About the presenter: Kathleen Whitmire is Director of School Services for the American Speech-Language-Hearing Association (ASHA). Prior to joining the ASHA staff, she served as a school-based clinician for fourteen years, and held positions as a clinic supervisor and lecturer at Syracuse University and as Assistant Professor and Chair of the Communication Disorders Department at The College of Saint Rose. She has served in a variety of capacities for regional and state professional associations and boards, for which she has received two Distinguished Service awards, and currently sits on the editorial board of Topics in Language Disorders. She has written and presented extensively at the state and national levels on issues related to the academic and social implications of communication disorders in school-age children and adolescents, with particular interests in language learning disabilities, stuttering and deafness. Dr. Whitmire received her MA, MS, and PhD from the University of Rochester.

You can post Questions/comments about the following paper to Kathleen Whitmire before October 22, 2002.


Provision Of Speech-Language Services In The Schools: Working With The Law

by Kathleen A. Whitmire
from Maryland, USA

In the United States, children with communication disorders are eligible to be served by speech-language pathologists in their school setting, if they "qualify for services." Every day in the United States, speech-language pathologists (SLPs) are faced with decisions regarding the students they serve in the school system and the manner in which they provide those services. Deciding which students will be eligible for services in the schools can be the most challenging decision to make, with the interplay of pressures from struggling children, large caseloads, budget constraints, and concerned parents. The situation may be further complicated for certain disability groups such as children with fluency disorders, when it is unclear if the school is responsible for providing services to a child who may not be getting failing grades. It is essential that clinicians and parents become informed about the federal mandates for services in the schools for children with special needs, in order to make appropriate decisions. This article discusses the main premises of those mandates and the implications for services to children with fluency disorders in the schools in the United States. A discussion about how children are served in other countries is welcome as well.

IDEA '97

Public Law 94-142, the Education for All Handicapped Children Act, was enacted by Congress in 1975 to guarantee a free, appropriate public education for children with disabilities. That act has undergone three major statutory reauthorizations, the latest of which was the Individuals with Disabilities Education Act amendments of 1997 or IDEA '97. The purpose of IDEA '97 is to establish an educational planning process that promotes meaningful access to the general curriculum for all students. The goals of IDEA '97 are to help each child:

Maintaining a focus on the components of this planning process and on the stated goals for each child is critical as guidance for decisions regarding eligibility and intervention. Those decisions can be made confidently by following the established process and by using IDEA's goals as the standard by which services are developed and implemented.

The Process

There are several interdependent components to the planning process as defined by IDEA '97. First, the child is referred to a building-level team for discussion and consideration. In some cases, the team may decide to institute some instructional modifications, consultation, and/or short-term intervention to determine if the child's needs can be met outside of the special education arena. Other times, the team will decide that an assessment is appropriate to determine if special education services are needed. In that case, the second step is that various members of the team will conduct their respective parts of the assessment, and then come together to review those results and decide if special education services are needed. If so, the third step is that the assessment findings will be used as the basis for developing the Individualized Education Program (IEP), that is, the plan for intervention. Implementation of the IEP constitutes the fourth step, intervention. When viewed this way, it becomes apparent that the IEP should emerge from the assessment findings and in turn should direct the intervention process, creating a cohesive picture of the child's needs and the best way to meet those needs in the school setting. The following sections highlight strategies and approaches that contribute to successful interdependence of these components, particularly for children with fluency disorders.

Assessment

The assessment should be designed to answer three questions:

  1. Does the child have a disability?
  2. Does the disability have an adverse effect on educational performance?
  3. Does the child need special education and related services in order to participate in the general curriculum as appropriate?
A team comprised of qualified professionals and the parent determines if the child has a disability. Decisions regarding eligibility for services are made by a larger team, comprised of the child's parent, at least one regular education teacher, at least one special education teacher or special education provider, a representative of the school who is familiar with the available programs, an individual who can interpret the instructional implications of the evaluation results, and if appropriate, the child. Team members may play more than one role, e.g., the SLP may serve as the special education provider and as the individual who interprets the evaluation results.

According to IDEA '97, no single procedure is used as the sole criterion for determining an appropriate educational program for the child. Rather, a variety of assessment tools and strategies should be used to gather relevant functional and developmental information, including information provided by the parent. The information should relate to enabling the child to be involved in and progress in the general curriculum, and should assist in determining the content of the IEP. In other words, the assessment must be contextually based. This requires information regarding the child's ability to function in educational settings and, as such, cannot rest solely on standardized test results. Rather, multiple forms of assessment (and not multiple norm-reference tests) are needed. These may include:

For the child with a fluency disorder, multiple forms of assessment are needed in order to capture relevant information on cognitive, affective, linguistic, social, and motor components of the disorder. For example, the assessment may include observations in several settings academic, nonacademic, and extracurricular as well as information from the parent and one or more teachers regarding the child's speech behaviors at various times and under varying circumstances. Checklists and interviews may prove helpful in obtaining information on attitudinal/affective dimensions.

Adverse Affect

For over twenty years, there has been debate about the determination of the "adverse affect" of a communication disorder upon a child's educational performance. Some school districts deny special education services to children with an obvious speech or language impairment who do not have an associated discrepancy in age/grade performance in one or more academic subject-matter areas that can be directly attributed to their speech or language impairment. This narrow interpretation of "adverse affect" requires academic failure before a child can receive special education services. This requirement is especially exclusive for children with fluency problems who are doing well academically. In 1980, ASHA sought and received clarification on this policy interpretation from the US Department of Education. Following are highlights from the official policy interpretation. (Information in brackets provides current terminology as included in IDEA '97.)

" ... an interpretation which denies needed service to speech [or language] impaired children who have no problem in academic performance is unreasonably restrictive in effect and inconsistent with the intent of the Act and regulations. There is strong support in the Act for a broad construction of the term "educational performance." ... The meaning of "educational performance" cannot be limited to showing of discrepancies in age/grade performance in academic subject-matter areas. The extent of a child's mastery of the basic skill of effective oral communications is clearly includable within the standard of "educational performance" set by the regulations. Therefore, a speech [or language] impairment necessarily adversely affects educational performance when the communication disorder is judged sufficiently severe to require the provision of speech [-language] pathology services to the child.

...It is clear that, in establishing the existence of a speech [or language] impairment that is [a disability]...a professional judgment is required. The basis for that judgment is the child's performance on formal and/or informal measures of linguistic competence and performance rather than heavy reliance on the results of academic achievement testing. The impact of the child's communicative status on academic performance is not deemed the sole or even the primary determinant of the child's need for special educational services. It is the communicative status -- and professional judgments made in regard to assessments of communicative abilities -- which has overriding significance. In the event the speech [-language] pathologist establishes through appropriate appraisal procedures the existence of a speech [or language] impairment, the determination of the child's status as a [child with a disability] cannot be conditioned on a requirement that there must be a concurrent deficiency in academic performance."

The policy interpretation related to "adversely affects educational performance" received in 1980 is still in effect today. Children with fluency disorders do not need to have concomitant low achievement in academic subjects in order to receive speech-language services. This is particularly true today, as state and local education agencies develop learning standards that include the acquisition of adequate and appropriate communication skills.

The IEP

Once it has been determined that the child is eligible for special education services, the next step in the planning process is the development of the IEP by a team of educators and the parent. Information from the assessment regarding the child's performance in educational contexts academic, nonacademic, and extracurricular now serves as the basis for the focus of intervention as defined in the IEP. As outlined earlier in this article, that plan should address the child's involvement in the general curriculum, participation in extracurricular and other nonacademic activities, and participation with other children with disabilities and nondisabled children. In other words, the intervention plan must be educationally relevant. It is not adequate to just report test scores or to establish an annual goal of "will increase fluent speech." The plan must be more reflective of the child's performance in the school setting at large.

Components of the IEP that are particularly relevant to this discussion include present levels of performance, annual goals, supports for school personnel, and service delivery. Present levels of performance describe how the child's disability affects involvement and progress in the general curriculum, broadly defined as academic, nonacademic, and/or extracurricular. This component of the IEP provides information on the child's educational strengths and weaknesses, including an understanding of the unique educational needs that result from the child's disability. Following is an example of a statement of present levels of performance that is useful as the basis for intervention planning:

"Score of 21 on SSI, 19 on CAT-R. Predominant disfluency is sound prolongation, with concomitant behavior of raising his head. John's teacher reports he does not participate in class discussion and often sits alone at lunch time. His parents report he will not talk on the phone or order in a restaurant." Annual goals must be measurable and must relate to the child being involved in and progressing in the general curriculum as well as the educational needs resulting from the disability. They must also be considered "achievable" within an academic year. Possible measurable annual goals based on the present levels of performance given above are as follows: "Answer questions in class at least 2/wk. Have telephone conversation with adult of his choice. Order lunch in one restaurant. Reduce frequency and duration of sound prolongations. Reduce score on CAT-R." Supports for school personnel are provided to the child's teachers or other school personnel to help the child achieve the overarching goals of IDEA '97. This could include training for a child's teacher or clinician that would assist that staff person in meeting the unique and specific needs of the child.

When developing the intervention plan, the team should take into consideration the full spectrum of service delivery options when deciding which options are appropriate for meeting the individual needs of the child. It may be appropriate to provide a mix of options, e.g., classroom-based, individual pull-out, and consultation, to help the child establish basic speech-language skills, examine attitudes and beliefs, and apply skills in various contexts. In addition, these options should be reviewed and changed over time as needed, as the child's needs change.

Summary

Being informed about the federal mandates of IDEA '97 is the best way to ensure that children with fluency disorders are receiving the services to which they are entitled in our schools. Using this law as guidance in decision-making will help to bring fairness and consensus to the process, resulting in appropriate support to these children and their families.

References

American Speech-Language-Hearing Association. (1999). IDEA and your caseload: A template for eligibility and dismissal criteria for students ages 3 to 21. Rockville, MD: Author.

Council for Exceptional Children. (2000). Developing educationally relevant IEPs: A technical assistance document for speech-language pathologists. Reston, VA: Author.

Dublinske, S. (2002). "Adversely affects educational performance" policy 1980-2002: Nothing has changed. Perspectives on School-Based Issues, 3(2), 3-7.

U.S. Congress. (1997). Individuals with Disabilities Education Act amendments of 1997. Washington, DC: U.S. Government Printing Office.


You can post Questions/comments about the above paper to Kathleen Whitmire before October 22, 2002.


September 11, 2002