Voice



TABLE OF CONTENTS

Eligibility Criteria For Speech/Language Impaired Services…………………………………………3

Introduction……………………………………………………………………………………….3

Role and Responsibility of the Speech Language Pathologist……………………………………3

Students Suspected of Having a Speech and Language Impairment: The Identification Process….4

Referrals for a Speech and Language Only Case Study Evaluation……………………………...4

The Assessment Process………………………………………………………………………………….4

Procedures for Speech and Language Evaluations……………………………………………….4

Evaluation…………………………………………………………………………………………4

Eligibility Determination………………………………………………………………………….4

Impartial Due Process Hearing……………………………………………………………………5

Other Factors to Consider When Determining Eligibility………………………………………...5

The Speech and Language Evaluation……………………………………………………………6

Severity Rating Guidelines………………………………………………………………………..6

Special Considerations for ESL students…………………………………………………………7

Articulation……………………………………………………………………………………………….8

Articulation and Phonology Eligibility……………………………………………………………8

Articulation and Phonology Matrix………………………………………………………………..9

Developmental Ages to Phoneme Mastery……………………………………………………….10

Poole Norms……………………………………………………………………………...10

Articulation and Phonology Assessment Instruments Commonly used at HBGSD……..10

Language………………………………………………………………………………………………….11

Pragmatics………………………………………………………………………………………...11

Language Eligibility Matrix………………………………………………………………………12

Language Assessments Commonly used at HBGSD……………………………………………..13

Fluency……………………………………………………………………………………………………13

Fluency Matrix……………………………………………………………………………………14

Continuum of Dysfluent Speech Behavior……………………………………………………….15

Voice………………………………………………………………………………………………………16

Voice Matrix……………………………………………………………………………………...16

Speech and Language Eligibility Criteria/Matrix……………………………………………………..17

Exit Criteria………………………………………………………………………………………………18

Service Delivery Models…………………………………………………………………………………19

Monitor…………………………………………………………………………………………...19

Integrated Services……………………………………………………………………………….19

Collaborative Consultation……………………………………………………………………….20

Traditional Pull Out………………………………………………………………………………20

Instructional Services (Language Intensive)……………………………………………………..20

References………………………………………………………………………………………………...21

Appendices………………………………………………………………………………………………22+

Cognitive Considerations………………………………………………………………………….A

Request for Speech and Language Screening…………………….……………………………….B

English as a Second Language – Parent Input Form………………………………………………C

Eligibility Criteria for Speech/Language Impaired Services

The following guidelines have been developed for determining eligibility for Speech and Language services within the Harrisburg School District. Significant portions of the document closely align with the State of Pennsylvania Department of Education and the recommendations stated by the American Speech/Language/Hearing Association (ASHA).

Introduction

Eligibility for special education and related services in the area of Speech and Language Impairment is determined through the IEP process beginning with Speech/Language screening or CAAST referral program.

Determining the existence of a speech and language impairment is the first step in determination of eligibility for special education under the eligibility of Speech/Language impaired. Subsequent to identifying impairment, the adverse impact of the disability on the student’s educational performance and the need for special education and related services must be documented.

It is very important to note that, although this document provides guidelines, specific circumstances affecting a particular student must be taken into consideration. Cultural influences or differences and the primary language of the student must be taken into account prior to test selection and evaluation. Clinical judgement may necessitate modification of these guidelines.

The guidelines described here are designed for a school population 3-21 years of age. All evaluation and interview data must be considered when determining the extent to which these children are adversely affected within their communication setting and the impact of future educational performance. Communicatively impaired children could be at risk for future academic failure without appropriate intervention and, therefore, may be eligible for speech and language services. These students are service through the continuum of service delivery models outlined later in this document.

Role and Responsibility of the Speech Language Pathologist

Speech/Language Pathologists currently trained to work in school programs may be made available as:

• Special education related services

• Special education resource programs

• Special education instructional programs

The scope of practice of the speech/language pathologist includes, but is not limited to:

1. Identification and evaluation of students with speech/language impairments

2. Participation in the determination of eligibility for special education and related services in the area of speech and language impairment

3. Participation in teacher and parent conferences including multidisciplinary conferences, IEP meetings, and annual reviews

4. Development and implementation of IEPs for all students eligible for special education and related services in the area of speech and language impairment

5. Provision of inservice programs to parents, teachers, students, administrators, and other professionals

6. Completion of required documentation and reports

7. Participation of child study and teacher assistance teams

8. Facilitation of curriculum and instructional modifications

9. Supervision of support personnel/CFY’s

10. Participation in continuing professional education

STUDENTS SUSPECTED OF HAVING A SPEECH AND LANGUAGE IMPAIRMENT: THE IDENTIFICATION PROCESS

A student may be identified as eligible to receive a special education evaluation to determine if he/she has a speech and language impairment through teacher or school-based referral; parent, self or other agency referral; or group screening. The school district must publicize its referral procedures.

Referrals for a Speech and Language Only Case Study Evaluation

It is important to document referrals by completing a referral packet (appendix D)

• The date of referral

• The referring agent

• The determination of the student’s language use pattern and cultural background (this is made by determining the language(s) spoken in the student’s home and the language(s) used most comfortably and frequently by the student);

• The determination of the student’s mode of communication (this is made by assessing the extent to which the student uses expressive language and the use he or she makes of other modes of communication as a substitute for expressive language).

In addition, it is important to note that the date of the decision to refer a student is the actual referral date. This date begins the 60-school-day timeline during which the IEP process (referral, evaluation, and placement) must be completed.

After a referral has been initiated, the review team determines whether the referral is appropriate (i.e., whether of not to conduct an assessment). Parental consent must be obtained for an individual screening. Parental consent is not necessary when the speech-language pathologist does not have direct individual contact with the student (i.e., observations, teacher interviews, record reviews, and student interviews).

The building team decides whether of not the assessment is warranted and the parent receives written notice of this decision. If an assessment is warranted, the IEP team confers and agrees on what types of assessments are necessary. The parent or legal guardian must sign consent for the designated evaluations to be completed. A copy of the “Explanation of Procedural Safeguards for Parents of Students with Disabilities” must be explained and provided to the parent at that time.

THE ASSESSMENT PROCESS

Procedures for Speech and Language Evaluations

Federal and state regulations require that the eligibility determination be multidisciplinary. This necessitates the involvement of at least three professional disciplines in determining eligibility. It also requires that the IEP and placement decisions be determined that speech testing is the only domain requiring assessment; the Speech-Language Pathologist becomes the facilitator for the assessment process.

The assessment should include vision and hearing screening completed within the last 6 months, as well as the other components identified by the team.

Evaluation

After parental consent has been obtained, the Speech-Language Pathologist is responsible for assuring necessary evaluations are completed:

Eligibility Determination

After the evaluation components are completed, the Speech-Language Pathologist sends home the invitation for the parent to attend a meeting to discuss the results of the testing. This form invites the parent to the conference which will be held to review their child’s case study and determine eligibility for special education and related services. This form must be sent to the parents at least ten calendar days before the conference. It must contain information regarding where the conference will be held, the purpose of the meeting, who will be invited to attend the meeting, and who should be contacted for more information. Individuals who are required to participate in the conference include a local education agency (LEA) representative, a regular education teacher, and those who have conducted assessments with the student.

During the conference, the conference team members interpret evaluation data and make an eligibility determination. The team must arrive at a consensus regarding the student’s eligibility for special education and related services. According to IDEA 1997 regulations, a student is eligible for special education and related services only when it is determined that a disability exists, that the disability has an adverse effect on the student’s educational performance and that the need for specialized services to address the adverse effect(s) is present and documented.

For example, speech and language impairments may affect the student’s educational performance in the classroom and with peers. Articulation and fluency disorders may create negative self-esteem that inhibits a student’s performance in the classroom. Students with language disorders lack a strong language base that is the foundation necessary for learning to occur within the academic curriculum. They often lack proficiency I language arts that is central to the curriculum across all grade levels. These factors frequently mask the true ability level and actual proficiency of the student and can limit participation in the classroom exchanges and discussions.

On the other hand, a student may have an articulation, fluency, or language disorder that does not create negative self-esteem, does not receive negative reactions to the disorder from the student and/or other students and does not inhibit the student’s performance in the classroom. In this case, the disorder does not interfere with the student’s ability to benefit from education. Therefore, no adverse effect on the student’s educational performance can be documented, and the student is not eligible for special education and related services.

If, according to IDEA 1997, a student is determined eligible for special education and related services, an IEP must be developed for the child. It must be noted that the educational placement decision is made after the entire IEP is developed.

Individuals who are required to participate in the IEP meeting include and LEA representative, the child’s teacher and, for initial placement, a person knowledgeable about the evaluation procedures utilized in this assessment and the results. If the parent(s) does not attend the meeting, documentation of three attempt to arrange a mutually agreed upon time and place for the meeting needs to be in the child’s temporary record.

Impartial Due Process Hearing

A parent or a school district may initiate a Level 1 due process hearing regarding the district’s proposal or refusal to initiate or change the identification, evaluation, or educational placement of the student or the provision of a free, appropriate public education to the student.

Other Factors to Consider When Determining Eligibility

Several other factors need to be taken into account along with the state-recommended eligibility criteria when determining eligibility for special education and related services in the area of speech and language impairment. A student may be found not eligible for special education and related services in the area of speech and language impaired if his/her language functioning is commensurate with overall cognitive ability. Guidelines outlining procedures for determining if language scores are commensurate with cognitive potential can be found in the Appendix under “Cognitive Considerations”.

This statement reflects the cognitive hypothesis, which claims that cognition is a prerequisite for language development, and therefore language depends upon and cannot develop beyond a student’s underlying cognitive limits (Casby, 1992). Many speech-language pathologists recognize that there is a relationship between cognition and language; however, these professionals do not uphold the idea that language cannot develop beyond a student’s underlying cognitive limits. They believe factors other than cognition can influence language development, and development in cognition (Casby, 1992). Therefore, these professionals recommend that, in addition to standardized testing result, the assessment team consider the following questions when determining eligibility for special education and related services in the area of speech and language impairment:

• Do the student’s communication skills meet his/her needs in current environments (i.e., if the student communicated better, would it make a significant difference)?

• Would working with this student significantly change his/her ability to communicate?

Other factors to consider when determining speech eligibility (i.e., existing disability, adverse effect and the need for specialized services) include:

1. Does the identified speech and language impairment interfere with the student’s educational, social, or emotional progress so as to consider it a disabling condition?

2. Is the student’s level of language functional for his/her adaptive behavior?

3. Does physiology or structural abnormality interfere with progress (unrepaired cleft palate, enlarged adenoids, or orthodontia)?

4. Has the child attended school consistently to gain appropriate knowledge and foundational skills to determine a disability?

The Speech and Language Evaluation

The purpose of the speech and language evaluation is to determine the degree and extent of oral language usage, receptively and expressively, and language processing abilities. Those areas of language competencies examined need to include rhythm (or fluency), articulation, and language.

Language is the ability to use the symbols of language through proper use and understanding of words and meanings (semantics), appropriate grammatical patterns (syntax), and correct usage and understanding of meaningful word markers or elements (morphology). Areas usually assessed are receptive and expressive language pragmatics.

Articulation is the accuracy and precision of speech sound selection and usage and the rules that govern their production (phonology). An oral peripheral examination is completed on each child presenting with articulation errors to rule out abnormality, weakness and malfunction as contributors to errors.

Rhythm or Fluency is the flow of speech. It covers breaks or interruptions, repetitions, or prolongations in that flow. Usually the number and type of dysfluencies are quantified based on conversational samples obtained under a variety of circumstances.

*Cultural influences, differences, and the primary language of the student must be taken into account prior to test selection and evaluation.

Severity Rating Guidelines

A severity rating helps to determine the scope of intervention required to meet the needs of students with speech and language impairments who are eligible for special education and related services. Speech and language assessment data, case study conclusions, and criteria on the Eligibility Criteria Matrix should be utilized to determine the severity of the impairment. No attempt should be made to determine severity based on the eligibility matrix until the appropriate team develops an IEP and placement is subsequently determined. The IEP must be the foundation for the placement determination, not a severity rating.

The severity rating are divided into four categories – mild, moderate, severe, and extreme – each of which is given a point value on the basis of standardized test results, observations, and clinical judgments. The amount of speech and language service a student receives may be proportional to the severity of his/her impairment and is in relation to the nature of the intervention model (s) and the goals and objectives determined by the IEP conference participants.

It is understood that students frequently exhibit multiple types of speech and language impairment. In these situations, the speech-language pathologist may need to modify the amount of and the options for service delivery. For example, the service delivery models for a language and articulation impaired student may be a combination of integrative and pull-out.

The following severity classifications apply to all disorder areas:

MILD: Impairment minimally affects the individual’s ability to communicate in school learning and/or social situations as noted by at least one other family member such as, teacher, parent, sibling, or peer.

MODERATE: 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.

SEVERE: Impairment limits the individual’s ability to communicate appropriately in school and/or social situations. Environmental and/or student concern is evident and documented.

PROFOUND: Impairment prevents the individual from communicating appropriately in school and/or social situations.

This severity rating scales takes into account many viable service delivery models and is not intended to be used solely with the traditional group and individual options. Times listed reflect direct service, but not necessarily a pull-out model. A range of service delivery options should be utilized with these severity and time guidelines.

Special Considerations for English as a Second Language Students (ESL)

Students who speak a language other than English may be eligible for speech/language services. The main goal to consider when evaluating these children is to differentiate a language difference from a language disorder. A language difference is an expected variation in syntax, morphology, phonlogy, semantics and pragmatics when an individual is acquiring another language. In this case, decreased language skills may be the result of experience rather than ability. A language disorder occurs when the child’s ability to learn a language is disordered. It is imperative that SLPs understand the normal processes and phenomena of second-language acquisition to avoid making "false positive" identifications. ELL students will usually not be commensurate with their average native English speaker. ELL students must outgain the native speaker by making 1.5 year's progress in English for six successive school years. Thus, in order to have skills that are commensurate with those of native English speakers, ELLs must make nine years progress in six years.

When evaluating ESL children for language disorders, the following factors are considered:

1. A detailed language history from the parent(s) (See appendix C).

2. The use of language in the classroom (basic intrapersonal communication skills vs. cognitive academic language proficiency)

3. The child’s rate of learning

4. Formal evaluations normalized on ESL students (SPELT-II Spanish version, EOWPVT/ROWPVT administered in English and the native language)

5. Informal observations/conversational samples

6. Teacher questionnaire/input

7. Dynamic Assessments (test-teach-re-test)

Articulation/Phonology Eligibility

The student with an articulation/phonological impairment is unable to produce sounds correctly in conversational speech. This impairment is typically characterized by the omission, distortion, substitution, addition, and/or inaccurate sequencing of speech sounds. Errors are not related to cultural or dialectical differences.

A student is not eligible for special education related services in the area of speech and language (articulation/phonological) impairment when:

1. Sound errors are consistent with developmental age or are within normal articulation development

2. Articulation differences are due primarily to unfamiliarity with the English language, dialectical differences, temporary physical disabilities or environmental, cultural, or economic factors.

3. The articulation errors do not interfere with the student’s ability to benefit from education.

At times referrals may be made from physicians or dentists regarding tongue thrust or reverse swallow in students. Tongue thrust is not an articulation disorder in itself, although is often found in tandem with interdentalization of /s/ and /z/, and may result in interference with other speech sounds. Therefore, the speech therapist in the school setting does not specifically enroll students to eliminate tongue thrust or correct deviant swallow patterns what do not interfere with nutrition, but may enroll this student if the resulting articulation disorder meets the eligibility criteria. No goals should specifically address the swallow, but rather only the articulation disorder.

Some students may demonstrate significant swallowing disorders including developmentally delayed or disordered patterns or loss of swallowing function due to brain injury or other circumstances. The decision to enroll a child for swallowing therapy should be made by all parties including the caregivers, teachers, school nurse, and occupational therapist as well as the speech pathologist. A feeding evaluation, feeding plan, and therapy plan may be established, if appropriate.

Students may be candidates for augmentative communication if, after a significant period of intervention, it is determined that the student lacks the appropriate modality to communicate expressively. If an evaluation appears appropriate, the child’s IEP team will need to have a meeting to document the need for the augmentative communication evaluation and any other

Articulation/Phonology Matrix

|Severity Rating |Behavioral Descriptions | Recommended Minimum |

| | |Service Minutes Per Week |

|No Problems |No errors |No eligibility |

|Minimal |Student exhibits developmentally appropriate |Rescreen when appropriate |

| |speech skills in the therapy room setting, but |. |

| |may require monitoring for successful | |

| |generalization of skills | |

|Mild |Speech is generally intelligible; prior |Rescreen when appropriate |

| |intervention has eliminated all but | |

| |developmental sound errors for which the | |

| |student is not yet stimulable. Intelligible | |

| |over 80% of the time in connected speech. | |

|Moderate |Intelligible 50-80% of the time in connected |2x per cycle |

| |speech. Substitutions, distortions and some | |

| |omissions may be present. There is limited | |

| |stimulability for the error | |

| |phonemes. | |

|Severe |Intelligible 20-49% of the time in connected |2-3x per cycle |

| |speech. Deviation may range from extensive | |

| |substitutions and many omissions to extensive | |

| |omissions. A limited number of phoneme classes| |

| |are evidenced in a speech-language sample. | |

| |Consonant sequencing is generally lacking. | |

| | | |

| |Augmentative communication system may be | |

| |warranted | |

|Profound |Speech is unintelligible without gestures and |3-4x per cycle |

| |cues and/or knowledge of the context. Usually | |

| |there are | |

| |additional pathological or | |

| |physiological problems such as neuro-motor | |

| |deficits or structural deviations. | |

| |Augmentative Communication Systems may be | |

| |warranted. | |

Developmental Ages to Phoneme Mastery

AGE SOUND

3 p,m,h,n,w

4 b,k,g,d,y

5 f

6 t,ng,l

7 ch,sh,j,th, and l blends

8 r,s,z,v, r blends

Articulation/Phonology Measurement Instruments Commonly Used

AAPS Arizona Articulation Proficiency Scale

CAAP Clinical Assessment of Articulation and Phonology

TOLD Test of Language Development – 3 (articulation subtest portion)

In the event the student fails to comply with therapy expectations as documented by the clinician, the child may be dismissed after one marking period. The re-evaluation process can be initiated at any time thereafter if/when the child shows willingness to comply with therapy.

Language

The student with a language demonstrates impairment and/or deviant developmental of comprehension and/or use of a spoken symbol system. This may include:

1. Language form- the portion of language that refers to the utterances/sentence structure if what is said (phonology, morphology, syntax)

2. Language content- the portion of language that refers to meaning of words and sentences including abstract concepts of language (semantics).

3. Language use- the context in which language can be used and the purpose of communication (pragmatics).

Individuals with pragmatic problems demonstrate difficulty in communicating effectively although form ands contact may be intact.

In some situations, severity of the disabling condition caused by language impairment may need to be determined by factors other than standardized tests. In these cases, eligibility and severity would need to be determined by the impact of the language impairment on the student’s communicative, academic, and social competence, thereby adversely impacting educational performance. Clinical observations, language samples, and consultation with other school personnel are important components in determining eligibility of language impaired students (Casby, 1992).

Pragmatics

Speech-language pathologists take into consideration the student’s use of pragmatics along with other case study assessment information obtained to determine eligibility of services.

Pragmatics includes:

1. The ability to use verbal labels to name objects, actions, attributes appropriately.

2. The ability to use language to request objects or information or to fulfill needs.

3. The ability to use language to relate previous incidents.

4. The ability to use language to relate original ideas.

5. The ability to use language to express emotions and needs.

6. Adherence to the basic rules of conversation, including imitating, turn taking and staying on topic.

7. Adherence of the social rules of conversation such as maintenance of personal space, eye contact, posture, and volume.

8. The ability to determine listener’s reception and interpretations.

9. The ability to react to various speech settings appropriately.

10. The ability to understand and react appropriately to idioms, figures of speech, inferences, and humor.

A student is not eligible for special education and related services in the area of speech and language impairment when:

1. Language and differences are primarily due to environmental, cultural, or economic factors including non-standard English and regional dialect.

2. Language performance does not interfere with the student’s ability to benefit from education.

It is very important to note that the criteria should be interpreted as guidelines and may vary with specific circumstances affecting a particular student.

Language Eligibility Matrix

Minimum Recommended

Severity Criteria Service Minutes per Week

Mild The student demonstrates a deficit in SLP/teacher

receptive, expressive or pragmatic language collaboration

as measured by two or more diagnostic

procedures/standardized tests. Performance

falls from 1-1.5 standard deviations below

the mean standard score, generally standard

scores between 85-78

Moderate The student demonstrates a deficit in receptive, 1-2x per cycle

expressive or pragmatic language as measured by

two or more diagnostic procedures/standardized tests.

Performance falls from 1.5-2.0 standard deviations below

the mean standard score, generally standard

scores between 78-70.

Severe The student demonstrates a deficit in 2x per cycle

receptive, expressive or pragmatic language

as measured by two or more diagnostic

procedures/standardized tests (if standardized

tests can be administered). Performance

falls from 2.0-2.5 standard deviations below

the mean standard score, generally standard

scores between 70-62.

Augmentative communication systems

may be warranted.

Profound The student demonstrates a deficit in receptive, 3x per cycle

expressive, or pragmatic language which prevents

appropriate communication in school and/or social

situations. Performance on standardized tests

(if standardized tests can be administered) is greater than

than 2.5 standard deviation below the mean standard

score, generally standard scores are below 62.

Augmentative communication systems

may be warranted.

The above listed frequencies are contingent when speech is the primary service, assuming a “normal range” IQ. Frequency of service may be decreased if speech and language is a related service and/or cognitive testing indicates language performance is commensurate with ability level.

LANGUAGE MEASUREMENTS COMMONLY USED

Clinical Evaluation of Language Fundamentals--Preschool (CELF-PS)

Clinical Evaluation of Language Fundamentals—third edition (CELF-3)

Expressive One-Word Picture Vocabulary Test-Revised (EOWPVT-R)

Kindergarten Language Screening Test (KLST)

Language Processing Test (LPT)

Oral and Written Language Scales (OWLS)

Peabody Picture Vocabulary Test-Revised (PPVT-R)

Preschool Language Scales (PLS)

Phonemic Awareness Test (PAT)

Receptive One-Word Picture Vocabulary Test-Revised (ROWPVT-R)

Structured Photographic Expressive Language Test--second edition (SPELT-2)

Test for Auditory Comprehension of Language-Revised (TACL-R)

Test of Language Development-Intermediate (TOLD-1)

Test of Language Development-Primary (TOLD-P)

Test of Pragmatic Language (TOPL)

Test of Problem-Solving (TOPS)

Test of Word Finding

The Listening Test

The HELP Test

FLUENCY

A fluency impairment is defined as the abnormal flow of verbal expression. It is characterized by impaired rate and rhythm of connected speech and may be accompanied by struggle behavior.

Consideration must be given to the student’s chronological age and perception of the problem by the student and parents, the contextual situations in which the student functions, and the overall impact on educational performance.

A student is not eligible for special education and related services in the area of speech and language fluency when disfluencies:

• are part of normal speech development

• do not cause the speaker to modify behavior

• do not interfere with the student’s ability to benefit from education

A tape-recorded sample with a minimum of 250 syllables from 2 different situations (reading, monologue or connected speech) is recommended to determine eligibility and severity. The sample should be taken from a variety of circumstances and/or settings.

Fluency Matrix

|Severity |Behavioral Description |Recommended Minimum Service Minutes per week |

|Mild |1-40% disfluent within a speech sample of at |Recommended consultative services to |

| |least 250 syllables. No tension to minimum |teacher(s). |

| |tension | |

| | | |

| |Rate and/or prosody: Minimal interference with| |

| |communication | |

|Moderate |41-77% disfluent within a speech sample of at |2X per cycle |

| |least 250 syllables. Noticeable tension and/or| |

| |secondary characteristics are present | |

| | | |

| |Rate and/or prosody: Limits communication. | |

|Severe |78-95% disfluent within a speech sample of at |2X per cycle |

| |least 250 syllables. Excessive tension and/or | |

| |secondary characteristics are present. | |

| | | |

| |Rate and/or prosody: Interferes with | |

| |communication | |

|Profound |96-99% disfluent within a speech sample of at |3-4X per cycle |

| |least 250 syllables. Excessive tension and/or | |

| |secondary characteristics are present. | |

| | | |

| |Rate and/or prosody: Prevents communication. | |

Continuum of Disfluent Speech Behavior

More Usual Typical Disfluencies

Hesitations (silent pauses)

Interjections of sounds, syllables or words

Revisions of phrases or sentences

Phrase Repetitions

One syllable word repetitions

Two or fewer repetitions per instance,

Even stress, no tension

Part word syllable repetitions

Two or fewer repetitions per instance

Even stress, no tension

Stuttering

Atypical Disfluencies

One syllable word repetitions

Three or more repetitions per

instance or uneven stress.

Part word syllable repetitions. Three or more repetitions per instance or uneven stress

Sound Repetitions

Prolongations

Blocks

Increased tension noted

(tremor of lips or jaw or vocal tension)

More Unusual

Developed by

Hugo Gregory, Ph.D., Professor

June Campbell, M.A., Clinical Supervisor

Diane Hill, M.A., Clinical Supervisor

Northwestern University

Department of Communication Sciences and Disorders

Voice

A voice impairment is defined as any deviation in pitch, intensity, quality, or other attribute which consistently interferes with communication; draws unfavorable attention; adversely affects the speaker or the listener; or is inappropriate to the age, sex or culture of the individual. Voice quality may be affected by either organic or functional factors.

Consideration must be given to age, sex, environment, and perception of the problem by the student, parents, speech-language clinician, and other school personnel or medical specialists.

A student is not eligible for special education and related services in the area of speech and language (voice) impairment when vocal characteristics:

1. Are the result of temporary physical factors such as allergies, colds, abnormal tonsils or adenoids, short-term vocal abuse or misuse

2. Are the result of regional, dialectic or cultural differences.

3. Do not interfere with the student’s ability to benefit from education

A tape-recorded speech sample of a minimum of 100 words of connected speech is recommended to determine eligibility and severity.

Voice Matrix

|Severity |Behavioral Description |Recommended Minimum service minutes per |

| | |week |

|Mild |Voice difference including hoarseness, nasality, denasality, pitch or |Based on Prescription from physician |

| |intensity inappropriate for the students’ age; disorder is of minimal | |

| |concern to parent, teacher student or physician. | |

| |Medical referral is required | |

|Moderate |Voice difference is of concern to parent, teacher, student or |Based on Prescription from physician |

| |physician. Voice is not appropriate for age and sex of student. | |

| |Medical referral is required | |

|Severe |Voice difference is of concern to parent, teacher, student or |Based on Prescription from physician |

| |physician. Voice is distinctly abnormal for age and sex of the | |

| |student. | |

| |Medical referral is required | |

|Extreme |Speech is largely unintelligible due to aphonia or severe |Based on Prescription from physician |

| |hypernasality. Extreme effort is apparent in production of speech. | |

| |Medical referral is required | |

Speech-Language Eligibility Criteria/Matrix

CLINICAL JUDGEMENT MAY NECESSITATE MODIFICATION OF THESE GUIDELINES

| |Mild |Moderate |

|Severity of disorder |Impairment minimally affects the individual’s |Impairment interferes with the individual’s |

| |ability to communicate in school learning |ability to communicate in school learning |

| |and/or other social situations as noted by at |and/or other social situation as noted by at |

| |least one other familiar listener, such as |least one other familiar listener |

| |teacher, parent, or sibling | |

|Articulation/Phonology |Intelligible over 80% of the time in connected |Intelligible 50-80% of the time in connected |

| |speech |speech. |

| | | |

| |No more than 2 speech sound errors outside the |Substituitions and distortions and some |

| |developmental guidelines. Students may be |omissions may be present. There is limited |

| |stimulable for error sounds |stimulability for error phonemes. |

|Language |The student demonstrates a deficit in |The student demonstrates a deficit in |

| |receptive, expressive or pragmatic language as |receptive, expressive or pragmatic language as |

| |measured by two or more diagnostic |measured by two or more diagnostic |

| |procedures/standardized tests. Performance |procedures/standardized tests. Performance |

| |falls from 1 to 1.5 standard deviations below |falls from 1.5-2.0 standard deviations below |

| |the mean standard score. Generally standard |the mean standard score. Generally, standard |

| |scores are between 85-78. |scores are between 78-70. |

|Fluency |1-40% disfluent within a speech sample of at |41-77% disfluent within a speech sample of at |

| |least 250 syllables. No tension to minimum |least 250 syllables. Noticeable tension and/or|

| |tension |secondary characteristics are present |

| | | |

| |Rate and/or prosody: Minimal interference with|Rate and/or prosody: Limits communication. |

| |communication | |

|Voice |Voice difference including hoarseness, |Voice difference is of concern to parent, |

| |nasality, denasality, pitch or intensity |teacher, student or physician. Voice is not |

| |inappropriate for the students’ age; disorder |appropriate for age and sex of student. |

| |is of minimal concern to parent, teacher |Medical referral is required |

| |student or physician. | |

| |Medical referral is required | |

Speech-Language Eligibility Criteria/Matrix, Cont.

CLINICAL JUDGEMENT MAY NECESSITATE MODIFICATION OF THESE GUIDELINES

|Severe |Profound |

|Impairment limits the individual’s ability to communicate |Impairment prevents the individual from communication |

|appropriately and respond in school learning and/or social |appropriately in school and/or social situations |

|situation. Environmental and/or student concern is evident and | |

|documented. | |

|Intelligible 20-49% of the time in connected speech. Deviation |Speech is unintelligible without gestures and cues and/or |

|may range from extensive substitutions and many omissions to |knowledge of the context. Usually there are additional |

|extensive omissions. A limited number of phoneme classes are |pathological or physiological problems, such as neuromotor |

|evidence in a speech-language sample. Consonant sequencing is |deficits or structure deviations. |

|generally lacking. | |

| |Augmentative communications system may be warranted |

|Augmentative communication system may be warranted | |

|The student demonstrates a deficit in receptive, expressive or |The student demonstrates a deficit in receptive, expressive or |

|pragmatic language as measured by two or more diagnostic |pragmatic language that prevents communication in the school |

|procedures/standardized tests (if standardized tests can be |and/or social situations. With measure performance (if |

|administered). Performance is between 2.0-2.5 standard |standardized tests can be given) falling greater than 2.5 |

|deviations below the mean standard score. Augmentative |standard deviations below the mean standard score. Augmentative |

|communication systems may be warranted. |communication systems may be warranted. |

|78-95% disfluent within a speech sample of at least 250 |More than 96-99% disfluent within a speech sample of at least 150|

|syllables. Excessive tension and/or secondary characteristics |syllables. Excessive tension and/or secondary characteristics. |

|are present. |Rate and/or prosody prevent communication. |

|Rate and/or prosody interferes with communication | |

|Voice difference is of concern to parent, teacher, student or |Speech is largely unintelligible due to aphonia or severe |

|physician. Voice is distinctly abnormal for age and sex of the |hypernasality. Extreme effort is apparent in production of |

|student. |speech. |

|Medical order is required. |Medical order is required. |

Exit Criteria

(Eligibility vs. Non-eligibility)

Exit decisions must be individualized, based on developmental norms and the current best practices, as determined by the IEP team. A student is no longer eligible for special education services and related services for speech/language support when it is determined that:

1. The need for specialized services to address the adverse effect(s) on educational performance is no longer present.

2. The impairment no longer has an adverse effect on the student’s educational performance.

3. The impairment no longer exists.

4. The student is not motivated to attend to and/or participate in speech-language services (this must be documented).

5. Further improvement is precluded by interference of physiological factors.

6. Maximum gains have been achieved from therapeutic intervention as evidenced by lack of further progress.

7. The student’s speech/language scores are commensurate with ability and one or more of the above are also true.

The determination of eligibility or non-eligibility is made at the IEP meeting on the basis of the data collected or other available assessment information.

Service Delivery Models

Students who have been identified as speech and language impaired have traditionally been serviced through a pull-out model. There are numerous reasons for the speech-language pathologist to consider alternative service delivery models, including:

• To provide a range of services appropriate to the needs of each student

• To provide a more natural communication environment

• To promote generalization from the therapy environment to other communication settings

• To provide an opportunity for interprofessional training

• To provide an opportunity for peer modeling and reinforcement

• To more effectively integrate the student’s communicative goals into the educational program

• To provide for a better understanding of overall student achievement

• To provide for more teacher involvement in specific communication skills development; and

• To reinforce and supplement clinical activities.

These issues, the necessity for a multidisciplinary approach and the least restrictive environment, have made it necessary to investigate alternate service delivery models.

Monitor

IEP’s are developed for students in this group. A student who has not exhibited carryover or generalization of skills may benefit from this service delivery option. This model is structure to provide feedback in the classroom for the teacher, consultation between the teacher and the speech-language clinician and/or intermittent intervention with the clinician.

This model achieves these goals:

1. To establish carryover of therapy gains to the instructional setting,

2. To provide feedback to the student from peers and other adults,

3. To enhance generalization of skills acquired.

Integrated Services

In an integrated service delivery model, the speech-language clinician provides direct services to students with speech and language impairments across educational activities/settings in cooperation with other education professionals. This model addresses one of the most consistent problems when providing therapeutic services, carryover or generalizations of skills. In order to facilitate the student’s use of emerging or acquired speech and/or language skills, the speech-language clinician works with the student in a variety of settings; classrooms, community, and/or social. By working with the various service deliverers (teacher, occupational therapist, physical therapist, etc) in multiple educational environments, the speech-language pathologist maximizes opportunities for the student to achieve the stated goals on the individualized educationa l program (IEP). The ability to provide ongoing assessment, to modify therapeutic techniques, to teacher strategies and to relay feedback to the student are enhanced when the speech-language pathologist can observe, treat, and gather data in multiple settings with the input of additional professionals. This model is also referred to as the transdiciplinary or multidisciplinary team approach.

This model achieves these goals:

1. To provide therapy in a natural setting

2. To involve the classroom teacher and other education professionals in the therapeutic process (knowledge and skills are shared between the speech-language clinician, the classroom teacher and other educational professionals);

3. To promote the generalization of skills

Collaborative Consultation

According to Idol, Paolucci-Whitcomb and Nevin (1986), “Collaborative consultation is an interactive process that enables people with diverse expertise to generate creative solutions to mutually defined problems. The outcome is enhanced, altered, and produces solutions that are different from those that the individual team members would produce independently. The major outcome of collaborative consultation is to provide comprehensive and effective programs for students with special needs within the most appropriate context, thereby enabling them to achieve maximum constructive interaction with their non-disabled peers. Collaborative consultation is a viable service delivery model using the classroom as a more natural environment and giving communication development more meaningful contexts.”

This model achieves these goals:

The speech-language pathologist functions as a consultant to:

1. Demonstrate teaching of alternative instructional approaches

2. Co-teach lessons based on the learning styles of students

3. Instruct groups for the purpose of re-teaching abstract course materials

4. Provide direct student skill instruction and material based on curricular content development in conjunction with the classroom teacher

5. Adapt instructional materials based on classroom teacher-defined curricular objectives

6. Recommend and provide supplemental materials to reinforce and explain course content

7. Prepare and/or adapt test materials specific to needs to students

8. Observe and/or chart behavior and performance of students with disabilities

9. Facilitate socialization goals

10. Make recommendations to regular/special instructional staff regarding instruction of students with disabilities based on observations

11. Communicate with education staff and parents regarding progress

12. Provide ongoing inserivce to parents and teacher on special education techniques.

Traditional (Pull out Model)

The traditional model has been the most frequently utilized service delivery model in the area of speech and language impairment. By utilizing this model, students with all types of impairments and varying degrees of severity are treated by a speech-language clinician in the following manner: students are seen individually, or in small groups, during specified blocks of time through the school day in a room specifically designed for this purpose. The traditional service delivery model can be used in combination with other therapy models.

This model achieves these goals:

1. To provide therapy in an intensive manner without intrusions or distractions to the student

2. To teach new skills

Instructional Services (Language Intensive Services)

Students whose primary disability is speech and language and whose needs are so great that they cannot be achieved satisfactorily in regular classes with the use of appropriate supplementary aids and services have the options of being placed in an instructional (self-contained) special education class for students with speech and language impairments. The following should be considered when determining a student’s placement in this program:

1. Documentation of a severe speech and language delay/impairment, academic delays social/emotional delays, and average cognitive potential.

2. Documentation of academic failure, low motivation, high frustration, and poor self-image and interpersonal relationships

3. Documentation that previous educational programming made little impact and progress was virtually at a standstill.

If placement is to be made in a regular education building that is not the students home school, the students IEP must identify reasons that make this placement determination appropriate.

The classroom teacher of this program is responsible for the students’ total academic curriculum and should be appropriately certified. The curriculum is adapted as needed to meet the specific speech-language goals of each student.

This model achieves these goals:

1. To provide a modified or an alternative curriculum for a student

2. To provide language learning in a structured, yet natural environment

3. To enhance pragmatic language learning and usage.

References

Casby, Michael W. (1992). The Cognitive Hypothesis and It’s Influence on Speech-Language Services in Schools. Language, Speech and Hearing Services in Schools, 23, 198-202.

Gregory, Hugo; Campbell, June; & Hill, Diane. Continuum of Disfluent Speech Behavior. Northwestern University.

Idol, Loma; Paolucci-Whitcomb, P.; & Nevin, A. (1986). Collaborative Consultation. Aspen Publications; Rockville, Maryland.

The Michigan Speech-Language Hearing Association. (1990). Speech and Language Service in Michigan; Suggestions for Identification, Delivery of Service and Exit Criteria.

Smith, A.B.; Hand, L.; Freilinger, J.J; Berthal, J.E.; Bird, A. (1990). The Iowa Articulation Norms Project and It’s Nebraska Replication. Journal of Speech and Hearing Disorders, 56, 779-798.

Appendix A

Cognitive Considerations

The purpose of the cognitive considerations appendix is to compare the student’s standard language scores to standard scores in other ability levels. This process helps differentiate the “slow learner” who is functioning in language at the expected level, from the student who is truly disordered and is functioning below the expected level.

Examples of these types of situations may include:

1. The student demonstrates a 15 (or greater) point discrepancy between IQ performance and language skills as judged by the results of language testing. Student shows significant discrepancy between ability and language performance and demonstrates deficits on one or more descriptive measures. Student may be eligible for speech and language services if he/she meets other eligibility requirements (adverse effect, etc.)

Example: WISC-III performance IQ 98 Verbal IQ 76

CELF-3 Receptive 81

Expressive 76

Has difficulty completing assignments in class; seldom speaks in full sentences; seems to lose his train of thought often and will change topics without completing a thought ot answering the questions asked of him.

2. If a student demonstrates no discrepancy between WISC-III performance score and language abilities as judged by the results of language testing, the student’s language appears to be commensurate with abilities. Student shows no difficulty in functional communication with cognitive abilities, language therapy services are not indicated.

Example: WISC-III performance IQ 75 Verbal IQ 72

CELF-3 Receptive 72

Expressive 72

This student has difficulty keeping up with the class and it takes several repetitions to assure that he has grasped new concepts presented. He socializes well and speaks easily with his friends. He can make his wants and needs known effectively in the classroom situation.

3. The student demonstrates no discrepancy between WISC-III performance score and the language testing results. However, two descriptive language measures indicate that the student has difficulty communicating and that this difficulty causes an adverse educational effect and therefore, the student may be eligible for speech and language services to address functional communication skills.

Example: WISC-III performance IQ 81 Verbal IQ 79

CELF-3 Receptive 84

Expressive 81

This student does well in communicating in guided, structured tasks; however, in the classroom he has difficulty attending and completing tasks assigned. He has difficulty following directions. Results of the assessments indicate he has skills below those of his classroom peers and significant weaknesses are noted in the pragmatic areas of topic maintenance, turn taking, transitions, and conversational initiation skills.

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Crossover

behaviors

Harrisburg Area School District

Speech/Language Resource Manual

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