Speech-Language Pathology Services in Schools

[Pages:138]Speech-Language Pathology Services in Schools:

Guidelines for Best Practice

Revised 2018

Virginia Department of Education, Office of Special Education and Student Services

Speech-Language Pathology Services in Schools: Guidelines for Best Practice

Table of Contents

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Commonly Used Acronyms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Overview of School-Based Speech-Language Pathology . . . . . . 4

Role of the School-Based Speech-Language Pathologist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Speech-Language Pathologists . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Speech-Language Pathology Assistants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Substitutes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Supervision and Mentoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Technical Assistance and Professional Development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Work Environment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Recruiting/Retaining Qualified Speech-Language Pathologists . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Evidence-Based Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Overview of Evidenced-Based Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Documentation and Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Evaluation of Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Assessment and Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Comprehensive Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 School-Based Data Collection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Observations of Academic Activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Tests and Measures of Academic Achievement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Speech-Language Specific Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Observation and Probes of Speech-Language Specific Skills . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Norm-Referenced Tests and Measures of Speech-Language Skills . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Educational Impact of the Speech-Language Impairment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 The Speech-Language Pathologist's Evaluation Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

Special Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Child Find Screening . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Special Education Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Related Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 IEP Development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Transitions from Early Intervention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Private School Students with Disabilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

Service Delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

Service Delivery Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Direct Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Indirect Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Other Service Delivery Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Scheduling, Service Delivery, and IEPs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 General Education Initiatives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Caseload Establishment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

Virginia Department of Education, Office of Special Education and Student Services

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Speech-Language Pathology Services in Schools: Guidelines for Best Practice

Special Topics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

Literacy Development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Autism Spectrum Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 Language Diversity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Limited English Proficiency (LEP) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 Phonological Processes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 Dysphagia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Auditory Processing Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 Assistive Technology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Medicaid/Famis Reimbursement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71

References and Resources. . . . . . . . . . . . . . . . . . . . . . . . . . 73

Appendices

APPENDIX A: Print and Web Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 APPENDIX B: Assessment Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 APPENDIX C: Speech-Language Sample Screening Forms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 APPENDIX D: Comprehensive Communication Assessment System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 APPENDIX E: Forms and Checklists . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107

Figures and Tables

Figure 1. Overview of Evidence-Based Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Figure 2. Factors to Consider When Integrating Evidence and Making Decisions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Figure 3. Aim and Trend Line . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Figure 4. The Components of Comprehensive Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Figure 5. Comprehensive Assessment of School Communication Abilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Figure 6. Steps in the Special Education Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Figure 7. SLI Criteria Worksheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Figure 8. A sampling of possible communication profiles. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Figure 9. Auditory Processing Skills Hierarchy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66

Table 1. Roles/Responsibilities of School-Based Speech-Language Pathologists . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Table 2. Responsibilities of Mentors and Newly Hired SLPs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Table 3. Equipment, Materials, and Space for School-Based SLP Use in School Setting . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Table 4. SLP Recruitment Strategies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Table 5. Types of Data Commonly Collected in Education Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Table 6. Advantages and Disadvantages of Common Assessment Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Table 7. Components of Discourse Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Table 8. Checklist for Reviewing Norm-Referenced Tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Table 9. Normal Distribution Curve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Table 10. IEP Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Table 11. IEP Checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Table 12. Teaching Models for Integrated Therapy in the Classroom . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Table 13. Possible Delivery Options for 60 Minutes of Services per Week . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Table 14. Examples of Caseload Reduction Based on Schedule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Table. 15 Common Features of SWE that Overlap with AAE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 Table 16. Comparison of Children with Limited English Proficiency with and without Disabilities . . . . . . . . . . . . . . . 58 Table 17. Phonological Processes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Table 18. Overlap Between Auditory Processing Disorders, Attention Deficit Disorders, and Speech-Language Impairments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67

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Virginia Department of Education, Office of Special Education and Student Services

Speech-Language Pathology Services in Schools: Guidelines for Best Practice

Introduction The development of communication skills is important for all students and can

impact school success. The school-based speech-language pathologist (SLP) plays an important role in education and may serve on both the special education and general education teams. SLPs may serve students directly or work with educators and families to address communication and language needs.

This guidelines document is designed to assist school-based SLPs, administrators, teachers, and parents as they explore the role of the SLP in the school-based setting and work together to serve students in Virginia.

The Virginia Department of Education (VDOE) Regulations Governing Special Education Program for Students with Disabilities and other VDOE guidance documents should be used in conjunction with this resource.

The VDOE employs staff who provide assistance understanding information provided in this and other VDOE resources. Additional information may be found on the VDOE Web site at: doe. or by contacting the VDOE at:

Virginia Department of Education Division of Special Education and Student Services P.O. Box 2120 Richmond, VA 23218-2120 1-800-422-2083

Virginia Department of Education, Office of Special Education and Student Services

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Speech-Language Pathology Services in Schools: Guidelines for Best Practice

Acknowledgements

The Department of Education would like to express its appreciation to the following people for their work on these guidelines:

Chondra Malson University of Virginia

Lisa Disney Chesterfield County Public Schools

Cynthia O'Donoghue, Ph.D. James Madison University

Myra Flint Virginia Beach City Public Schools

Donna Bryant Spotsylvania County Public Schools

Marie Ireland Virginia Department of Education

LaVae Hoffman, Ph.D. University of Virginia

Traci Morris Prince William County Public Schools

Lee White Prince William County Public Schools

Vicki Reed, Ph.D. James Madison University

Lisa Kinton Chesterfield County Public Schools

In addition, the following persons at the Virginia Department of Education provided valuable assistance in their review of the document:

Amy Edwards Medicaid Specialist

Patricia Abrams, Ph.D. Director, Special Education Instructional Services

Phyllis Mondak Early Childhood Specialist

Scottie Alley Complaints Specialist

Vivian Stith-Williams, Ph.D. Specialist

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Virginia Department of Education, Office of Special Education and Student Services

Speech-Language Pathology Services in Schools: Guidelines for Best Practice

Commonly Used Acronyms

AAC APD

Augmentative and Alternative Communication

(Central) Auditory Processing Disorder

DMAS

Department of Medical

IFSP

Assistance Services

(Virginia's Medicaid agency)

DSM

Diagnostic and Statistical

Manual

LEA

Infant and Family Service Plan (treatment document for children receiving services through EI)

Local Education Agency

ASD

Autism Spectrum Disorders EBP

Evidence-Based Practices LEP

Limited English Proficiency

ASHA AT BASLP BICS CA L P CCC CF

CLD CMS CFR dBHL

American SpeechLanguage-Hearing Association

Assistive Technology

Board of Audiology and Speech-Language Pathology

Basic Interpersonal Communication Skills

Cognitive Academic Language Proficiency

Certificate of Clinical Competence granted by ASHA

Clinical Fellowship (supervised work experience after completing Master's degree requirement, required for CCC)

Culturally and linguistically diverse

Centers for Medicare and Medicaid (the agency overseeing Medicaid)

Code of Federal Regulations

decibels, measured in Hearing Level (measure of a sound's loudness)

EI

Early Intervention

LRE

ESL

English as a Second

Language

L1

FA M I S FA P E

Family Access to Medical L2 Insurance Services (Virginia's health insurance MBSS programs for families that do not qualify for Medicaid)

NBPTS

Free Appropriate Public Education

FERPA Family Educational Rights NOMS and Privacy Act

FM

Frequency Modulated

PLOP

Hz

Hertz (measure of a sound's

frequency)

POC

ICD-9-CM International Classification

of Diseases, 9th revision, RtI

Clinical Modification

(standardized listing of

S H AV

descriptive terms and

identifying codes for

reporting diagnoses

SOL

and medical services

performed)

SRS

ID IDEA

Intellectual Disability (formerly Mental Retardation)

Individuals with Disabilities Education Act

T TAC

USC VAC

IEP

Individualized Education

Program

VDOE

Least Restrictive Environment

First Language of a child

Second Language of a child

Modified Barium Swallow Study

National Board for Professional Teaching Standards

National Outcome Measurement System (developed by ASHA)

Present Level of Educational Performance

Plan of Care

Response to Intervention

Speech-Language-Hearing Association of Virginia

Standards of Learning

Severity Rating Scale

Training and Technical Assistance Centers

United States Code

Virginia Administrative Code

Virginia Department of Education

Virginia Department of Education, Office of Special Education and Student Services

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Speech-Language Pathology Services in Schools: Guidelines for Best Practice

Overview of School-Based Speech-Language Pathology

This opening section addresses

Regulations Governing Special

teacher assistance teams, and child

questions that frequently arise about: Education Programs for Children with

study committees). On these teams,

? The role of the SLP

Disabilities in Virginia1(Virginia Special Education Regulations), 8 VAC 20-80-

the speech-language pathologist may conduct observations, complete

? Personnel requirements for

10 et al. defines speech-language

assessments, plan with teachers, model

licensure and duties

pathology services as: identification

interventions, coach teachers, and/

? Supervision

of children with speech-language impairments, appraisal and diagnosis

or gather data, all in the context of general education. Speech-language

? Skill development, and

of the impairment, referral for medical pathologists may provide prevention

? Recruitment and retention of SLPs.

or other professional attention, provision of speech-language services for prevention or habilitation of

and intervention services based on local programs and policies.

Role of the School-

communication impairments, and counseling and guidance for parents,

In the early years of school practice, provision of services focused on

Based Speech-

children and teachers regarding speech

Language

Pathologist

and/or language impairments. Speechlanguage pathology services are

fluency, voice, and articulation disorders, with later inclusion of language disorders. Although these

The focus of school-based speechlanguage pathologists is the communication abilities of students. The school-based speech-language pathologist's goal is to remediate, improve, or alleviate student communication and swallowing problems within the educational environment. To meet this goal, schoolbased speech-language pathologists:

both special education and a related service and may also be provided as part of a general education initiative. Table 1 summarizes the roles and responsibilities of school-based speechlanguage pathologists.

The school-based speech-language pathologist may serve as a member of a variety of teams that make decisions regarding evaluation, eligibility,

areas continue to be included within the SLP's roles and responsibilities, changing legal mandates and an expanded scope of practice for SLPs across settings has prompted a redefinition of work in the schools. Several professional practices may now be included as part of the SLP's workload.... These areas include work with students who are medically fragile; work with those

and services. The speech-language

(a) prevent, correct, improve, or pathologist does not make decisions

alleviate articulation, fluency, in isolation regarding the needed

voice, language, and swallowing evaluation components, the child's

impairments

eligibility for special education and

with dysphagia; work with reading, writing, and curriculum; EBP; RtI; and telepractice. (ASHA, 2010, page 10)

The field of speech-language

related services, or the goals and

(b) reduce the functional

objectives of intervention. The needs

consequences of the

of students with disabilities are best

communication and swallowing addressed in a transdisciplinary manner

disabilities by promoting the with a team of professionals providing

development, improvement, services.

and use of functional

communication skills; and

Speech-language pathologists may

pathology is dynamic. Research in the field provides new information on assessment and intervention approaches. Fully qualified speechlanguage pathologists possess the foundational knowledge and skills to provide service for all clients. To develop specialized skills, speech-

also provide support when students

(c) provide support in the general are not eligible for speech-language

educational environment to

services by participating on various

lessen the handicap (the social prevention/early intervention teams

consequence of the impairment (e.g., Instructional Support Teams,

or disability) by facilitating

language pathologists and their employers must be willing to participate in continuing education to maintain best practice in aspects of the field such as assistive technology, dysphagia

successful participation,

socialization, and learning (ASHA, 1999).

1 Regulations Governing Special Education Programs for Children with Disabilities in Virginia became effective July 7, 2009. These regulations can be found on the Virginia Department of Education Web

site at doe.

4

Virginia Department of Education, Office of Special Education and Student Services

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