard score between 76-79), from the 5th to the 8th percentile Grade Do not include regional or dialectal differences when scoring Consider normal language differences if student is an English Language Learner At least one of the standard scores must be obtained from a comprehensive language assessment Circle score for the most appropriate description for each category Compute the total score and record below Circle the total score on the bar/scale below to determine the severity rating Functional/Academic Language skills within expected range Language skills are within expected range Standard score* of 80 or above School LANGUAGE SEVERITY RATING SCALE Department of Special Education Cherokee County School District TOTAL SCORE SEVERITY RATING (Circle one): No Disorder (Score – 3); Mild Disorder (Score 4-7); Moderate Disorder (Score 8-10) Severe Disorder (Score 11-12) Instructions: FUNCTIONAL/ACADEMIC LANGUAGE SKILLS OTHER ASSESSMENTS Circle descriptive tools used: Language/communication sample Checklist(s) Observations School Psychologist Test Results Other: FORMALSpeech-Language ASSESSMENT Comprehensive, standardized measure (if more than one assessment used, use the lowest score obtained): Student Table 7–1. CCSD Severity Rating Scales 193 Age Do not include cultural differences when scoring Circle score for the most appropriate description for each category Compute the total score and record below Circle the total score on the bar/scale below to determine the severity rating The student needs several more cues or assistance than the typical student in order to interact with adults and peers Pragmatic language weaknesses Pragmatic language weaknesses are noted in two settings are noted in three settings The student needs more cues and more explanations or assistance than the typical student in order to interact with adults and peers The student interacts effectively with adults and peers most of the time with some minimal assistance or visual supports Conversational Skills Social judgment Flexible thinking Figurative Language Inferences Perspective taking Understanding/use of nonverbal language Conversational Skills Social judgment Flexible thinking Figurative Language Inferences Perspective taking Understanding/use of nonverbal language Pragmatic language skills are within expected range Two of the following areas are deficient SLP 4 Determination of eligibility as a student with a Speech and/or Language Impairment is made by the Eligibility Committee *Standard scores are based on a mean of 100 and a standard deviation of 15 continues August, 2018 Pragmatic language weaknesses are noted in almost all settings The student is unable to interact with adults and peers most of the time, despite the provision of supports Conversational Skills Social judgment Flexible thinking Figurative Language Inferences Perspective taking Understanding/use of nonverbal language At least three of the following areas are deficient >2 SD below test mean Between 1.67 to SD below (standard score below 70) or test mean (standard score nd between 70-75), from the 2nd to below the Percentile the 5th Percentile DOB TOTAL SCORE SEVERITY RATING (Circle one): No Disorder (Score – 4); Mild Disorder (Score 5-8); Moderate Disorder (Score 9-12) Severe Disorder (Score 13-16) Instructions: Date of Rating Between 1.33 and 1.67 SD below test mean (standard score between 76-79), from the 5th to the 8th percentile Grade One of the following areas is deficient Standard score of 80 or above School SETTINGS (e.g., large group instruction, small group instruction, Pragmatic Language playground, lunch room, hallway, bus, weaknesses are noted in only etc.) one setting FUNCTIONAL PRAGMATIC LANGUAGE SKILLS INFORMAL ASSESSMENT Circle descriptive tools used: Language/communication sample Checklist(s) Behavior observed in at least educational settings School psychologist report Other: FORMAL SPEECH-LANGUAGE ASSESSMENT Standardized measure(s) of pragmatic language skills (if more than one assessment used, use the lowest score obtained): Student Department of Special Education PRAGMATIC LANGUAGE SEVERITY RATING SCALE Cherokee County School District 194 Connected speech is between 50 to 80% (50% to 70% for preschool age) intelligible when context is unknown Oral motor and/or sequencing difficulties interfere with speech production Although not correct, some errors approximate correct production Age Sound errors/phonological processes one to two years below age Three to four sounds are produced incorrectly DOB Speech does not affect the student's ability to communicate in school learning and/or other social situations Spelling skills are not affected Determination of eligibility as a student with a Speech and/or Language Impairment is made by the Eligibility Committee August, 2018 Connected speech less than 50% intelligible; gestures/cues usually needed to aid listener’s comprehension Speech disorder limits the student's ability to communicate in school learning and/or other social situations Several spelling errors consistent with articulation errors are noted Oral motor and/or sequencing greatly interfere with speech production, the use of cues or gestures needed 4 No error sounds are stimulable for correct production or if multiple errors present, no more than one error sound is stimulable Sound errors/phonological processes two or more years below age More than four sounds are produced incorrectly SLP TOTAL SCORE SEVERITY RATING (Circle one): No Disorder (Score – 4); Mild Disorder (Score 5-10); Moderate Disorder (Score 11-16) Severe Disorder (Score 17-22) Instructions: Connected speech is at least 80% intelligible (70% for preschool age); some errors noticeable Connected speech is intelligible most of the time 0 Oral motor and/or sequencing difficulties are minimal and not contribute to speech production problems Oral motor and/or sequencing adequate for speech production Most errors stimulable in at least one context 1 Date of Rating Sound errors/ phonological processes less than one year below age No more than two sounds are produced incorrectly Grade Most errors stimulable in several contexts No sound/phonological process errors; errors consistent with typical development School SPEECH SOUND PRODUCTION SEVERITY RATING SCALE Department of Special Education Cherokee County School District Speech disorder interferes with the Speech minimally affects the student's ability to communicate in student's ability to communicate in school learning and/or other social school learning and/or other social situations Occasional spelling errors situations Some spelling errors consistent with articulation errors consistent with articulation errors are noted are noted Do not include regional or dialectal differences when scoring Consider normal speech differences if student is an English Language Learner Circle the score for the most appropriate description for each of the five categories Compute the total score and record below Circle the total score on the scale below Functional Speech Skills Intelligibility Oral Motor and/or Motor Sequencing Stimulability Sound Production Student Table 7–1. continued 195 Dysfluencies minimally affect the student's ability to communicate in school learning and/or other social situations Rate is between 82-99 WSM* OR between 125-150 WSM Speaking rate affected to mild degree Rate difference rarely notable to observer, listener Whole-word repetitions, interjections, part-word repetitions and/or prolongations are present with no secondary characteristics Fluent speech periods predominate Rate is between 60-81 WSM OR between 150-175 WSM Dysfluencies interfere with the student's ability to communicate in school learning and/or other social situations Speaking rate affected to moderate degree Rate difference somewhat distracting to observer, listener Whole-word repetitions, interjections, part-word repetitions and/or prolongations are present Secondary characteristics, including blocking avoidance and physical concomitants may be observed 2 Age DOB Frequent dysfluent behaviors are observed in many speaking situations and/or 5-9 stuttered words per minute and/or 12% to 22% stuttered words Date of Rating Transitory dysfluencies are observed in speaking situations and/or 3-4 stuttered words per minute and/or 5% to 11% stuttered words Grade Circle the score for the most appropriate description for each of the categories Compute the total score and record below Circle the total score on the rating bar/scale below Dysfluencies not affect the student's ability to communicate in school learning and/or other social situations Speaking rate not affected Speech flow and time patterning are within normal limits Developmental dysfluencies may be present Frequency of dysfluency is within normal limits for age, sex and speaking situation and/or ≤ stuttered words per minute and/or ≤ 4% stuttered words School Determination of eligibility as a student with a Speech and/or Language Impairment is made by the Eligibility Committee continues August, 2018 * WSM = Words spoken per minute Dysfluencies limit the student's ability to communicate in school learning and/or other social situations Rate is 175 WSM Speaking rate affected to severe degree and distracting to listener/observer Whole-word repetitions, interjections, part-word repetitions and/or prolongations are present Secondary symptoms predominant Avoidance and frustration behaviors are observed Habitual dysfluent behaviors are observed in majority of speaking situations and/or more than stuttered words per minute and/or ≥23% stuttered words SLP TOTAL SCORE SEVERITY RATING (Circle one): No Disorder (Score – 4); Mild Disorder (Score 5-6); Moderate Disorder (Score 7-9) Severe Disorder (Score 10-13) Instructions: Functional Fluency Skills Speaking Rate Descriptive Assessment Frequency Forma/Informal Assessment Student FLUENCY SEVERITY RATING SCALE Department of Special Education Cherokee County School District 196 Grade DOB Voice disorder interferes with the student's ability to communicate in school learning and/or other social situations There is a noticeable difference in nasality, which may be intermittent There is a noticeable difference in quality, which may be intermittent There is a noticeable difference in intensity, which may be intermittent There is a noticeable difference, which may be intermittent Date of Rating Do not include regional or dialectal differences when scoring Be sure to consider age and gender expectations Circle the score for the most appropriate description for each category Compute the total score and record below Circle the total score on the bar/scale below Voice does not affect the student's ability to communicate in school learning and/or other social situations Nasality is within normal limits or differences can be explained by a temporary condition (e.g., nasal congestion) Quality is within normal limits or difference can be explained by a temporary condition (e.g., a cold) 0 Pitch is within normal limits or differences can be explained by a temporary condition (e.g., vocal variation due to puberty) Intensity is within normal limits School VOICE SEVERITY RATING SCALE Department of Special Education Cherokee County School District SLP Voice disorder limits the student's ability to communicate in school learning and/or other social situations There is persistent, noticeable cul de sac, hyper or hyponasality, or mixed nasality There is persistent, noticeable, breathiness, glottal fry, harshness, hoarseness, tenseness, stridency or other abnormal quality There is persistent, noticeable, inappropriate increase or decrease in the intensity of speech or the presence of aphonia There is a persistent, noticeable inappropriate raising or lowering of pitch for age and sex Age Determination of eligibility as a student with a Speech and/or Language Impairment is made by the Eligibility Committee August, 2018 TOTAL SCORE SEVERITY RATING (Circle one): No Disorder (Score – 2); Mild Disorder (Score 3-5); Moderate Disorder (Score 6-10) Severe Disorder (Score 11-16) Instructions: Functional Voice Skills Resonance Quality Intensity Pitch Student Table 7–1. continued 197 Language score of 4-7 Pragmatic score of 5-8 Articulation score of 5-8 Fluency score of Voice score of 3-5 Impairment minimally affects the individual's ability to communicate in school learning and/or other social situations as noted by at least one other familiar listener Severity of disorder (Using rating scales) Language score of 8-10 Pragmatic score of 9-12 Articulation score of 9-12 Fluency score of 6-9 Voice score of 6-10 Impairment interferes with the individual's ability to communicate in school learning and/or other social situations as noted by at least one other familiar listener 45 to 60 mpw direct speech-language intervention Language score of 11-12 Pragmatic score of 13-16 Articulation score of 13-18 Fluency score of 10-13 Voice score of 11-16 Impairment limits the individual's ability to communicate appropriately and respond in school learning and/or social situations Student may require an AAC system or device 75 to 90 mpw direct speech-language intervention Impairment prevents the individual from communicating appropriately in school and/or social situations Student requires an AAC system or device Language score of 11-12 Pragmatic score of 13-16 Articulation score of 19-22 More than 90 mpw direct speech-language intervention Source: Developed by Patti Howard, CCC-SLP, Ed.D., Lead Speech-Language Pathologist, Cherokee County School District Department of Special Education August, 2018 Service times listed above are for direct service Adverse impact on the student’s educational performance MUST BE DOCUMENTED Need for specialized instruction by the SLP MUST BE DOCUMENTED If student demonstrates a disorder in more than one category (e.g., articulation AND language), consider adding 15 to 30 minutes/week Add 15 to 30 minutes per week of consult time if student uses an AAC device Add 15 to 30 minutes per month of consult time if student is served solely in collaborative/inclusion model If student is in MS/HS and receives significant amounts of other services (e.g., resource reading and written expression), consider reducing the amount of service time by 15 to 30 minutes Impact of disorder(s) 15 to 30 mpw direct speech-language intervention Service Time Guidelines Speech/Language Service Time Guidelines Note: Clinical Judgment may necessitate modification of these guidelines Service Delivery Time is an IEP Committee Decision Department of Special Education Cherokee County School District 198 School Programs in Speech-Language Pathology: Organization and Service Delivery Describing Functional Communication Identifying the nature of a student’s communication impairment is important However, describing how the student functions provides key information that can be used for planning appropriate services The National Outcomes Measurement System (NOMS) is an instrument that was developed by ASHA decades ago to provide a framework and process for SLPs to obtain and report data about treatment outcomes The NOMS represents a national effort to develop a common language for describing and rating students’ functional communication skills An adult version of the NOMS has been used in health care settings since the early 1990s A preschool version was launched and adoption by early intervention SLPs is slowly catching on ASHA leaders also envisioned a K–12 version of the NOMS for the school setting to promote understanding of the outcomes of service delivery and to demonstrate the value and benefits of therapy services However, adoption has been a challenge due to the complex nature of service delivery and reporting in schools In 2010 use of the a NOMS school version was suspended pending further study Since then, teams of school-based practitioners have worked together to review how clinicians had used the tool, challenges that arose, and the importance of systematically capturing data about services and outcomes of treatment Members of ASHA’s school related committees and task forces have embarked on projects to identify methods and make recommendations for developing a viable outcomes measurement system Even though the NOMS was pulled for review and improvement, there are many positive aspects about the NOMS process that bear discussion Most importantly, the NOMS design offers a systematic method for measuring specific aspects of a student’s functional communication The NOMS Functional Communication Measures (FCMs) provide a mechanism for school-based SLPs to report descriptive data about their caseloads and service delivery models It could also be used to measure the effectiveness of treatment over time The NOMS includes a 7-point rating scale ranging from least functional (1) to most functional or independent (7) Functional communication is defined as the ability to convey or receive a message regardless of the mode of communication Guidelines are provided for measuring each aspect of functional communication skills: composition, fluency, emergent literacy, intelligibility, pragmatics, reading comprehension, speech sound production, spoken language comprehension, spoken language production, voice, word recognition, and writing accuracy The NOMS definitions provide a way for determining the functional status measures considering the support required to assist the student in becoming a functional and independent communicator The NOMS also considers the verbal, comprehension, pragmatic, or vocal demands placed on the student in variety of situations including educational, social, and extracurricular activities The explanations for each of the seven levels for each of the functional communication measures enable the user to rate the student’s functional communication from very dependent to consistently independent As an illustration, the box below provides some examples of the type of terms that are used to describe the student’s functional communication at Levels 1, 4, and The intent of the NOMS and Functional Communication Measures is to provide SLPs with a tool that will enable them to measure change in functional communication abilities over time from entrance to dismissal from speech-language services In other words, outcomes measurement systems like the NOMS can be very useful to SLPs but they must be designed so that they not add extra burden to the SLP’s workload ASHA’s NOMS project continues As the results are verified through additional research, there will be opportunities for 7. Establishing the Workload and Caseload determining how these instruments can be used to describe students’ communication behaviors and make clinical decisions in the school setting n The possible impact of the communication problem on the listener; n The ability of the student to communicate well enough to satisfy his or her needs; Example Terms Used in the NOMS Rating Scale Level 1: Rarely grade or age appropriate; not functional for communication; not understandable to familiar listeners; unaware of incorrect productions; avoids spoken interactions Level 4: Usually age appropriate in low demand educational activities; occasionally age appropriate; usually successful when maximum support to reduce the verbal demand is provided; ability to participate is occasionally limited; rarely self-monitors Level 7: Consistently in grade level; consistently appropriate; consistently successful; speech does not call attention to itself; selfmonitoring is used as needed; consistently understood by listeners; not dependent on others Clinical Judgment Regardless of the rating procedure or scale used, we cannot dismiss the importance of clinical judgment In conjunction with assessment methods, the speech-language clinician needs to consider the following factors: n The consistency of the inappropriate communication patterns; n The student’s ability to interact verbally with others; n The effect of the communication problem on school performance; n The status of speech and language stimu- lation in the home; n The student’s response to stimulation of the deficit in speech and language structures; and n The student’s chronologic age in compar- ison with the expected age for developing the communication skills that are in deficit or missing Matching the Right Student with the Right Services and Interventions After the assessment data has been gathered, the speech-language pathologist evaluates the data and reaches a conclusion about the nature and severity of the communication disorder It is at this point, that the SLP and fellow team members, (including educators and family), face three difficult tasks First, the student’s functional communication level should be established Second the team must determine if the student meets the eligibility criteria for treatment and services Third, the instructional intervention program/s and service delivery model most appropriate to meet the student’s needs must be determined The type of services to be provided as well as the qualifications of the service providers and the amount, frequency, and intensity of treatment are critical aspects of establishing the SLP’s caseload, schedule, and workload A key to evidence-based practice is implementing intervention approaches that have “proven” to be effective The literature describing many of the evidence-based speech-language 199 200 School Programs in Speech-Language Pathology: Organization and Service Delivery intervention approaches provides specific guidance, protocols, procedures and requirements for implementing the approach Among the elements described are the recommended “treatment dosage” (amount, frequency, and intensity of the treatment) that is required for the approach to be effective The challenge for the SLP is to develop a “therapy service plan” that will enable accurate implementation of the approach for improving skills Thus, after the treatment approach is identified, the SLP must determine the appropriate amount, frequency, and intensity of “therapy service dosage” that will enable accurate execution of the protocols, procedures, and dosage to achieve positive treatment outcomes This is especially difficult for schoolbased SLPs who experience limitations due to time constraints, high caseloads, and the need to divide the therapy service time between several children who may present different impairments and thus need different treatment approaches Educational colleagues and school administrators responsible for determining policy for special education programs in the district should be aware of the decision-making criteria that SLPs follow to determine eligibility, severity, and priority case selection The case identification and selection system and procedures should be in written form and made available to administrators and educators within the district in order to improve accountability and understanding of the functioning of the program If the case selection system is understood, then the cooperation of other school personnel can be readily enlisted The principal is a key figure in the success of SLP and other related services programs Teachers who are familiar with case selection procedures tend to work collaboratively with clinicians and assist children in their classroom Having a documented eligibility and case identification system is also useful for helping parents understand the rationale for recommendations regarding their child’s program This knowledge also helps others understand why some children are not eligible for services, or discharged from services, should questions arise from the parents or staff Service Completion: Exiting Students from Therapy In the process of identifying students for therapy, diagnosing, providing therapeutic intervention, and maintaining students in therapy, sometimes too little attention is paid to dismissal or discharge from services It is important to continuously reevaluate whether or not a student should continue to receive speech-language services, discontinue services, or be provided with another type of services that may be more appropriate given the student’s performance Initial discussions about dismissal from services should begin when the student is first determined eligible for services and the IEP is formulated Make goals of the speech-language intervention services clear to parents and teachers at that time Help them realize that success means dismissal from therapy The question of when a child should be exited from treatment may be predicated on when the pupil reaches maximum anticipated performance or when the student’s communication problem has been completely improved Here are a few important points to highlight in your conversation with parents and teachers: n The student should be dismissed when his or her impairment no longer creates an adverse effect on education n The focus of services may be to reduce the effect of the impairment n Dismissal may occur before a student demonstrates complete mastery of all targeted skills In other words, intervention should not be expected to continue until performance is perfect or 100% accurate n As the student improves, the context and/ or location of the services may shift from the therapy room to other contexts such as the classroom or resource room and more 7. Establishing the Workload and Caseload people will be engaged to give the student experience at using improved communication skills with others After the student has been placed in a therapy program the short- and long-term performance objectives are identified and written in the intervention plan The objectives are based on characteristics identified through testing, observation, comments from parents and teachers, and discussion with the student The desired outcomes of treatment are a statement of what the student should be able to at the termination of the treatment program The short-term objectives are the steps through which the student must progress successfully to reach the long-term objectives This, in effect, means that long-term (or terminal) objectives constitute the exit criteria, or the point at which the student is dismissed from therapy This is part of the intervention plan (IEP, IFSP, or ITP) Obviously, the nature of the disorder will have a direct bearing on the expected outcome of treatment For example, a student with cerebral palsy and apraxia may not be expected to attain “normal” speech patterns, depending on the extent of the involvement This dismissal point for this student may be “adequate” speech or understandable communication using an augmentative device A student with a phonological problem potentially may be able to attain a more complete mastery of the distorted sounds, and the dismissal point for this student would be when the student could use the sounds correctly Discharge from services is covered in IDEA (2004) regulations Unless the student graduates from secondary school, or has reached the age of 22, reassessment of a student is required SLPs must develop criteria for service completion that is unique for each student and terminate therapy when these criteria are met This means that dismissal from therapy may occur at any time during the school year This is a change in practice for some clinicians who are used to carrying students on their caseloads throughout an entire academic year Students who have not reached optimum improvement at the end of the school term are often continued into the following term Students who transfer to another school are referred to the SLP in that school system Parents should be urged to inform the new school that their child has been in therapy and they wish it to continue In this situation, the referring clinician secures the proper release forms to transfer the student’s therapy records to the new school When a dismissal is made, the child should be scheduled for periodic rechecks to find out if the skills developed in therapy are being maintained The classroom teacher and parents can be called on and coached to observe the student’s communication and report on progress as well When engaging others in this way, it is helpful to be very specific about what communication patterns sound like Four steps that practitioners follow when determining if services should be continued are as follows: n Hold a reevaluation planning meeting to review existing current data regarding the student’s progress and performance n Determine what additional data may be needed to make the decision (standardized and nonstandardized assessments, curriculum-based assessments, student work portfolios) n Conduct additional assessment procedures recommended by the IEP Team n Include the family in the planning and discussions When the student has reached the optimum levels of performance, it is time to exit the student from services The criteria for dismissal are unique to each child and must be carefully established, evaluated, and reevaluated during the course of treatment If necessary, they must be adjusted or modified in the light of more knowledge about the student In addition to providing 201 202 School Programs in Speech-Language Pathology: Organization and Service Delivery rating scales for determining selection for the caseload (eligibility criteria), it is also important to provide clear guidelines for determining readiness for program completion (dismissal criteria) Some examples of dismissal criteria are listed below: n Speech and language goals and objectives have been met n Speech and language skills are develop- mentally appropriate or are no longer academically, socially, personally, or emotionally affecting the student Documentation must be presented by one or more of the following: student, teachers, parents, speech, and language clinician n The student has made minimal or no measurable progress after one academic school year of consecutive management strategies During that time, program modifications and varied approaches have been attempted and a second opinion has been obtained n Maximum compensatory skills have been achieved or progress has reached a plateau due to cognitive ability level, structural deviations (e.g., severe malocclusion, repaired cleft lip or palate, physical condition of the vocal mechanism, or other physical deviations or conditions); or neuromotor functioning (e.g., apraxia or dysarthria) n Limited carryover has been documented due to the student’s lack of physical, mental, or emotional ability to selfmonitor or generalize the behavior in one or more environments n Due the nature of the student’s impair- ment, he or she could be served better elsewhere n Lack of progress or inability to retain learned skills due to poor attendance and participation, although program IEP goals and objectives have not been met Poor attendance and participation records should not stand alone; rather it is the lack of progress or retention, which is of primary concern when utilizing these criteria n The student has graduated from high school or has reached the age of 22 years n Individuals who are significant in the child’s life no longer see a need for services n Associated and/or disabling conditions prevent the student from benefiting from services n The student uses assistive technology aids appropriately, effectively, and independently Who Determines Eligibility or Dismissal? A placement team composed of those individuals with the greatest knowledge of the child must always make the decision regarding eligibility for services and appropriate placement of the child with disabilities This includes the child’s parents The parent need not be the natural parent of the child as long as he or she meets the legal qualifications of the parent surrogate The federal law also specifies that the team should include a representative of the local educational agency, the teacher, and if appropriate, the child Although the law does not state that other individuals are required to be present, good educational practice would suggest that other team members also attend This list would include those persons who by virtue of their professional backgrounds and the child’s unique needs would reasonably be expected to be involved It might include the principal, psychologist, read- ing teacher, occupational therapist, physical therapist, vision consultant, and speech-language pathologist and audiologist The results of the multifactored evaluation and the possible placement options should be available when the placement team meets Coordinator of the Placement Team The representative of the local educational agency usually is the case manager and coordinator, and as such arranges for the meeting, presides over the meeting, determines that all necessary persons are present, and acts as spokesperson for the school system The chairperson presents the necessary information and data or calls on the person responsible for presenting it The chairperson also has the responsibility of informing the parents of their rights Setting the tone of the meeting and seeing that all the basic ingredients of the Individualized Education Program are present, and that the procedures are carried out according to state and local guidelines, are also within the responsibilities of the chairperson The Teacher as a Team Member The teacher is the person most responsible for implementing the student’s educational program The specific teachers, in the case of the student with communication disabilities, may be the classroom teacher for instruction, and the speech-language pathologist, or for communication intervention The teacher’s responsibilities as a team member at the meeting include explaining to the parents the learning objectives, curriculum and various techniques that are used to meet the annual goals The teacher will also explain to parents why one particular strategy was used instead of another In addition, the teacher will answer questions parents might have about events that occur within the classroom In effect, the teacher is the main emissary between the school and the parents 7. Establishing the Workload and Caseload Speech-Language Pathologist’s Role on the Team The role of the speech-language clinician on the IEP team may vary according to state regulations and the guidelines and practices of the local education agency If the child in question has a communication problem, the person providing the language and speech services in the school needs to participate in the decision process Although the full placement team has the responsibility of developing an educational program for each student, the school clinician should be prepared to provide input into the process of establishing goals, objectives, prognosis, and intervention strategies The school clinician will also be responsible for reporting to the placement team the results of any diagnostic and assessment testing and may recommend further testing Family as Team Members Including the family as team members can provide insights about the home situation, the impact of the disability on interactions in home activities Making family “team members” gives both the family and the speech-language pathologist, as well as other members of the team, an opportunity to observe each other’s interaction with the student The family may be team members in the actual diagnosis, treatment, and carrying out of the IEP, IFSP, or ITP Furthermore, the more caregivers are included in these processes, the smoother and more consistent is the delivery of instruction to the child Both family and SLPs gain from the insights of the other, and both will be able to use each other as a source for ideas In addition, family and SLPs will be able to keep each other informed about the progress of the child Reports to caregivers, both oral and written, should be in clear, understandable language and not in professional terminology, sometimes referred to as jargon Clear explanations of the diagnosis and treatment strategies should be 203 204 School Programs in Speech-Language Pathology: Organization and Service Delivery made to caregivers The SLP should make it plain to caregivers that diagnosis is an ongoing process and that, as the student changes and progresses, the assessment of his or her condition will change Speech-language pathologists should avoid labels as much as possible when talking with family If labels have to be used, it should be made clear to family that the terms are merely words for explaining the communication disorder The Placement Team’s Purpose The ultimate result of the placement meeting is to develop an IEP, IFSP, or ITP for the child, and to achieve agreement for that plan by the parents and professionals The plan must be a written document, prepared and distributed according to the policies of the state and local education agencies Policies also regulate who shall have access to the report and how copies shall be made available A copy of the report is made available to the parents All placement team members sign the report In most cases, the speech-language pathologist is a member of the team if the child displays communication difficulties If the clinician is not on the team (an unlikely, but not impossible, situation), a copy of the document should be made available Ethics and Responsibilities Selection of testing procedures and, ultimately, of those students who will or will not receive services in our programs should be guided by professional ethics and standards of practice For example, if during the testing session with a child another area of testing is identified, it is the SLP’s responsibility to refer that child for services by the appropriate professional This may mean a medical referral for a physical condition observed, referral from the school psychologist for a learning disability detected, or referral from the guidance counselor for a suspected emotional or social problem This necessitates looking at the “whole child,” not just the speech and language behaviors displayed Children are complex human beings We cannot diagnose or treat them in isolation We must report the total picture that we observe when we create our description of the child’s behaviors and needs Discussion Questions and Projects Observe a classroom in action using the Classroom Observation Guide The third-grade teacher refers “problem readers,” as well as students who have articulation problems How would you handle this situation? How would you invite self-referrals on the high school level? Compose a memorandum to the teachers of Pierside Elementary School in which you explain the procedures of the speech-language referral system you will be conducting there 7. Establishing the Workload and Caseload Interview a school-based SLP to find out what procedures are used to identify, select, and prioritize students for the speech-language caseload Survey several SLPs in the schools to find out how they identify students who may have a hearing loss Find out how preschool children with communication disorders are identified in your area Using the Communication Severity Scale, determine the level of severity of two of the students on your caseload Develop a library of examples of speech and language disorders 10 Develop a list of materials that can be incorporated into a presentation to parents and/or teachers 205 ... Inventory Records 96 96 99 10 0 10 0 10 1 10 2 10 2 10 4 10 4 10 6 10 6 10 7 11 2 11 2 11 3 11 3 11 3 11 4 11 5 11 6 11 6 11 8 Contents vii Accountability, Documentation, and Outcomes 12 1 Documenting and Reporting... Management Plan 12 2 12 3 12 5 12 6 13 2 13 3 13 3 13 4 Establishing the Workload and Caseload 14 7 13 4 13 5 13 7 14 0 14 2 14 2 14 3 A Philosophy: The Basis on Which to Build the SLP Workload and Caseload 14 8 The... in 19 26 to 330 in 19 40, to 1, 623 in 19 50, and again to 6,249 in 19 60 In 19 64, the “associate” category was eliminated and there were 11 ,703 members By 19 75, the membership had climbed to 21, 435,