guidelines for the roles and responsibilities of the school-based speech-language...

Guidelines • Roles and Responsibilities of the School-Based Speech-Language Pathologist 1999 / III - 249

Guidelines for the Roles andResponsibilities of the School-BasedSpeech-Language Pathologist

Guidelines

Reference this material as: American Speech-Language-Hearing Association. (2000). Guidelines for the roles andresponsibilities of school-based speech-language pa-thologist. Rockville, MD: Author.

Index terms: Caseload (service delivery), documentationactivities, Individuals with Disabilities Education Act,practice scope and patterns, schools (practice issues), ser-vice delivery models, speech-language pathology

Document type: Standards and guidelines

American Speech-Language-Hearing Association

These guidelines are an official statement of the Ameri-can Speech-Language-Hearing Association (ASHA). Theywere approved by ASHA’s Legislative Council in March1999. They provide guidance for school-based speech-language pathologists but are not official standards of theAssociation. The guidelines were prepared by the ASHA AdHoc Committee on the Roles and Responsibilities of theSchool-Based Speech-Language Pathologist: JoAn Cline,chair; Susan Karr, ex officio; Jacqueline Green; RonaldLaeder; Gina Nimmo; and Ronnie Watkins. NancyCreaghead, 1997–1999 vice president for professionalpractices in speech-language pathology, served as monitor-ing vice president in 1997; Crystal Cooper, 1994–1996vice president for professional practices in speech-language pathology, served as monitoring vice presidentin 1996 and consultant in 1997–1998. Committee membershave extensive experience providing direct speech-languagepathology services in school settings. The contributions ofASHA members, committee members, and staff peer review-ers are gratefully acknowledged and have been carefully con-sidered. Additionally, the committee wishes to thank thosewho shared state handbooks and district procedure manu-als from the following states: California, Connecticut,Florida, Georgia, Illinois, Iowa, Kentucky, Maryland,Michigan, Nevada, New York, North Carolina, Ohio.

Table of ContentsI. Introduction

PurposeGuiding PrinciplesDefinitionsHistory

Current ModelII. Roles and Responsibilities

PreventionIdentificationAssessmentEvaluationSpecific Evaluation ConsiderationsEligibility DeterminationIEP/IFSP DevelopmentCaseload ManagementIntervention for Communication DisordersIntervention for Communication VariationsCounselingRe-evaluationTransitionDismissalSupervisionDocumentation and Accountability

III. Additional Roles and OpportunitiesCommunity and Professional PartnershipsProfessional Leadership OpportunitiesAdvocacy

IV. SummaryReferencesBibliographyAppendicesA. ASHA Code of EthicsB. ASHA School Related ResourcesC. Goals 2000 Educate America Act: National Educa-

tion GoalsD. School Reform Issues Related to Speech-Language

PathologyE. Advantages and Disadvantages of Types of Assess-

mentsF. Developmental Milestones for Speech and LanguageG. Examples of a Severity/Intervention MatrixH. Signs and Effects of Communication DisordersI. Example of an Educational Relevance ChartJ. Example of Entry/Exit Criteria for Caseload Selec-

tionsK. Example of Dismissal Criteria Chart

III - 250 / 1999 ASHA 2002 Desk Reference Volume 3 • Speech-Language Pathology

I. IntroductionSchool-based speech-language pathology services

have changed dramatically during the past decadesbecause of numerous legislative, regulatory, societal,and professional factors. Meanwhile fiscal con-straints and increased paperwork have made it morechallenging to provide effective services. In order toprovide appropriate speech and language services, itis important to understand and consider the corre-sponding changes in the development and manage-ment of the school-based speech-language pathologyprogram.

The current roles and responsibilities of theschool-based speech-language pathologist requireclarification, expansion, and readjustment. Core rolesand responsibilities are described in Section II, whileadditional roles and opportunities are suggested inSection III.

PurposeThe purpose of this document is to define the roles

and delineate the responsibilities of the speech-language pathologist within school-based speech-language programs.

These guidelines were developed in response torequests by speech-language pathologists, school ad-ministrators, lobbyists, and legislators who seek guid-ance from the American Speech-Language-HearingAssociation (ASHA) for a description of the roles andresponsibilities of school-based speech-language pa-thologists.1 These guidelines can be used as a modelfor the development, modification, or affirmation ofstate and local procedures and programs. Parents,2

families,3 speech-language pathologists, teachers,school administrators, legislators, and lobbyists mayfind the information helpful when advocating for qual-ity services and programs for students with commu-nication disorders. This document may also be usedas a resource by program administrators and supervi-sors who wish to support and enhance the profes-sional growth of individual speech-languagepathologists.

Guiding PrinciplesThe following premises guided the development

of this document:

1 The ASHA School Services Division receives approxi-mately 100 requests each year for such guidelines. Manyrequests represent the interests of entire school districtsor local and state education agencies. Additionally, re-quests for this type of information are received by otherdivisions at the ASHA National Office for use in stateand federal advocacy efforts.

2 Within this document parent refers to the biologicalparent(s), legal guardian(s), or surrogate parent(s).

3 Within this document family may include relatives or indi-viduals with a common affiliation, such as caregivers orsignificant others.

4 Further citations of the U.S. Congress 1997 Amendmentsto the Individuals with Disabilities Education Act (IDEA)will be denoted by section numbers only. Unless other-wise stated, IDEA refers to the IDEA 1997 Amendments.At this writing, the final federal regulations for the IDEA1997 legislation have not been promulgated by theDepartment of Education.

Guidelines Quick Reference

WHO Definition of speech-language pathologist

WHAT Core roles

WHEN Eligibility determination

WHERE Caseload management/Service delivery options

WHY Guiding principles

HOW “How to” techniques for each of the core roles are learned through pre-servicetraining and clinical practicum experiences. In-service learning continues viaclinical fellowships, continuing education programs, literature review,mentorships, Special Interest Division or other professional affiliations, studygroups, and research.


• “Disability is a natural part of the human ex-perience and in no way diminishes the right ofindividuals to participate in or contribute to so-ciety. Improving educational results for chil-dren with disabilities is an essential element ofour national policy of ensuring equality ofopportunity, full participation, independentliving, and economic self-sufficiency for indi-viduals with disabilities.” (U.S. Congress, 1997[Sec. 601(c)]).4

• Society’s trends and challenges affect the roleof speech-language pathologists.

• Educational success leads to productive citi-zens.

• Language is the foundation for learning withinall academic subjects.

• School-based speech-language pathologistshelp students maximize their communicationskills to support learning.

• The school-based speech-language patholo-gist’s goal is to remediate, ameliorate, or allevi-

ate student communication problems withinthe educational environment.

• A student-centered focus drives team decision-making.

• Comprehensive assessment and thoroughevaluation provide information for appropriateeligibility, intervention, and dismissal deci-sions.

• Intervention focuses on the student’s abilities,rather than disabilities.

• Intervention plans are consistent with currentresearch and practice.

Although speech-language pathologists are boundby federal mandates, state regulations and guidelines,and local policies and procedures, they are also influ-enced by ASHA’s policy statements. School-basedspeech-language pathologists are encouraged to referto ASHA’s Code of Ethics (Appendix A) when mak-ing clinical decisions. As indicated in Figure 1,ASHA’s Code of Ethics encompasses all ASHA policy.

Source: Scope of Practice in Speech-Language Pathology. (ASHA, 2001)


The guidelines in this document are consistentwith ASHA’s Scope of Practice, Preferred Practice Pat-terns, and position statements, yet are specific to issuesrelating to school-based speech-language pathologists.Additional complementary documents, such as ASHAguidelines, technical reports, tutorials, and relevantpapers, are available through the ASHA National Of-fice (see Appendix B).

These guidelines reflect the Committee’s review ofcurrent law related to providing services to studentswith disabilities; policy and procedure documentsfrom a variety of geographic areas; current professionalliterature; contemporary practices from rural, subur-ban, and urban areas; and extensive feedback from peerreviewers in the profession. Likewise, the terminologyused within this document mirrors current wide-spread use; however, regional or geographical varia-tions may occur. In the interest of clarity, the variousaspects of school-based speech-language pathologists’roles and responsibilities are discussed separately.However, school-based speech-language pathologyservices are interrelated, as are all aspects of commu-nication.

The field of speech-language pathology is dy-namic and evolving, therefore the examples withinthis document are not meant to be all-inclusive. Addi-tional emerging roles or responsibilities should not beprecluded from consideration if they are based onsound clinical and scientific research, technologicaldevelopments, and treatment outcomes data.

DefinitionsThe range of the profession of speech-language pa-

thology has been defined by many sources, includingASHA, federal legislation, and such other sources asthe World Health Organization.

ASHA Definition

Speech-language pathologists are professionallytrained to prevent, screen, identify, assess, diagnose,refer, provide intervention for, and counsel personswith, or who are at risk for, articulation, fluency, voice,language, communication, swallowing, and relateddisabilities. In addition to engaging in activities to re-duce or prevent communication disabilities, speech-language pathologists also counsel and educatefamilies or professionals about these disorders andtheir management (ASHA, 1996c).

Federal Definitions

The Individuals with Disabilities Education Act(IDEA) includes speech-language pathology as both arelated service and as special education. As related ser-vices, speech-language pathology is recognized as“developmental, corrective, and other supportive ser-

vices. . . as may be required to assist a child with a dis-ability to benefit from special education. . .and includesthe early identification and assessment of disablingconditions in children” [Section 602(22)]. Speech-language pathology is considered special educationrather than a related service if the service consists of“specially designed instruction, at no cost to the par-ents, to meet the unique needs of a child with a dis-ability, including instruction conducted in theclassroom, in the home, . . . and in other settings.” Statestandards may further specify when speech-languagepathology services may be considered special educa-tion rather than a related service.

According to the IDEA definition, speech-language pathology includes:

• identification of children with speech and/orlanguage impairments

• appraisal and diagnosis of specific speechand/or language impairments

• referral for medical or other professional atten-tion necessary for the habilitation of childrenwith speech or language impairments

• provisions of speech and/or language servicesfor the prevention of communication impair-ments or the habilitation of children with suchimpairments

• counseling and guidance for parents, children,and teachers regarding speech and/or lan-guage impairments.

IDEA similarly identifies the early interventionservices provided by speech-language pathologists forchildren from birth to age 3 with communication orswallowing disorders and delays. In Part C of IDEA,early intervention services are defined as being “de-signed to meet the developmental needs of an infantor toddler with a disability in any one or more of thefollowing areas: physical, cognitive, communication,social or emotional and adaptive development” [Sec-tion 632(c)]. An infant or toddler with a disability mayalso include, at a state’s direction, at-risk infants andtoddlers [Section 632(5-8)].

World Health Organization Definitions

School-based speech-language pathologists pre-vent, identify, assess, evaluate, and provide interven-tion for students with speech, language, and relatedimpairments, disabilities, and handicaps. The WorldHealth Organization, in an effort to describe what mayhappen in association with a health condition, definesimpairment, disability, and handicap and differentiatesoutcome measures for each. See Table 1.


School-based speech-language pathologists focuson all three aspects of a student’s communicationneeds: impairment, disability, and handicap. Theschool-based speech-language pathologist (a) pre-vents, corrects, ameliorates, or alleviates articulation,fluency, voice and language impairments; (b) reducescommunication and swallowing disabilities (the func-tional consequences of the impairment); and (c) less-ens the handicap (the social consequences of theimpairment or disability).5

Ultimately, the school-based speech-languagepathologist’s purpose in addressing communicationand related disorders is to effect functional and mea-surable change(s) in a student’s communication sta-tus so that the student may participate as fully aspossible in all aspects of life—educational, social, andvocational (ASHA, 1997e).

HistoryThe roles and responsibilities of school-based

speech-language pathologists have changed over theyears in response to legislative, regulatory, societal,and professional influences.

Traditional Role

School-based speech-language programs have along history. Records indicate that in 1910 the Chicagopublic schools were the first schools to hire “speech

correction teachers” (Darley, 1961). In the 1950s,speech-language pathologists who worked in a schoolsetting, formerly referred to as “speech correctionists,”“speech specialists,” or “speech teachers,” workedprimarily with elementary school children who hadmild to moderate speech impairments in the areas ofarticulation, fluency, and voice. Later, with increasedknowledge about language development, the “speechtherapist” developed skills in identifying andremediating language disorders, thereby expandingthe range of the profession (Van Hattum, 1982). Stu-dents were typically treated in large groups, contrib-uting to caseload sizes that in most situationssignificantly exceeded those of today. The speech-lan-guage pathologist often employed a medical/clinicalapproach to treating students with communicationimpairments. With this approach the student’s prob-lems were diagnosed, developmental tasks were pre-scribed, clinical materials were used for treatment, andthe individual was treated until the pathology was“corrected.” All of this was most often conducted bypulling students out of the classroom to receive ser-vices within a separate therapy resource room. Theemphasis was on correcting the specific speech or lan-guage impairment.

Legislative Influences

Federal and state governments have been instru-mental in obtaining rights for children with disabili-ties through the authorization of public laws. Practicesdefining speech-language pathologists’ roles and re-sponsibilities in schools today have been shaped inpart by the laws and regulations, administrative poli-cies and procedures, and court rulings that govern theprovision of services to students with communicationdisorders. Relevant federal laws are noted in Table 2.

Table 1. World Health Organization (WHO) classifications.

IMPAIRMENT DISABILITY HANDICAP

Definitions Abnormality of structure orfunction at the organ level

Functional consequencesof an impairment

Social consequences of animpairment or disability

Examples Speech, language, cogni-tive, or hearing impair-ments

Communication problemsin context of daily lifeactivities

Isolation, joblessness, de-pendency, role changes

Outcome Measures Traditional instrumentaland behavioral diagnosticmeasures

Functional status mea-sures

Quality of life scales,handicap inventories,wellness measures

Source: International classification of impairments, disabilities, and handicaps. (World Health Organization, 1980)

5 The World Health Organization (1997) has drafted a revi-sion of its classification of impairments, disabilities, andhandicaps for field trials only. If finalized in currentform, the dimensions will include impairments of struc-ture and impairments of function, activities (formerlydisabilities), and participation (formerly handicaps).


Table 2. Federal Statutes Relating to Education of Students With Disabilities

Year Name of Law Law # Highlights

1973 Section 504 of the Rehabili- PL 93-112 Civil rights law to prohibit discrimination on the basistation Act of 1973 of disability in public or private programs and activities

receiving federal financial assistance.

1975 Education for All Handi- PL 94-142 Mandates a free, appropriate education for all handi-capped Children Act of 1975 capped students between the ages of 3 and 21. Provides(EHA) for Individualized Education Programs (IEPs), due

process, protection in evaluation procedures, and educa-tion in the least-restrictive environment.

1986 Education for All Handi- PL 99-457 Extends protections of the EHA to infants and toddlerscapped Children Act (birth to age 3) through the establishment of a formulaPart H) grant program. An important component of early inter-

vention is the comprehensive Individualized FamilyService Plan (IFSP).

1990 Americans with Disabilities PL 101-336 A civil rights law to prohibit discrimination solely onAct (ADA) the basis of disability by mandating reasonable accom-

modations across all public and private settings,including private and public schools.

1990 Individuals with Disabilities PL 101-476 (Includes birth through 21). Expands the discretionaryEducation Act of 1990 programs, includes the additional categories of autism(IDEA) and traumatic brain injured as separate disability

categories. Adds the statutory definitions of assistivetechnology device and service. Expands transitionrequirements.

1993 Goals 2000: Educate America PL 103-85 Describes inclusion of children with disabilities inAct of 1993 school reform effort. Develops eight National Education

Goals. Ensures that students with disabilities are educat-ed to the maximum extent possible.

1994 Improving America’s Schools PL 103-382 Provides for professional development and listsAct (IASA) competencies for all persons providing services,

including related services and special education.

1997 Individuals with Disabilities PL 105-17 Encourages participation of students with disabilitiesEducation Act Amendments in the general education curriculum and state- andof 1997 district-wide assessments. Encourages parental

involvement in the IEP team placement decisions.Assures that communication and assistive technologyneeds of students are considered. Encourages use ofvoluntary mediation rather than attorneys and nocessation of services for disciplinary reasons if related

Source: U.S. Congress to student’s disability.


As can be seen in Table 2, legislative changes haveinfluenced many aspects of speech-language pro-grams. Before the Education for All HandicappedChildren Act of 1975 (EHA) and its focus on provid-ing services in the least-restrictive environment, “onemillion of the children with disabilities were excludedentirely from the public school system and did not gothrough the educational process with their peers” [Sec-tion 601c (2C)]. Others with disabilities were in thepublic schools, but their disabilities were undetected;this prevented them from having a successful educa-tional experience. With the lack of adequate serviceswithin the school system, families had to find servicesoutside the public school system, often far from homeand at their own expense [Section 601c (2D-E)]. EHAassured free, appropriate public education for all stu-dents. It also increased accountability and documen-tation, which consequently has directly affectedschool-based speech-language pathologists.

Other legislation followed. With the enactment ofEHA-Part H in 1986, services were expanded to includeinfants and toddlers and more categories of disabili-ties. IDEA, in 1990, further broadened the range of theprofession with the addition of more discretionaryprograms. In 1993, Goals 2000: Educate America Actestablished eight national education goals (see Appen-dix C) and reinforced the notion that school reformlegislation was relevant to speech-language pathologyservices (see Appendix D and ASHA, 1994i).

Goals 2000, Improving America’s Schools Act(IASA), and recent IDEA amendments all underscorethe importance of postsecondary initial preparationand continuing professional development to ensure ahigh quality of education for students with disabili-ties. And most recently, the IDEA amendments of 1997require that the IEP include information regarding theimpact of the student’s disability in terms of the gen-eral education curriculum.

In addition to federal legislative mandates, speech-language pathologists must also be familiar with andfollow existing state regulations and guidelines andlocal policies and procedures in carrying out their rolesand responsibilities.

Societal Influences

External factors other than legislative changeshave influenced the roles of the school-based speech-language pathologist. America’s racial and ethnic pro-file is rapidly changing, with an attendant shift instudent demographics. By the turn of the millennium,nearly one of every three Americans will be AfricanAmerican, Hispanic, Asian American or AmericanIndian. As a group, minorities constitute an ever-largerpercentage of public school students. In addition, the

limited-English-proficient population is the fastestgrowing population in America [Section 601 (7A-F)].The move toward pluralism—in which numerous dis-tinct ethnic, religious, or cultural groups co-exist—hasproduced students who are culturally and linguisti-cally more diverse. Hence, speech-language patholo-gists need to address such professional issues asnonbiased assessment and eligibility and interventionconsiderations related to a diverse population.

The nature and complexity of disorders have in-tensified. Speech-language pathologists within generaleducation settings provide services for more studentswho are medically fragile and/or multihandicapped.The emphasis on least-restrictive environment onlypartially explains the increase. Medical advancementsare saving more lives, yet many who survive are physi-cally or medically challenged. Additionally, withhealth care reform, many students are released earlierfrom hospitals or rehabilitation centers and enter publicschools requiring intensive speech-language services.Such other societal influences as an aging populationand squeezed budgets have often translated to fiscalcutbacks to K–12 and postsecondary education pro-grams (ASHA, 1997h). These fiscal constraints havemade it more challenging to provide effective service.

Professional Influences

School-based speech-language pathologists pos-sess a high degree of clinical competence by virtue oftheir professional study and experience. The field ofspeech-language pathology has developed a widenedscope of practice. Research and efficacy studies havebeen conducted and published to help determine bestpractices relating to speech-language pathology in allsettings and within schools in particular. Advancedtechnology has increased the scope and capabilitiesof speech-language pathologists.

Personnel shortages and changes in state licen-sure or department of education certification have af-fected the roles and responsibilities of school-basedspeech-language pathologists in many states. The rolesof the speech-language pathologist may vary depend-ing upon the composition or severity of the caseload,state or district mandates, and staffing needs.

Current ModelAlthough the mission of the school-based

speech-language pathologist—to improve the com-munication abilities of students—has remained con-stant, the manner in which the school-basedspeech-language pathologist addresses prevention,assessment, evaluation, eligibility determination,caseload management, and intervention has changedand will continue to evolve.


Today’s school-based speech-language patholo-gists serve students who have complex communica-tion disorders, many of which require intensive,long-term interventions. Many school speech and lan-guage caseloads consist of students with a wide rangeof disabilities and diverse education needs. Accordingto the Twentieth Annual Report to Congress on the Imple-mentation of IDEA, students with speech or languageimpairments are the second largest category of stu-dents served (20.2%) after specific learning disabilities(51.2%) (U.S. Department of Education, 1998). Speech-language pathologists also provide services to stu-dents with related disability categories—includingmental retardation; emotional disturbance; multipledisabilities; hearing, orthopedic, visual, or other healthimpairments; autism; deaf-blindness; and traumaticbrain injury.

Several education reform initiatives have influ-enced and shaped the policies that we have today. Theregular education initiative (REI) proposed that asmany children as possible be served in the regularclassroom by “encouraging a partnership with regu-lar education” (Will, 1986, p. 20). Full-inclusion advo-cates went a step further and supported completeinclusion of students with special needs in the regu-lar education classroom. Legislative mandates andgeneral changes in philosophy have dictated thatspecial education be provided in the least restrictiveenvironment (LRE). Careful consideration of LRE andmeaningful curriculum modifications based on thestudents’ needs have led to expanded service-deliverymodels. Now, in addition to taking students out of theclassroom for services, the speech-language patholo-gist has an array of direct and indirect service-deliv-ery options available to help students withcommunication disorders (see Table 6). To integratespeech and language goals with educational (aca-demic, social/emotional, or vocational) objectives, di-rect intervention may take place in a variety of settings,including the general education or special educationclassroom, the speech-language treatment room, theresource room, the home, or community facility (ASHA,1996b). Indirect service is also provided for profes-sional staff, parents, and families.6

Contemporary speech-language pathologists notonly provide assessment and intervention for studentsidentified as having communication disorders, theyalso may recommend environmental modifications orstrategies for communication behaviors of childrenwho have not been identified as being eligible for spe-cial education or related services (see Prevention).

With the expanding consulting role, it is essentialfor school-based speech-language pathologists to havea manageable caseload size. Adequate planning and

conference time is needed during the school week toserve the student, educators, and parents appropri-ately.7 (See Caseload Management.)

Currently, the school-based speech-language pa-thologist is expected to fulfill a variety of roles (seeTable 3 in Section II). The roles and responsibilities willvary in accordance with the work setting (e.g., home,community, preschool, elementary or secondaryschool), with the types of communication impairmentsand disorders exhibited by children in these settings,and with the speech-language pathologist’s experi-ence, knowledge, skills, and proficiency. The level ofexperience, knowledge, skills, and proficiency may beexpanded through additional training, such asmentoring, teaming, peer coaching, co-teaching, orthrough continuing education (CE) opportunities(workshops, seminars, institutes, and course work).

School-based speech-language pathologistskeep current with best practices in assessment andintervention. When providing services for studentswith impairments, disabilities, and/or handicaps,speech-language pathologists work with studentswith speech, language, hearing, and swallowing orrelated impairments; promote the development andimprovement of functional communication skills forstudents with communication and swallowing dis-abilities; and provide support in the general educa-tional environment for students with communicationhandicaps to facilitate their successful participation,socialization, and learning. School-based speech-lan-guage pathologists’ roles and responsibilities haveevolved. They now include preparing students for aca-demic success and the communication demands of thework force in the 21st century as well as alleviatinghandicapping conditions of speech and language dis-orders (ASHA, 1994i).

In the future, research and outcomes data mostcertainly will alter assessment and interventiontechniques, influence models and theories of practice,and further expand ASHA’s Scope of Practice (1996c)and Preferred Practice Patterns for the Profession(1997e).

6According to the results of the ASHA Schools Survey, 80%of the speech-language pathologist’s time is spent inproviding direct intervention and diagnostics. The re-maining 20% is spent on such activities as meetings,paperwork, training, and travel between schools (ASHA,1995c).

7ASHA’s recommended maximum caseload size is 40 stu-dents regardless of the type or number of service deliv-ery models selected (ASHA, 1993b).


II. Roles and ResponsibilitiesThis section describes specific roles and respon-

sibilities of school-based speech-language patholo-gists. Table 3 on the following page provides an outlineof the various core roles and related responsibilitiesdiscussed in this section. Note that specific responsi-bilities may be shared by other members of teams8

working together to meet the education and commu-nication needs of students with disabilities and theirfamilies. (Additional roles and opportunities are dis-cussed in Section III).

8IDEA encourages team evaluations and decision making.School-based teams may be multidisciplinary, interdis-ciplinary, or transdisciplinary in philosophy, dependingupon the setting, members, and the purpose of the team.Krumm, Aussant, Barcomb, Low, Lunday, andSchmiedge (1997) define each of these types of teams asfollows:

Multidisciplinary: One person heads the team, but eachmember communicates regarding his or her own disci-pline. Knowledge of skills of other professions is mini-mal, and team members assume that the otherprofessionals know the right thing to do. Evaluationoverlap is minimal.

Interdisciplinary: Team members communicate freelyacross disciplines. Team members have substantialknowledge of other team areas regarding testing andtest results. Some redundancy of testing occurs.

Transdisciplinary: Several professionals support and con-sult with one implementor. Team is holistic and expandsfocus to parents and community. (This model is consis-tent with early intervention program philosophy.)

For consistency, “interdisciplinary” will be used through-out this document.

PreventionThe concept of prevention has broadened in scope

in speech-language pathology in the last 20 years. Pre-vention now includes more than speech improvementand language stimulation; it encompasses providinginformation on general health maintenance, environ-mental hazards, and prenatal factors, in addition toearly identification and intervention.

The school-based speech-language pathologisthas an important role to play on the education team inaddressing prevention of communication disorders.For the school-based provider, this may include con-sultation regarding the acquisition of proficient lan-guage and communication skills by students ingeneral education preschool and early interventionclassrooms. The school-based speech-languagepathologist’s active involvement in general educationsupport will promote increased awareness that com-munication skills are the basis of most teaching, learn-

ing, and social relationships (ASHA, 1994i; Cazden,1988; Nelson, 1989).

Although intervention for students with commu-nication disorders is still the primary role, this empha-sis on prevention suggests an expanding role for theschool-based speech-language pathologist that goesbeyond identification and intervention for childrenwith speech and language disorders (ASHA, 1991c;Butler, 1996; Connecticut State Department of Educa-tion, 1993; Kavanaugh, 1991). Prevention requires in-creased efforts to avoid or minimize the onset ordevelopment of communication disorders and theircauses (ASHA, 1997d, 1997e). The causes are oftencharacterized as biological, environmental, or multi-factorial. In the latter case, the environment interactswith genetic predisposition. This terminology andprimary, secondary, and tertiary prevention are de-fined in ASHA’s Prevention of Communication Dis-orders Tutorial (1991c) and discussed below.

Primary Prevention: The elimination or inhibition ofthe onset and development of a communication disorder byaltering susceptibility or reducing exposure for susceptiblepersons.

The emphasis of primary prevention is on elimi-nating or reducing biological and environmental riskfactors through disseminating prevention informationto parents, families, education personnel, health careand social service professionals, organizations, andpolicy-making groups. Students who do not qualify forservices under IDEA may benefit from the services ofthe school-based speech-language pathologist whoprovides primary prevention services.

Primary prevention activities may range from in-dividual conferences to school-wide presentations orcommunity in-services. They may include educatingand collaborating with parents, families, educators,administrators, and the community regarding:

• classroom strategies that will enhance commu-nication for all students

• injury/accident prevention (e.g., wearing seatbelts or bicycle helmets)

• fluency-enhancing strategies• prevention of vocal abuse• students’ lifestyle choices affecting their com-

munication skills and that of their offspring

Secondary Prevention: Early detection and treatmentof communication disorders. Early detection and treatmentmay lead to elimination of the disorder or retardation of thedisorder’s progress, thereby preventing further complica-tions.

Tertiary Prevention: Reduction of a disability by at-tempting to restore effective functioning. The major ap-


Table 3. Core Roles and Responsibilities of School-Based Speech-Language Pathologists

Core Roles Responsibilities

Intervention Assistance Team / Child Study Team

PREVENTION In-Service TrainingConsultation

IDENTIFICATION Prereferral InterventionsScreening: Hearing, Speech, and LanguageReferral and Consent for Evaluation

Interdisciplinary Team

ASSESSMENT Assessment Plan(Data Collection) Assessment Methods

Student HistoryNonstandardized AssessmentStandardized Assessment

EVALUATION Strengths/Needs/Emerging Abilities(Interpretation) Disorder/Delay/Difference

Severity RatingEducational Relevance: Academic, Social-Emotional, and Vocational FactorsEvaluation Results and Team RecommendationsSpecific Evaluation Considerations

AgeAttentionCentral Auditory ProcessingCognitive FactorsCultural and/or Linguistic Diversity/Limited English ProficiencyHearing Loss and DeafnessNeurologic, Orthopedic, and Other Health FactorsSocial-Emotional Factors

IEP Team

ELIGIBILITY Federal Mandates, State Regulations/Guidelines, and Local Policies/ProceduresDETERMINATION Presence of Disorder

Educational RelevanceOther Factors

IEP/IFSP Federal Mandates, State Regulations/Guidelines, and Local Policies/ProceduresDEVELOPMENT IEP Team, Factors, Components, Caseload Size

CASELOAD Coordination of ProgramMANAGEMENT Service-Delivery Options

Scheduling Students for InterventionCaseload Size


Core Roles Responsibilities

Education Teams

INTERVENTION For Communication Disorders

General Intervention MethodsScope of Intervention

CommunicationLanguageSpeech: Articulation/Phonology, Fluency, Voice/ResonanceSwallowing

INTERVENTION For Communication Variations

Cultural and/or Linguistic DiversityLimited English ProficiencyStudents Requiring Technology Support

COUNSELING Goal Setting and PurposeReferral

IEP Team

RE-EVALUATION TriennialAnnualOngoing

TRANSITION Between Levels (Birth to 3, Preschool, Elementary, Secondary)Secondary to Postsecondary Education or EmploymentMore-Restrictive to Less-Restrictive Settings

DISMISSAL Federal Mandates, State Regulations/Guidelines, and Local Policies/ProceduresPresence of DisorderEducational RelevanceOther Factors

Speech-Language Pathologist

SUPERVISION Clinical FellowsSupport PersonnelUniversity Practicum StudentsVolunteers

DOCUMENTATION Federal Mandates, State Regulations/Guidelines, and Local Policies/ProceduresAND Progress ReportsACCOUNTABILITY Third-Party Documentation

Treatment Outcome MeasuresPerformance AppraisalRisk Management


proach is rehabilitation of the disabled individual who hasrealized some residual problems as a result of the disorder.

Early screening, assessment, and treatment of animpairment—traditionally considered special educa-tion or related services—may actually prevent furtherdisability or handicapping conditions. Such second-ary and tertiary prevention activities are included inthe following sections on Identification, Assessment,and Intervention.

IdentificationA core role of the speech-language pathologist is

to participate as a member of a team in identifying stu-dents who may be in need of assessments to determinepossible eligibility for special education or related ser-vices. These assessments assist in determining thepresence of disabilities and eligibility/ineligibility forspecial education and related services under IDEA. Itis necessary for the speech-language pathologist toexamine the identification and assessment/evaluationprocess through the prism of legal and ethical codes,policies, procedures, and guidelines specific to thestate or local education agency.

The basic phases of the identification process areprereferral, screening, and referral when indicated.

Prereferral

Although not always required, the prereferral pro-cess is a recommended option in many districts as afirst step in deciding whether a student is in need ofreferral for a special education and related servicesevaluation or simply needs assistance or modificationwithin the general education environment. Manyschools establish educational problem-solving teams,often referred to as a Child Study Team, InterventionAssistance Team, or Student Success Team. Theseteams are defined as school-based problem-solvinggroups whose purpose is to assist teachers with inter-vention strategies for addressing the learning needsand interests of students before a formal referral for anevaluation (Ohio Department of Education, 1991). Thisprocess is consistent with IDEA. The emphasis is onclassroom modifications and supports that, when suc-cessful, actually prevent the need for special educationintervention. Team members collaborate to determineif accommodations or modifications have been success-ful. An effective method is using dynamic assessmentto gauge a student’s potential to learn independentlywhen given a mediated learning experience (see theAssessment Methods and Intervention sections). Someschools have more than one team. The first-level teamis responsible for the prereferral process and documen-tation of general education intervention implementedin the classroom; a second-level team is responsible forthe assessment and identification process, when rec-ommended.

A core prereferral team may consist of any combi-nation of the following: an administrator; the student’steacher; one or more other regular education teachers;a curriculum specialist; and student or pupil servicepersonnel, as appropriate, such as the school psy-chologist, social worker, counselor, or nurse. Parents/families may also participate on prereferral teams. Thecomposition of a prereferral team varies considerablyamong districts and states. Some teams are limited togeneral education staff; others include special educa-tion and related service staff. One or more special edu-cation or related service providers may be added asnecessary for specific student concerns. The speech-language pathologist may consult regarding perceivedcommunication needs of students who may benefitfrom classroom accommodations or special educationservices. During the prereferral phase, it may be theresponsibility of the speech-language pathologist, asa team participant, to provide one or more of the fol-lowing services as appropriate for specific students:

• review pertinent school records• collect and review data to substantiate the out-

comes of attempted classroom modificationsand interventions

• observe the student in the classroom• collaborate with parents, teachers, and other

professionals to provide strategies, resources,and additional recommendations for teacherinterventions in the classrooms

• demonstrate intervention strategies, proce-dures, and techniques

• provide follow-up consultation or participatein processing a formal referral for assessment

• gather additional data

Screening

Screening is the process of identifying candi-dates for formal evaluation. Any procedure thatseparates those students in need of further evaluationfrom those not needing evaluation fulfills the pur-pose of screening. Screening may be accomplishedby using published or informal screening measuresadministered by the speech-language pathologist. Insome states, trained support personnel may conductscreening under the direction of the speech-languagepathologist, who then interprets the measures. Non-standardized checklists, questionnaires, interviews, orobservations interpreted by the speech-language pa-thologist may also be considered screening measures.Individual or mass speech/language screenings maybe mandatory in some regions and optional in others.If and when it is the responsibility of the school-basedspeech-language pathologist to conduct the screen-ings, the speech-language pathologist:


• selects screening measures meeting standardsfor technical adequacy

• administers and/or interprets a speech/lan-guage screening

• administers and/or interprets a hearing screen-ing in accordance with state and local policy,procedures and staffing patterns (ASHA, 1997e)

Referral

When accommodations and interventions havebeen attempted but have not been successful, a refer-ral for assessment may be initiated by any individual,including a parent, teacher, or other service provider.The referral is a request for assessment of a studentwith suspected special education needs. The assess-ment focuses on all areas related to a suspected dis-ability that may result in eligibility for specialeducation and/or related services. The written refer-ral includes a brief description of any previously at-tempted supplementary aids and services, programmodifications and supports to the general educationenvironment, a statement regarding the effectivenessof those modifications, and a rationale for the assess-ment.

If a speech-language pathologist is a member orcase manager of a team, in accordance with local poli-cies, it may be the responsibility of the speech-languagepathologist to:

• review referrals• participate in the development of the assessment

plan• obtain the results of current hearing/vision

screenings and monitor follow-up when appro-priate

• initiate referrals for additional assessment toother service providers

• serve as liaison to appropriate nonpublicschool agencies and/or providers

• communicate with general education class-room teacher(s) and parent(s) regarding thestatus of the referral

• schedule referral meetings• obtain written parent/guardian consent for

evaluation in accordance with federal man-dates, state regulations and guidelines, andlocal policy and procedures

• complete and distribute the paperwork to pro-cess the referral

AssessmentA core role of the school-based speech-language

pathologist is to conduct a thorough and balancedspeech, language, or communication assessment.

Within this document, a distinction is made betweenthe role of assessment and the role of evaluation. As-sessment “refers to data collection and the gathering ofevidence”; evaluation “implies bringing meaning tothat data through interpretation, analysis and reflec-tion” (Routman, 1994, p. 302).

A responsibility of the school-based speech-language pathologist is to select assessment measuresthat:

• are free of cultural and linguistic bias• are appropriate for the student’s age• match the stated purpose of the assessment tool

to the reported needs of the student• describe differences when compared to peers• describe the student’s specific communication

abilities and difficulties• elicit optimal evidence of the student’s commu-

nication competence• describe real communication tasks (see Appen-

dix E)

Assessment Plan

A comprehensive assessment plan is developedwithin local or state mandated time lines. It documentsthe areas of speech and language to be assessed, thereason for the assessment, and the personnel conduct-ing the assessment. If an initial screening was com-pleted, the results are used to identify the specific areasof speech and language to be addressed. The student’sdominant language and level of language proficiencyare specified in the assessment plan. Parents may par-ticipate in the development of the assessment plan. Thewritten assessment plan is provided to parents in theirdominant language or native language, wheneverpossible, as per IDEA [Section 612(a)(6)(B)]. (See spe-cific evaluation considerations below.)

Assessment Methods

The foundation of a quality individualized assess-ment is to establish a complete student history. Thatinformation will direct subsequent assessment selec-tion. The assessment data should reflect multiple per-spectives. No single assessment measure canprovide sufficient data to create an accurate and com-prehensive communication profile (Haney, 1992;IDEA [Section 612(a)(6)(B)]). Conducting bothnonstandardized and standardized assessments en-ables the speech-language pathologist to view the stu-dent in settings with and without contextual support.

Combining standardized (norm-referenced) withnonstandardized (descriptive) assessment usingmultiple methods will assure the collection of datathat can furnish information about the student’sfunctional communication abilities and needs. Ex-


amples of descriptive assessment methods are check-lists and developmental scales, curriculum-basedassessment, dynamic assessment data, and portfoliosof authentic assessment data9 (e.g., student classroomwork samples, speech and language samples, and ob-servations of the student in various natural contexts).A descriptive assessment allows focus on languageduring actual communication activities within natu-ral contexts.

During assessment data collection, it is the respon-sibility of the speech-language pathologist to gatherinformation, select appropriate assessment methods,and conduct a balanced assessment.

This balanced assessment may include:• gathering information from parent(s), family,

student, teachers, other service-provider profes-sionals and paraprofessionals

• compiling a student history from interviewsand thorough record review

• collecting student-centered, contextualized,performance-based, descriptive, and functionalinformation

• selecting and administering reliable and validstandardized assessment instruments thatmeet psychometric standards for test specific-ity and sensitivity

Examples of each follow.

Parent/staff/student interviews. Parents are anessential source of information—especially for stu-dents who are very young or who have severe disabili-ties. Parents provide insight regarding communicationskills in various settings outside the school and pro-vide additional information about functional and de-velopmental communication levels.

Classroom teachers, instructional assistants, andother school professionals are a primary source of in-formation regarding a student’s functional communi-cation skills among peers within the classroom andschool environment. They also provide specific infor-mation regarding listening, speaking, reading, writing,spelling/invented spelling, and the relationship be-tween the student’s communication skills and the cur-riculum. Various teacher/staff checklists provideinformation specific to disability areas or communica-tion functions.

Student interviews are appropriate in many cases,depending on the student’s age or cognitive level. Thespeech-language pathologist may gain insight intopersonal attitudes of the student related to communi-cation difficulties and motivation to change.

Student history. The speech-language pathologistcollects relevant and accurate information throughrecord review, observation, and parent, teacher, or stu-dent interviews. Information regarding the student’smedical and family history, communication develop-ment, social-emotional development, academicachievement from previous education placements,language dominance, community/family languagecodes and social-behavioral functioning are especiallyvaluable when completing a student case history.

Checklists and developmental scales. These toolsare used to obtain a large amount of information in anorganized or categorized form to note the presence orabsence of specific communication behavior. They maybe completed either by the speech-language patholo-gist or by others for the speech-language pathologist.

Curriculum-based assessment. Curriculum-basedassessment (CBA) refers to the “use of curriculum con-texts and content for measuring a student’s languageintervention needs and progress” (Nelson, 1998).Nelson suggests that CBA may extend the assessmentbeyond the identification of a student as communica-tion-impaired by including activities/skills that mayassess the acquisition of effective oral and written com-munication abilities.

An example of a curriculum-based measure thatmay be used by the speech-language pathologist is aninformation reading inventory that could be analyzedcollaboratively by the speech-language pathologistand the classroom teacher.

Dynamic assessment. Dynamic assessment is de-fined as a “term used to identify a number of distinctapproaches that are characterized by guided learningfor the purpose of determining a learner’s potential forchange” (Palincsar, Brown, & Campione, 1994). Dy-namic assessment is concerned with how well a stu-dent can perform after being given assistance. Theresponse the student makes to assistance helps to de-termine future effective instruction (see Intervention).

Portfolio assessment. Portfolio assessment can bedefined as a collection of such products as studentwork samples, language samples, dictations, writingsamples, journal entries, and video/audio recordingsand transcriptions. A portfolio approach requires de-cisions regarding:

• what samples are included• how many samples are included• student reflections on his or her work over time• analysis of the underlying processes repre-

sented by the samples as either learned or notlearned

9Authentic refers to real-life activities and situations.


Observation/anecdotal records. The observationof real-life communication behavior and the applica-tion of the resulting data describe language develop-ment and function in a variety of natural contexts.The speech-language pathologist can also use the an-ecdotal records and observations conducted by otherindividuals to complete various checklists, surveys,and developmental scales.

Standardized assessment information. When ap-propriately selected for validity and reliability, stan-dardized tests yield important information regardinglanguage and speech abilities and are part of thecomprehensive assessment. They are norm-referencedand used to compare a specific student’s perfor-mance with that of peers. Statistical scores are validonly for students who match the norming populationdescribed in the test manual.

Although all areas of speech, language, andcommunication are interrelated, broad spectrum,norm-referenced tests may be used to measure suchskills of language comprehension and production assyntax, semantics, morphology, phonology, pragmat-ics, discourse organization, and following directions.Additional tests may be administered to assess suchspecific areas as auditory abilities and auditory pro-cessing of language. Tests are used to assess articula-tion, phonology, fluency, and voice/resonance; andinstrumental and noninstrumental protocols are usedto assess swallowing function.

The assessment data are compiled, records arereviewed, and observations and interviews are noted.The best means to valid, nonbiased testing may be aspeech-language pathologist with a solid knowledgebase in speech and language development, delay,difference, and disorders who understands the valueand the inherent obstacles of standardized andnonstandardized assessments and who possessesthe skills to analyze data generated through allassessment methods.

EvaluationOnce the comprehensive assessment has been

completed, the results are interpreted. It is the inter-pretation that gives value to the assessment data,hence the term evaluation (Routman, 1994). Consider-ation is given to the nature and severity of a student’sdisorder and its effect on academic and social perfor-mance. Clinical judgment is used when evaluatingassessment information. Informed decisions are madeabout eligibility and subsequent intervention strate-gies.

It is the responsibility of the speech-languagepathologist, as part of a team, to assist in interpretingdata that will:

• identify strengths, needs, and emerging abili-ties

• establish the presence of a disorder, delay,or difference—including determining thestudent’s communication abilities within thecontext of home and/or community

• determine a severity rating (when required bystate regulations and guidelines or local policyand procedures)

• define the relationship between the student’slevel of speech, language, and communicationabilities and any adverse effect on educationalperformance

• determine if the communication disability isaffected by additional factors influencing theresults of the communication assessment

• summarize evaluation results and make recom-mendations

The speech-language pathologist’s responsibili-ties in specific areas are described below:

Communication Strengths and Needs

A careful analysis of the assessment data revealsthe student’s strengths, needs, and emerging abilities.These may include differences between receptive andexpressive oral and written language skills. Analysismay also reveal differences in the components of lan-guage form (phonologic, morphologic, and syntacticsystems), content (semantic system), or function/use oflanguage in communication (pragmatic system).

Strengths, needs, and emerging abilities are alsoidentified within specific speech areas including ar-ticulation/phonology, fluency, and voice or resonance.The student’s preferred communication modality isalso considered. Identifying communication strengthsand needs as prognostic indicators assists in deter-mining the probable potential for remediation and cre-ates a direct link from assessment to planning andconducting intervention. These strengths and needs areconsidered within the broader context of classroom,home, and community.

Disorder, Delay, or Difference

Research on the sequence and process of normallanguage and speech development provides the frame-work for determining whether the student exhibits acommunication disorder, delay, or difference (see Ap-pendix F, Developmental Milestones). Although thedistinction among disorder, delay, and difference isnot always easily determined, the following ASHAdefinitions are provided to clarify the terms.

A communication disorder is an impairment in theability to send, receive, process, and comprehend ver-


bal, nonverbal, and graphic symbol systems. A com-munication disorder may be evident in the process ofhearing, language, or speech; may be developmentalor acquired; and may range in severity from mild toprofound. A communication disorder may result in aprimary disability or may be secondary to other abili-ties (ASHA, 1993a, p. 40).

A communication delay exists when the rate ofacquisition of language or speech skills is slower thanexpected according to developmental norms; however,the sequence of development is following a predictedorder (Nicolosi, 1989). For eligibility purposes, deter-mination of the level of delay that is considered sig-nificant is specified in state regulations and guidelinesor local policies and procedures.

A communication difference is a “variation of asymbol system used by a group of individuals thatreflects and is determined by shared regional, social,or cultural/ethnic factors. A regional, social, cultural,or ethnic variation of a symbol system is not consid-ered a disorder of speech or language” (ASHA, 1993a,p. 41).

Severity Rating

A severity rating scale provides a consistentmethod of describing overall communication function-ing. Many states have developed and published sever-ity rating scales to help substantiate eligibility ordismissal criteria. Some states use the determined se-verity rating as a “best practice” guide to assist in de-termining a recommended amount of intervention perweek. An example of a matrix based on severity wasdeveloped by the Illinois State Board of Education (seeAppendix G). Obviously, the needs of the student andclinical judgment affect the amount of service that thestudent receives. Consult state regulations and guide-lines or local policies and procedures for severity rat-ing information.

Educational Relevance

Education takes place through the process of com-munication. The ability to participate in active andinteractive communication with peers and adults inthe educational setting is essential for a student toaccess education (Michigan Speech-Language-Hear-ing Association, 1995). In order for a communicationdisorder to be considered a disability within a school-based setting, it must exert an adverse effect on educa-tional performance. The speech-language pathologistand team determine what effect the disorder has on thestudent’s ability to participate in the educational pro-cess. The educational process includes preacademic/academic, social-emotional, and vocational perfor-mance.

A speech, language, or hearing disorder may se-verely limit a student’s potential vocational or careerchoices regardless of the student’s other competencies.(See Appendix H for examples of signs and effects ofcommunication disorders and Appendix I for an ex-ample of a chart to document educational relevance.)

Evaluate Results and Make Recommendations

Many factors affect a child’s learning. Some ofthese include quality of instruction; emotional status;home environment/support; family attitudes towardschool services; composition of the classroom; charac-teristics of the teacher; educational history; and thestudent’s planning, attention, and simultaneous andsequential processing abilities. The student’s commu-nication competence is evaluated in the context of thestudent’s history and educational environment. Allaspects of the assessment and evaluation are docu-mented within the evaluation report. The speech andlanguage information may be written in a self-contained communication report or may be includedin a unified team report. The report interprets, sum-marizes, and integrates all relevant information thathas been gathered, and describes the student’s presentlevel of functioning in all speech, language, and hear-ing areas and the relationship to academic, social-emotional, and/or vocational performance.

The evaluation report serves as the basis for theteam’s discussion of alternatives and recommenda-tions. It includes the following information:

• student history information from record reviewand parent, teacher, and/or student interview

• date(s) of assessment(s)• relevant behaviors noted during observation• assessment information from all disciplines• observation/impressions in a variety of com-

munication settings• results of previous interventions• descriptive assessment results• standardized assessment results and docu-

mentation of any variations from standardadministration

• discussion of student’s strengths, needs, andemerging abilities

• disorder/delay/difference determination, in-cluding the student’s communication abilitieswithin the context of home and community

• severity rating (when applicable)• educational relevance, including academic,

social-emotional, and vocational areas• interpretation/integration of all assessment

data


• evaluation results and recommendations forstrategies, accommodations, and modifications

Specific Evaluation ConsiderationsWhen interpreting the assessment data, consider-

ation is given to the effect of specific factors influenc-ing the results of the communication evaluation.Numerous relevant factors follow in alphabetical or-der.

Age

Chronological age and developmental level areconsidered during assessment and evaluation. School-based speech-language pathologists assess individu-als from birth through age 21. The validity ofstandardized tests varies among instruments andacross age levels. Careful observation and use ofnonstandardized procedures assure a balanced as-sessment whether the assessment is conducted withinfants and toddlers, preschool and/or elementaryschool children, or secondary school adolescents.Dynamic and authentic assessment data for all agelevels provide information on the student’s functionalabilities or needs and potential to learn.

Speech-language pathologists involved in infant/toddler and preschool assessment should have anunderstanding of the health issues and effects of hos-pital stay on the child and the family, have access to acomplete medical history, communicate with medicalpersonnel, and should interview an affected child’sfamily as part of a family-based assessment so that adetailed developmental history can be obtained.School-based speech-language pathologists chargedwith responsibility for early identification and pre-school students need to be sensitive to the wide varia-tion in family systems and interactive stylessurrounding successful communication and languagedevelopment, as well as have knowledge of all aspectsof “normal” development. With respect to assessmentand evaluation, speech-language pathologists assumethe ongoing monitoring of a child’s communication,language, speech, and oral-motor development. Be-cause young children change rapidly and families re-spond differently to their children at various periodsin development, speech-language pathologists devisesystematic plans for periodic evaluation of progress(ASHA, 1989b).

Comprehensive evaluation of school-age childrenand adolescents includes assessment of the under-standing and use of both oral and written language,including pragmatic abilities (Damico, 1993; Nippold,1993). Intervention strategies reflect the student’schanging developmental stages and language needs/proficiencies throughout elementary and secondaryeducational programs (Larson, McKinley, & Boley,

1993; Nelson, 1998; Work, Cline, Ehren, Keiser, &Wujeck, 1993).

Attention

Attentional behaviors and activity levels differacross ages, genders, and cultural background (ASHA,1997e). The student’s ability to focus and attend dur-ing the assessment is considered when evaluating theresults of the assessment. The effectiveness of modifi-cations used during an assessment are documented.Information about the type and extent of variation fromstandard test conditions is included in the evaluationreport. This information is used by the team to evalu-ate the effects of variances on validity and reliabilityof the reported information.

Speech-language pathologists and audiologistsare increasingly involved with students with attentiondeficit hyperactivity disorders (ADHD). These profes-sionals are often among the first to assist in the evalu-ation of students and youth suspected of having ADHDbecause of its co-occurrence with language learningdisabilities and central auditory processing disorders(ASHA, 1997f).

Attention deficit hyperactivity disorder is asyndrome characterized by serious and persistentdifficulties in terms of inattention and hyperactivity-impulsivity. According to the Diagnostic and StatisticalManual (DSM-IV) of the American Psychiatric Associa-tion (1994), to confirm a diagnosis of ADHD, at leastsix characteristics within either category “must havepersisted for 6 months to a degree that is maladaptiveand inconsistent with developmental level” (p. 84).10

An inattentive student may not exhibit hyperac-tive or impulsive characteristics and, therefore, may beoverlooked in the classroom. That student may be athigher risk for educational failure than the studentwith hyperactive and/or impulsive tendencies be-cause the student’s needs are not apparent.

Some professionals assert that hyperactive/impul-sivity behaviors may not be due to inattention butcaused instead by poor inhibition or poor self-regula-tion (Barkley, 1990; Westby, 1994). This may be relatedto executive function, which is discussed further inASHA’s technical report on ADHD (1997f).

A diagnosis of ADHD is made by medical profes-sionals only after ruling out other factors related tomedical, emotional, or environmental variables thatcould cause similar symptoms. Therefore, physicians,psychologists, educators and speech-language pa-

10 The previous edition, DSM-III, made a distinction be-tween undifferentiated attention deficit disorder (ADD)and ADHD. DSM-IV uses ADHD with the two subcat-egories noted above.


thologists conduct a comprehensive evaluation, whichincludes medical studies, psychological and educa-tional testing, speech-language assessment, neurologi-cal evaluation, and behavioral evaluations compiledby both the parent and teacher(s). The student’s per-formance should be assessed across multiple domainsin multiple settings by several persons. A differentialdiagnosis is difficult because of the complex interac-tion existing between ADHD and cognitive,metacognitive, linguistic, social-emotional, andsensori-integrative abilities.

Central Auditory Processing

A central auditory processing disorder (CAPD) isan observed deficiency in sound localization and lat-eralization, auditory discrimination, auditory patternrecognition, temporal aspects of audition, use of audi-tory skills with competing acoustic signals, and useof auditory skills with any degradation of the acous-tic signal (ASHA, 1995a). CAPD may affect languagelearning and language use as well as cognitive lan-guage processing areas (e.g., attention, memory, prob-lem solving, and literacy). According to Chermak, “Thebehavioral profiles of students with CAPD, specificlearning disabilities and ADHD often overlap, asmight be expected given the complex interactionsamong auditory processing, language skills, cognition,and learning” (1995, p. 208). CAPD may be evident incombination with other disabilities, making differen-tial diagnosis difficult.

The assessment of central auditory processingdisorders (CAPD) is a crossover area between the twoprofessions of audiology and speech-language pathol-ogy and requires a cooperative effort among parents,teachers, speech-language pathologists, audiologistsand other professionals for a successful outcome.Speech-language pathologists contribute to the assess-ment process by formally evaluating receptive lan-guage and phonemic processing skills and bydocumenting observed auditory processing behaviors.This information is used by the audiologist to augmentthe formal central auditory processing assessment bat-tery (Keith, 1995). ASHA has established preferred prac-tice patterns in CAPD assessment and treatment forboth professions (ASHA, 1997d, 1997e). The currentdevelopments in CAPD are described in Central Audi-tory Processing: Current Status of Research and Implica-tions for Clinical Practice (ASHA, 1995a).

Cognitive Factors

Cognition and language are intrinsically and re-ciprocally related in both development and function.An impairment of language may disrupt one or morecognitive processes; similarly, an impairment of oneor more cognitive processes may disrupt language.

Cognitive-based impairments of communication arereferred to as cognitive-communication impairmentsand are disorders that result from deficits in linguisticand nonlinguistic cognitive processes. They may beassociated with a variety of congenital and acquiredconditions (ASHA, 1988; 1991b). Speech-languagepathologists are integral members of interdisciplinaryteams engaged in the identification, diagnosis, andtreatment of persons with cognitive-communicationimpairments (ASHA, 1987).

The role of the school speech-language patholo-gist in evaluating the communication needs of stu-dents with cognitive-communication impairmentsis delineated in the Guidelines for Speech Language Pro-grams (Connecticut State Department of Education,1993, pp. 90–91). Examples include:

• collaborating with families, teachers, and oth-ers in locating and identifying children whosecommunication development and behaviormay suggest the presence of cognitive impair-ments or whose communication impairmentsaccompany identified cognitive impairments

• collaborating with other professionals to inter-pret the relationship between cognitive andcommunication abilities

• assessing communication requirements andabilities in the environments in which the stu-dent functions or will function (Cipani, 1989)

• assessing the need for assistive technology incollaboration with audiologists including alter-native/augmentative communication systemsand amplification devices (Romski, Cevcik, &Joyner, 1984; Flexer, Millin, & Brown, 1990,Baker-Hawkins & Easterbrooks, 1994).

Cultural and/or Linguistic Diversity

The demographics of our society are changingrapidly and dramatically. The number of studentswith cultural and/or linguistic diversity is increasingin school systems across the nation, especially in largecities. In some states, over 40% of residents come fromculturally and linguistically diverse backgrounds(California Speech-Language-Hearing Association,1996). It has been estimated that in the near future one-third of the U.S. population will consist of racial andethnic minorities [IDEA Section 601(7)(A-D)]. TheAmerican Speech-Language-Hearing Association’sposition paper on social dialects (ASHA, 1983) empha-sizes the role of the speech-language pathologist indistinguishing between dialects or differences anddisorders. Additionally, the Office of MulticulturalAffairs has developed a related reading list on thistopic (ASHA, 1997a).


Responsibilities relating to assessment of studentswith culturally and linguistically diverse backgroundsinclude:

• reviewing the student’s personal history, in-cluding cultural, linguistic, and family back-ground

• assisting instructional staff in differentiatingbetween communication disorders and cultur-ally or linguistically based communication dif-ferences

• determining difference/disorder distinctions ofa dialect-speaking student and recommendingintervention only for those features or charac-teristics that are disordered and not attributableto the dialect

Limited English Proficiency

School-based speech-language pathologists playan important role in determining appropriate identifi-cation, assessment, and academic placement of stu-dents with limited English proficiencies (Adler, 1991;ASHA, 1998f). Prereferral interventions usingInterventinon Assistance Teams are used to addressstudent, teacher, curriculum, and instruction issues(Garcia & Ortiz, 1988). The differing mores, culturalpatterns, and—particularly—the linguistic behaviorsof these students require input from their family mem-bers and a culturally sensitive and competent team ofprofessionals, which may include bilingual speech-language pathologists, teachers, English as a secondlanguage (ESL) staff, interpreters/translators, and/orassistants (Cheng, 1991; Langdon, Siegel, Halog, &Sanchez-Boyce, 1994; Leung, 1996). Many speech-language pathologists are trained to distinguish stu-dents who have a communication disorder in their first(also called home or native) language (L-1) from stu-dents who may be in the process of second language(L-2) acquisition. The speech-language pathologistwho has not had such training must seek consultationwith knowledgeable individuals.

In order to effectively distinguish difference fromdisorder in bilingual children, it is important forspeech-language pathologists to understand the firstas well as the second language acquisition process andto be familiar with current information available onmorphologic, semantic, syntactic, pragmatic, and pho-nological development of children from a non-English language background. Assessment includesmeasuring both social language and academic lan-guage abilities. Proficiency in social language maydevelop within the first 2 years of exposure to English;it may take an additional 5 years for academic languageproficiency to develop. Basic interpersonal communi-cation skills (BICS) are the aspects of language associ-

ated with the basic communication fluency achievedby all normal native speakers of a language (sociallanguage). Cognitive academic linguistic proficiency(CALP), on the other hand, relates to aspects of lan-guage proficiency strongly associated with literacy andacademic achievement (Cummins, 1981).

Approximately 200 languages are spoken in theUnited States (Aleman, Bruno, & Dale, 1995). Withineach group of students whose first language is otherthan English, there is also a continuum of proficiencyin English (ASHA, 1985a). In evaluating speakers oflanguages other than English, some of whom may beaccustomed to more than two languages, the con-tinuum is particularly relevant. The continuum ofEnglish language learners includes speakers who fallwithin the following designations:

• bilingual English proficient (proficient in L-1and L-2)

• limited English proficient (proficient in L-1, butnot L-2)

• limited in both English and the primary lan-guage (limited in L-1 and L-2)

A further caution regarding bilingual evaluationis that if a test was not normed on bilingual or limited-English-proficient students, then the test norms maynot be used for a bilingual or limited-English-proficientstudent (Langdon & Saenz, 1996). Responsibilitiesrelated to bilingual assessment may include:

• serving as a member of the interdisciplinaryprereferral team when there is concern about alimited-English-proficient student’s classroomperformance

• seeking collaborative assistance from bilingualspeech-language pathologists, qualified inter-preters, ESL staff, and families to augment thespeech-language pathologist’s knowledge base(ASHA, 1998f)

• teaming with a trained interpreter/translator togather additional background information,conduct the assessment, and report the resultsof assessment to the family (Langdon et al.,1994)

• compiling a history including immigrationbackground and relevant personal life historysuch as a separation from family, trauma orexposure to war, the length of time the studenthas been engaged in learning English, and thetype of instruction and informal learning op-portunities (Cheng, 1991; Fradd, 1995)

• gathering information regarding continuedlanguage development in the native languageand current use of first and second language


• providing a nonbiased assessment of commu-nication function in both the first (native/homelanguage) and second language of the student(Note: IDEA Section 612(a)(6)(B) requires as-sessment in “the child’s native language ormode of communication unless it clearly is notfeasible to do so.”)

• evaluating both social and academic languageproficiency

Hearing Loss and Deafness

In the United States, more than 1.2 million childrenunder 18 years of age have either a congenital or anacquired hearing loss (Adams & Marano, 1995). Theultimate academic and social outcomes for these stu-dents depend on the coordinated efforts of many indi-viduals, including but not limited to, the student,parents, classroom teachers, the audiologist, and thespeech-language pathologist. A teacher of the deaf andhard of hearing, a speech-language pathologist, or anaudiologist often serves as the coordinator of servicesand liaison for the parents and student to the schoolsystem. The heterogeneous population of childrenwith hearing loss or deafness encompasses a broadrange of functional communication styles and abilitiesand types of services ranging from students in regulareducation classes requiring support services to stu-dents attending a school for the deaf. The relationshipthat exists between a child’s and family’s choice ofcommunication systems and his/her ability to developa language or languages in one or more communica-tion modalities varies among children (ASHA, 1998c).

When a student has a hearing loss, the methodschosen for development of language skills are relatedto such factors as:

• age of onset of the hearing impairment• type/severity of hearing loss• availability and use of residual hearing• presence of additional disabilities• access to assistive technology (computer-

assisted real-time captioning, hearing aids, FMsystems) and interpreters/translators (sign,ASL, cued speech)

• level of acceptance, skills, and support by fam-ily, educators, and peers

• acoustic environment of the classroom andother spaces used for instruction and extracur-ricular activities

Numerous reports and studies document theeffects of hearing loss on speech, language, social-emotional, and academic development (Baker-Hawkins & Easterbrooks, 1994, Kretschmer &Kretschmer, 1978, Maxon & Brackett, 1987, Quigley &

Kretschmer, 1982). Even students with mild, fluctuat-ing, or unilateral hearing loss often exhibit significantacademic delays and grade failure (Bess et al., 1998;Connecticut Advisory School Health Council, 1988;Davis, Elfenbein, Schum, & Bentler, 1986; GallaudetUniversity Center for Assessment and DemographicStudy, 1998; Joint Committee on Infant Hearing, 1994;Oyler, Oyler, & Matkin, 1988).

The Agency for Health Care Policy and Researchreports that the most common etiology of temporaryand fluctuating hearing loss in children from birth to3 years of age is otitis media, which can be acute orchronic and may occur with or without effusion (U. S.Department of Health and Human Services, 1994). Notall children who experience otitis media have signifi-cant hearing loss or develop subsequent communica-tion and learning problems. However, the prevalenceof otitis media (especially chronic otitis media) duringwhat is known to be a significant period in the acqui-sition of communication skills places children exhib-iting this illness at risk for delay or disorder of speechand oral language that may adversely affect educa-tional performance (Friel-Patti, 1990; Roberts, 1997;Roberts & Medley, 1995).

In cooperation with audiologists who serve chil-dren in educational settings, the responsibilities of theschool speech-language pathologist in assessing thecommunication needs of children with hearing lossmay include:

• collaborating with audiologists and promotingearly detection of children with hearing loss

• conducting hearing screenings for identifica-tion of children who can participate in condi-tioned play or traditional audiometry andreferral of individuals with possible ear disor-der or hearing loss to audiologists for follow-up audiologic assessment (ASHA, 1998b)

• collaborating with health professionals andaudiologists to integrate case history andaudiologic information into speech-languageassessments

• identifying the communication demands of thevarious settings in which the child functions(Creaghead, 1992; Palmer, 1997)

• daily trouble shooting and hearing aid andassistive listening device maintenance in theeducational setting

• collaborating with audiologists regarding lan-guage assessment of students with suspectedcentral auditory processing disorders

• monitoring speech and language developmentand related educational performance of stu-dents with known histories of chronic otitis


media and students with unilateral hearingloss

• collaborating with other professionals to evalu-ate language performance levels and identifycommunication disorders, if present

• providing aural rehabilitation and sign lan-guage development (if competent to do so) (Con-necticut State Department of Education, 1993;English, 1997)

Neurological, Orthopedic, and Other Health Factors

The neurophysiological systems underlyingspeech and language development are particularlyvulnerable to organic insults that may produce paraly-sis, weakness, or discoordination. Students with con-genital or acquired neurological, orthopedic, or certainhealth impairments (e.g., TBI) frequently exhibit com-munication impairments in one or more of the areas oflanguage, articulation/phonology, fluency, voice,resonance, oral motor function, swallowing, or cogni-tive communication. These deficits may range frommild to severe, with variations in severity over time. Theage of onset of the neurological or other physicalimpairment, as well as its locus and nature, will affectthe type of communication impairment that thestudent exhibits. Although the primary basis of thesedisorders may be structural, environmental influenceson communication development can also be signifi-cant—the result of limitations on environmental inter-action. The multidimensional nature of theseimpairments requires the development of comprehen-sive interdisciplinary programs for evaluation andservice (Connecticut State Department of Education,1993).

The responsibilities of the school speech-languagepathologist in evaluating the communication needs ofstudents with neurological, orthopedic, other healthimpairments, or multiple impairments include:

• promoting early identification of childrenwhose communication development and be-havior may suggest the presence of neurologic,orthopedic, other health, or multiple impair-ments

• collaborating with other professionals to inte-grate medical history into speech-language as-sessment

• collaborating with other professionals in theassessment of prespeech skills in the areas ofmotor development, respiration and feeding,and in assessing the effect of the impairment oncommunication development and interactions

• assessing the communication requirements ofhome, school, and vocational settings

• assessing the need for assistive technology topromote communication development and in-teraction (Connecticut State Department ofEducation, 1993)

Social-Emotional Factors

Communication is an important tool in creatinga secure and safe school environment that fosterslearning for all students. Speech, language, and listen-ing skills provide the communication foundationfor the development and enhancement of confidenceand self-esteem in learners. Giddon (1991) emphasizesthe need for expanding the role of the school-basedspeech-language pathologist in mental health issuesand behavioral management as part of the team,specifically to assist with communication issues andinsights.

Responsibilities when assessing a student withdysfunctional social-emotional communication in-clude:

• participating as a member of a team thatassesses students at risk for communication-related education problems

• collaborating with other professionals andfamilies in an effort to differentiate difficultbehaviors that may be due to psychosocialdisorders from those related to communicationimpairments (e.g., misunderstanding orallypresented information and using aggression inthe absence of appropriate communication)

• assisting educators in identifying behaviorpatterns that may be related to language dys-function as well as identifying behavior thatnegatively affects communication (e.g., selectivemutism)

• assisting in assessment of communication de-mands and interactions within various envi-ronments to determine factors that maycontribute to breakdowns in learning or inter-personal relations (Connecticut State Depart-ment of Education, 1993)

Eligibility DeterminationComprehensive assessment (data collection) and

evaluation (interpretation of that data) enable thespeech-language pathologist to identify students withsignificant educationally relevant communicationdisorders. As part of the eligibility determination forspecial education and related services, the speech-language pathologist who has identified the student’sspeech-language needs and the team address therelationship between the student’s speech and lan-guage disabilities and any adverse effect on the abilityto learn the general curriculum, including academic,


social-emotional, or vocational areas. The team relieson the evaluation results to determine both a student’sneed for service and the student’s eligibility for specialeducation and related services on the basis of federallegislative mandates, state regulations and guidelines,and local policies and procedures.

The definition of speech or language impairmentat the federal level appears in IDEA: “a communica-tion disorder, such as stuttering, impaired articulation,a language impairment or a voice impairment thatadversely affects a child’s educational performance”[Section 300.7 (b)(11)]. State codes may establish eligi-bility criteria for each area of speech and language, forspecific age groups (e.g., infants, preschoolers), andconsiderations for culturally/linguistically different oreconomically disadvantaged students.

School-based speech-language pathologists areresponsible for obtaining and following their state eli-gibility criteria. States may use different indicators forclassification of mild, moderate, severe, or profound.Differing state criteria may result in variations in eli-gibility decisions, recommended amount of service,and service delivery options. Local procedures mayfurther define severity levels and eligibility criteria.

For general eligibility and dismissal consider-ations, school-based speech-language pathologistsmay also refer to the ASHA technical reports, includ-ing Issues in Determining Eligibility for Language In-tervention (1989c) and Admission/Discharge Criteriain Speech-Language Pathology (1994a).

IEP/IFSP DevelopmentAn individualized education program (IEP) is

developed for students (age 3 or older) who qualify forspeech and/or language services. The IDEA Amend-ments of 1997 added new requirements for the compo-sition of the IEP team, detailed several special factorsfor the development of the IEP, and expanded specificrequired components [Section 614].

The IEP document is developed by the total IEPteam, including the speech-language pathologist asappropriate. The IEP team includes:

• “the parents of a child with a disability• “at least one regular education teacher of such

child (if the child is, or may be, participating inthe regular education environment)

• “at least one special education teacher or,where appropriate, at least one special educa-tion provider of such child

• “a representative of the local educational agencywho—

—“is qualified to provide, or supervise the pro-vision of, specially designed instruction to meetthe unique needs of children with disabilities—“is knowledgeable about the general curricu-lum—“is knowledgeable about the availability ofresources of the local educational agency

• “an individual who can interpret the instruc-tional implications of evaluation results. . .

• “other individuals. . . who have knowledge orspecial expertise regarding the child, includingrelated services personnel as appropriate

• “whenever appropriate, the child with a dis-ability” [Section 614(d)(1)(B) (i-vii)]

Special factors in developing the IEP content in-clude:

• “in the case of a child whose behavior impedeshis or her learning or that of others, consider,when appropriate, strategies including positivebehavioral interventions and supports to ad-dress that behavior

• “in the case of a child with limited English pro-ficiency, consider the language needs of thechild as such needs relate to the child’s IEP

• “in the case of a child who is blind or visuallyimpaired, provide for instruction in Braille andthe use of Braille unless the IEP team deter-mines—after an evaluation of the child’s read-ing and writing skills, needs, and appropriatereading and writing media (including an evalu-ation of the child’s future needs for instructionin Braille)—that the use of Braille is not appro-priate for the child

• “consider the communication needs of thechild; and in the case of a child who is deaf orhard of hearing, consider the child’s languageand communication needs, opportunities fordirect communications with peers and profes-sional personnel in the child’s language andcommunication mode, academic level, and fullrange of needs, including opportunities for di-rect instruction in the child’s language andcommunication mode

• “consider whether the child requires assistivetechnology devices and services” [Section614(d)(3)(B)(i-v)]

The IEP includes the components listed in Table 4.


Table 4. Required Components of IEP.

Strengths The strengths of the child and the concerns of the parents for enhancing theeducation of their child

Evaluation results The results of the initial evaluation or the most recent evaluation

Present level of The effect of the student’s disability on the involvement and progress in theeducational general education curriculum (or participation in appropriate preschoolperformance activities)

Annual goals and Measurable goals, benchmarks, or objectives related to meeting generalshort-term objectives education curriculum or other educational needs that result from the disability

Amount of special Projected beginning date, frequency, and duration of serviceeducation or relatedservices

Supplementary aids Program modifications or support services necessary for the student to advanceand services toward attaining annual goals, be involved and progress in the general education

curriculum, participate in nonacademic activities, and be educated and participatein activities with other students with and without disabilities

Participation with Extent of participation with students without disabilities in the generalstudents without education class and in extracurricular activitiesdisabilities

Test modifications Modifications in the administration of state- or district-wide assessments ofstudent achievement that are needed in order for the student to participate in theassessment (If exempt, the reason the test is not appropriate must be stated.)

Transition service At age 14, transition services that focus on a student’s courses of study. At age 16,transition services specify interagency responsibilities or needed community links

Notification of Documentation that the student has been informed of the rights that willtransfer of rights transfer to the student upon reaching the age of majority under state law (must

notify at least one year before the student reaches that age of majority)

Evaluation Measures of the student’s progress (e.g., criterion-referenced test, standardizedprocedures and test, student product, teacher observation, or peer evaluation) and how often themethod of evaluation will take place (e.g., daily, weekly, monthly, each grading period/measurement semester, or annually). Progress must be reported as often as progress is reported

for general education students.

IEP team members Signatures of all members of the IEP team that developed the IEP

Source: Section 614d(3)(A)(i-ii), 614d (1)(A)(i-viii)


The IEP is reviewed at least annually (or moreoften to reflect program changes). The IEP must be ineffect at the beginning of each school year.

For each IDEA-eligible infant and toddler (under3 years of age), an Individualized Family Service Plan(IFSP) is required. The IFSP must be developed at anIFSP meeting held within mandated time lines. Speech-language pathologists are responsible for being famil-iar with the required procedures for the developmentand review of the IFSP [Section 636]. Speech-languagepathologists who work with infants and toddlers areinvolved in ensuring that the child’s communicationneeds are addressed on transition to preschool ser-vices under IDEA.

Caseload ManagementThe role of the school-based speech-language pa-

thologist is to assist the team in selecting, planning,and coordinating appropriate service delivery andvarious scheduling options throughout the durationof services—not just for initial placement decisions.

If the speech-language pathologist serves as thecase manager for any student identified as needingspecial education and or related services, the respon-sibilities of the speech-language pathologist may in-clude:

• scheduling and coordinating both school-basedand community assessments

• assuming a leadership role in developing theIEP/IFSP

• assisting families in identifying available ser-vice providers and advocacy organizationswithin the community

• coordinating, monitoring, and ensuring timelydelivery of special education and/or relatedservices

• scheduling and coordinating the re-evaluationprocess

• facilitating the development of transition plans• coordinating services or providing consultation

for students in charter schools and privateschools (ASHA, 1989b)

Service Delivery Options

Recommendations regarding the nature (direct orindirect), type (individual or group), and location ofservice delivery (speech-language resource room,classroom, home, or community) are based on the needto provide a free, appropriate public education for eachstudent in the least-restrictive environment and con-sistent with the student’s individual needs as docu-mented on the IEP. Considerations include:

• strengths, needs, and emerging abilities• need for peer modeling• communication needs as they relate to the gen-

eral education curriculum• need for intensive intervention• effort, attitude, motivation, and social skills• severity of the disorder(s)• nature of the disorder(s)• age and developmental level of the student

The 18th Annual Report to Congress on the Imple-mentation of the Individuals with Disabilities Educa-tion Act stressed the importance of providing a fullcontinuum of services for students with disabilities.The report specifies that there is no single special edu-cation setting that benefits all students. A range ofoptions, tailored to meet the individual needs of allstudents, continues to be the most effective approach(U. S. Department of Education, 1996).

The Department of Education recommendation isconsistent with ASHA’s position statement on inclu-sive practices, which states that “an array of speech,language, and hearing services should be available ineducational settings to support children and youthswith communication disorders” (1996b, p. 35). Theinclusive practices philosophy emphasizes serving stu-dents “in the least restrictive environment that meetstheir needs optimally” (p. 35). See Table 5 for an ex-planation of service delivery options. During thecourse of intervention, a student might participate inseveral service delivery models before dismissal.

Scheduling Students for Intervention

An ongoing caseload management responsibilityof the school-based speech-language pathologist is todetermine the most effective use of time and services.Intensity and duration of service for a student are basedon such factors as the:

• nature and severity of speech-language disor-ders

• impact on educational performance• student’s academic program• student’s involvement in other special educa-

tion programs• additional support systems available• levels of service to be given• provision for consultative service

Additional considerations that affect the speech-language pathologist’s schedule include:

• time for screening, testing, test interpretation,report writing, team meetings, case manage-ment, and conferences


• collaboration/consultation and planning time• master schedule (e.g., lunch, music, school-

wide activities)• special schedule considerations (e.g., half-day

kindergarten, block schedules)• number of schools served• travel between schools• availability of appropriate facility/location for

services (U. S. Congress, 1990a)• programming of AAC devices and planning for

and training parents and educators in the useof assistive technology

• continuing education

Caseload Size

The Guidelines for Caseload Size and Speech-Language Service Delivery in the Schools (ASHA,1993b) delineate many considerations to be observed

in determining caseload size, including roles and re-sponsibilities of the speech-language pathologist, ageand severity of students, and service delivery models.The following statement from that ASHA documentprovided recommendations for caseload size in 1993;however, changes in student population and IDEArequirements should also be considered in determin-ing appropriate caseload size today.

“Caseload size must reflect a balance betweenhow many hours are available in the school day forservices to students, and how many hours are neededto complete paperwork, staffing, and other requiredactivities. The recommended maximum caseload forappropriate services is 40 students, regardless of thetype or number of service delivery models selected.Special populations may dictate fewer students on thecaseload. A recommended maximum caseload com-posed entirely of preschoolers is 25. Other populationsthat may require additional time, and therefore fewer

Table 5. Service Delivery Options.

Service delivery is a dynamic concept and changes as the needs of the students change.

No one service delivery model is to be used exclusively during intervention.

For all service delivery models, it is essential that time be made available in the weekly schedule for collabo-ration/consultation with parents, general educators, special educators and other service providers.

Monitor: The speech-language pathologist sees the student for a specified amount of time per grading period tomonitor or “check” on the student’s speech and language skills. Often this model immediately precedes dis-missal.

Collaborative Consultation: The speech-language pathologist, regular and/or special education teacher(s), andparents/families work together to facilitate a student’s communication and learning in educational environ-ments. This is an indirect model in which the speech- language pathologist does not provide direct service to thestudent.

Classroom-Based: This model is also known as integrated services, curriculum-based, transdisciplinary, interdis-ciplinary, or inclusive programming. There is an emphasis on the speech-language pathologist providing directservices to students within the classroom and other natural environments. Team teaching by the speech-lan-guage pathologist and the regular and/or special education teacher(s) is frequent with this model.

Pullout: Services are provided to students individually and/or in small groups within the speech-language re-source room setting. Some speech-language pathologists may prefer to provide individual or small group ser-vices within the physical space of the classroom.

Self-Contained Program: The speech-language pathologist is the classroom teacher responsible for providing bothacademic/curriculum instruction and speech-language remediation.

Community-Based: Communication services are provided to students within the home or community setting.Goals and objectives focus primarily on functional communication skills.

Combination: The speech-language pathologist provides two or more service delivery options (e.g., provides indi-vidual or small group treatment on a pullout basis twice a week to develop skills or preteach concepts and alsoworks with the student within the classroom).Sources: ASHA, 1993b, 1996b


students on the caseload, include students who aretechnologically dependent, medically fragile, multilin-gual or limited-English proficient. Some states limit thenumber of students in self-contained classrooms. Eightstudents without a support person, or 12 students witha support person, are the recommendations for thistype of setting” (ASHA, 1993b).

Intervention for Students WithCommunication Disorders

Speech-language pathology services may be pro-vided for students with speech, language, or commu-nication disorders as defined by the evaluation and

eligibility criteria established within federal mandates,state guidelines, and local policies and procedures forspecial education and related services.

Students receive intervention when their ability tocommunicate effectively is impaired (or their diagno-sis indicates risk for impairment) and there is reasonto believe that intervention will reduce the degree ofimpairment, disability, or handicap and lead to im-proved communication behaviors (ASHA, 1997e).Established IEP goals and objectives are implementedfor students who qualify for services under IDEAthrough direct and/or indirect services to facilitate theachievement of the stated objective criteria. Interven-

Table 6. Methods for Effective Intervention.

Responsibilities Methods

Planning intervention Determine priority areas for interventionDetermine content to meet goals and objectivesSelect appropriate materialsDetermine intervention methods based on student learning styles

Managing intervention Establish classroom management systemEstablish positive environmentUse time productivelyCommunicate realistic expectationsCoordinate curricula and goals with other educational staff, parents/familiesMotivate students

Delivering intervention Present instructionPromote problem-solving and thinking skillsProvide relevant practice of skills taughtProvide opportunity for communication in the natural environmentKeep students actively involvedProvide feedbackPrompt/cue as appropriate during guided learning

Evaluating intervention Monitor engaged timeMonitor student understandingMake judgments about student performanceMaintain records of student progressInform students, parents, and teachers of progressUse treatment outcomes data to make decisionsDetermine effect on classroom performanceModify instruction

Based on the work of Algozzine, B., & Ysseldyke, J., 1997. Strategies and Tactics for Effective Teaching. Adapted withpermission.


tion, aimed at achieving functional communicationoutcomes, is provided through various methods andtechniques. Just as evaluation decisions are based ona thorough understanding of speech and languagedevelopment and the processes of communication, sotoo are intervention decisions.

It is beyond the scope of this document to describespecific techniques for intervention. Entire universitycourses and texts, professional institutes and semi-nars, professional literature and articles, ASHA Spe-cial Interest Divisions, and Web sites are devoted tointervention techniques for specific deficits and disor-ders within each speech and language area. Commer-cially published materials for remediation of speech,language, and communication disorders, when appro-priately selected to match student needs, are additionaluseful tools to help students meet their goals and ob-jectives. It is the responsibility of the speech-languagepathologist to keep current on intervention methodsreflecting best practices in speech-language pathology.

General Intervention Methods

Speech-language pathologists benefit from the lit-erature produced by effective schools research.Christenson and Ysseldyke (1989) identified 10 factorswithin the four components of effective teaching: plan-ning, managing, delivering, and evaluating instruc-tion. Algozzine and Ysseldyke (1997) expanded thatwork by delineating numerous “effective” strategiesand specific tactics (activities) that teachers couldimplement. These strategies are used for teacher train-ing, as well as by Intervention Assistance Teams.

School-based speech-language pathologists relyon principles of effective intervention when workingwith students who have disorders within all areasencompassed by ASHA’s Scope of Practice in Speech-Language Pathology (1996c). Table 6 outlines respon-sibilities for intervention that include planning,managing, delivering, and evaluating intervention.These general methods facilitate effective interventionfor students.

During intervention, the speech-language patholo-gist communicates with parents, families, educators,and other community professionals to reinforce IEP/IFSP goals at home and in the classroom, facilitate gen-eralization of communication abilities, and monitorthe student’s progress. Speech-language pathologistsmay also provide information concerning the charac-teristics of the classroom environment conducive tocommunication development. Classroom or indi-vidual accommodations or modifications may be sug-gested related to seating and positioning; timedemands; pragmatic/social language; organizationalor note-taking skills; assistive technology devices, sys-tems, or services; and materials that may assist the stu-

dent in communicating more effectively in the schoolenvironment.

Scope of Intervention

Speech-language pathology is a dynamic and con-tinuously developing practice area. The scope of prac-tice should not be regarded as all-inclusive; that is, itdoes not necessarily exclude new or emerging areas.

ASHA’s Scope of Practice in Speech-Language Pa-thology includes treatment and intervention (i.e., pre-vention, restoration, amelioration, compensation) andfollow-up services for disorders of:

• “language (involving the parameters of phonol-ogy, morphology, syntax, semantics, and prag-matics; and including disorders of receptiveand expressive communication in oral, written,graphic, and manual modalities)

• “cognitive aspects of communication (includ-ing communication disability and other func-tional disabilities associated with cognitiveimpairment)

• “social aspects of communication (includingchallenging behavior, ineffective social skills,lack of communication opportunities)

• “speech: articulation, fluency, voice (includingrespiration, phonation, and resonance)

• “oral, pharyngeal, cervical esophageal, andrelated functions (e.g., dysphagia, includingdisorders of swallowing and oral function forfeeding; orofacial myofunctional disorders)”(ASHA, 1996c, p. 18)11

Although the components of the Scope of Practiceare listed separately within this document for ease ofdiscussion, each component of communication is in-terconnected with and greatly influences the othercomponents. If there is a deficit in any one area of lan-guage or speech, it may directly influence other areas.

The responsibilities of the speech-language pa-thologist in intervention for all communication disor-ders within the Scope of Practice of Speech-LanguagePathology include:

• reviewing all assessment/evaluation informa-tion

• comparing assessment data with knowledge ofnormal language, speech, and communicationdevelopment

• considering other factors that may have de-pressed communication ability, and addressing

11 The list of disorders has been reordered to follow thetext of this document.


those through intervention, recommending ac-commodations or modifications to the environ-ment, or referring to other health professionals

• selecting materials appropriate to age and de-velopmental level

• applying effective teaching principles (seeTable 6)

• collaborating with parents and education per-sonnel

• observing student responses during interven-tion to determine progress

Following are descriptions of the areas includedin the scope of practice of school-based speech-language pathologists.

Communication. Communication is the process ofexchanging ideas and information through verbal andnonverbal means. It is a complete process for bothspeaker and listener.

According to ASHA, “A communication disorderis an impairment in the ability to receive, send, process,and comprehend concepts or verbal, nonverbal, andgraphic symbol systems. A communication disordermay be evident in the processes of hearing, language,and/or speech. A communication disorder may rangein severity from mild to profound. It may be a develop-mental or acquired disorder. Individuals may demon-strate one or any combination of speech/languagedisorders. A communication disorder may result in a

Table 7. Oral and Written Receptive and Expressive Language Factors.

Listening Speaking Reading WritingReceptive Expressive Receptive Expressive

Form Applies Uses words and Applies Uses words andphonological, sentences correctly graphophonemic, sentences correctlymorphological, in discourse morphological, in writingand syntactic rules according to and syntactic rules according tofor comprehension phonological, for comprehension spelling,of oral language morphological, of text morphological,

and syntactic rules and syntactic rules

Content Comprehends the Selects words and Comprehends the Selects words andmeaning of words uses oral language meaning of words uses writtenand spoken to convey meaning and text language to conveylanguage Formulates meaning

thoughts into oral Formulateslanguage thoughts intoUses precise and written languagedescriptive Uses precise andvocabulary descriptiveUses literal and vocabularyfigurative language Uses literal and

figurative language

Function Follows directions Uses appropriate Understands mood, Follows rules ofUnderstands social language for the tone, style, and discoursemeanings social context context of text Uses various styles

Takes turns in and genres oflistener/speaker writingrole

Cognitive Attention, long- and short-term memory, problem solving, and related componentsCommunicationComponents


primary disability or it may be secondary to other dis-abilities” (1993a, p. 40). A deficit in any of the follow-ing components of language or speech may interferewith communication competence.

Language. Language is a complex and dynamicsystem of conventional symbols that is used in vari-ous modes for thought and communication.

“Contemporary views of human language holdthat:

• Language evolves within specific historical,social, and cultural contexts.

• Language, as rule-governed behavior, is de-scribed by at least five parameters: phonology,morphology, syntax, semantics, and pragmat-ics.

• Language learning and use are determined bythe interaction of biological, cognitive, psycho-social, and environmental factors.

• Effective use of language for communicationrequires a broad understanding of human in-teraction including such associated factors asnonverbal cues, motivation, and socioculturalroles”(ASHA, 1987, p. 54).

Table 7 lists a few examples of communicationbehaviors representative of each language domain andsystem. The table is not intended to be all-inclusive ofthe myriad communicative behaviors that reflect lan-guage knowledge and skills.

“A language disorder is impaired comprehensionand/or use of spoken, written, and/or other symbolsystems. The disorder may involve the form of language(phonology, morphology, syntax), the content of lan-guage (semantics), and/or the function of language incommunication (pragmatics) in any combination”(ASHA, 1993a, p. 40). Intervention is conducted toachieve improved, altered, augmented, or compensatedlanguage behaviors for listening, speaking, reading,and writing (ASHA, 1996c).

Cognitive-Communication. Speech-language pa-thologists provide intervention for both congenital andacquired cognitively based communication impair-ments. The speech-language pathologist concernedwith the management of students with cognitive com-munication disorders assumes responsibility for thor-ough and flexible exploration of relations betweencognitive deficits and their communication conse-quences (ASHA, 1987).

Impairments of cognitive processes may contrib-ute to deficits in the syntactic, semantic, phonologic,and/or pragmatic aspects of language. Speech-language pathologists engage in interventions forcognitive communication impairments such as:

• determining the appropriateness of interven-tion on the basis of potential for functional im-provement in a reasonable and generallypredictable period of time

• selecting or designing appropriate tasks,stimuli, and methods—including such ad-vances as the use of computers and augmenta-tive devices

• implementing individual and group programsspecifically designed to treat cognitive-commu-nication deficits

• training and counseling students, family mem-bers, educators, and other professionals inadaptive strategies for managing cognitive-communication disorders

• recognizing the effects of pharmacologic inter-vention and neurodiagnostic procedures oneach student’s behavior and reporting behav-ioral changes to appropriate physicians

• integrating behavior modification techniques asappropriate for the management of associatedproblems, such as self-abusive and combativebehaviors and agitation

• recommending prosthetic and augmentativecognitive-communication devices (ASHA,1987)

Language and academic success. In addition to theirtraditional roles, school speech-language pathologistshave a growing impact on students’ success frompreschool through adolescence in such areas as en-hancing literacy development and developing social-emotional communication skills. Speech-languagepathologists working in school settings have increas-ingly assumed the role of collaborating with classroomteachers to enhance academic success for all students(ASHA, 1993d; Canady & Krantz, 1996).

Literacy development. Speech-language patholo-gists in the schools have become increasingly awareof the need for expanding their contributions in theareas of reading and writing skills. Butler (1996) em-phasizes the importance of recognizing the complexinterplay between spoken and written language andthe need to go beyond listening and speaking to read-ing and writing. Children’s reading and writing skillshave been found to reflect their oral language compe-tence (Achilles, Yates, & Freese, 1991; Adams, 1990;Canady & Krantz, 1996; Horowitz & Samuels, 1987;Olson, Torrance, & Hildyard, 1985), thereby linkingoral language disorders with specific reading disabili-ties. Research demonstrates that language is continu-ous across both oral and written modalities. One of theobstacles “to skilled reading is a failure to transfer thecomprehension skills of spoken language to reading


and to acquire new strategies that may be specificallyneeded for reading” (National Research Council, 1998,p. 4). Silliman and Wilkinson (1994a) discuss this in-tegration of communication processes as the pathwayto literacy (p. 27). Reading is a complex behavior re-quiring high-level linguistic (semantic and syntactic)abilities as well as decoding skills.

Research has also shown that explicit awarenessof the speech sound system (phonological awareness)is related to early reading development (Blachman,1994; Catts, 1993; Swank & Catts, 1994; Torgeson &Wagner, 1994, Wagner & Torgeson, 1987). Speech-language pathologists’ knowledge of specific interven-tion techniques for phonological deficits enables themto plan and support early intervention programs fo-cusing on training of phonological awareness in pre-school and primary grades (Catts, 1991; Gillam & vanKleeck, 1996). Training in oral and written languageassessment and remediation allows the speech-language pathologist to make valuable contributionsin the intervention of the full range of reading andwriting disabilities (Catts & Kamhi, 1986, 1999; Kamhi& Catts, 1991).

Thus, the speech-language pathologist’s goal is toestablish an environment that allows for maximumpractice and development of all language skills,whether through reading, writing, listening, or speak-ing.

It is the speech-language pathologist’s responsi-bility regarding literacy to:

• collaborate with other school personnel to de-velop emergent literacy and language arts pro-grams that incorporate activities appropriate tothe developmental communication levels ofchildren

• participate in the selection or modification oflanguage arts and instructional strategiescurricula and materials for use in integratinginstruction in reading, writing, listening, andspeaking

• provide information and training regardingthe linguistic bases of reading and writing andthe development of environments and activitiesthat foster the development of literacy skills

• provide information and support for parents ofat-risk children regarding the importance of lit-eracy activities within the home environment

• provide intervention by teaching phonemic,syntactic, morphemic, and semantic aspects oflanguage in both oral and written modalities

• assist in the development of students’ oral andwritten discourse skills

• collaborate with classroom teachers and read-ing professionals to enhance academic successfor children who experience difficulty withreading, writing, listening, and speaking

Social-emotional communication skills. One of themajor identified problems facing American schools isdisruptive, violent, or unacceptable behavior that im-pedes learning not only for the violating student butfor other students in the same classroom (ASHA, 1994i;U.S. Congress, 1993). These students create a threat-ening environment for themselves, classmates, and theschool staff. Language skills are an important ingre-dient in establishing social relationships. Typicallydeveloping children employ their language skills toshare information, express feelings, direct behavior,and negotiate misunderstandings as they interact withothers. Classroom behavior management systems en-couraging students to communicate with their teach-ers and peers are important. Students with speech andlanguage impairments, however, have been shown toexhibit poorer social skills and fewer peer relation-ships than their normally developing peers (Fujiki,Brinton, & Todd, 1997). It is also well documented thatstudents with a range of disabilities involving lan-guage deficits experience significant social difficulties(Antia & Kreimeyer, 1992; Aram, Ekelman, & Nation,1984; Bryan, 1996; Guralnick, 1992). The speech-language pathologist, as a team professional in theschool setting, can contribute to solutions that mayresult in positive change.

The responsibilities specific to developing social-emotional communication skills are to:

• provide information to the instructional staffregarding the role of pragmatics and dynamicsof communication when dealing with social-emotional problems in the school

• assist in the training of educational staff on theeffective use of verbal and nonverbal commu-nication in conflict resolution and discipline

• collaborate with educational staff and parentsto determine the communication intent of thechild’s obvious and subtle behaviors, and tofacilitate the use of socially appropriate commu-nication

• collaborate with the school staff, as a memberof a school peer mediation team, to enhance stu-dents’ self-esteem by increasing their skills aseffective communicators

• demonstrate lessons, team teach, and modeltechniques to enhance pragmatic communica-tion skills in the areas of problem solving, so-cial communication, and coping skills


Table 8. Articulation/Phonology Components.

Phonemic Phonological Oral-Motor

Speech sounds. The rules for the sound system Oral motor range, strength, andCategorized by vowels and of the language, including the set mobility. Planning, sequencing,by consonant manner, place, of phonemes with allowable and co-articulation of speechand voicing. combination and pattern movements.

modifications.

• provide consultative services that address de-velopment of vocabulary to enhance emotionalexpression and control.

Central auditory processing disorders. The speech-language pathologist is the professional who may bemost involved in the management of children withcentral auditory processing disorders (CAPD), particu-larly if recommendations involve direct therapeutictechniques that can best be handled in an individualtherapy situation or if the student exhibits a language-based CAPD that requires more traditional languageintervention. The speech-language pathologist moni-tors the student’s speech and language capabilitiesduring the CAPD intervention process.

Components of a comprehensive CAPD interven-tion program include:

• training and education of key individuals• resources for implementing management sug-

gestions• methods of data collection and research to docu-

ment program efficacy

Intervention leads to improvement in listening,spoken language processing, and the overall commu-nication process. Intervention for students with CAPDincludes:

• auditory training or stimulation• communication and/or educational strategies• metalinguistic and metacognitive skills and

strategies• use of assistive listening devices as recom-

mended• acoustic enhancement and environmental

modification of the listening environment asrecommended

• collaboration with professionals and familiesto increase the likelihood of successfully imple-menting intervention strategies

• family counseling regarding their role in themanagement process (Bellis, 1997)

Speech. Speech disorders may be impairments ofarticulation/phonology, fluency, or voice/resonance.Impairment of any of these categories may have a nega-tive effect on general communication and general edu-cational progress if the disorder is distracting enoughto interfere with the speaker’s message. Assessmentthat identifies specific areas of need assists interven-tion decisions.

Articulation/phonology. Accurate production ofspeech sounds relies on the interplay of phonemic,phonological, and oral-motor systems. See Table 8 forrepresentative aspects of each area.

An articulation or phonological disorder is “theatypical production of speech sounds characterized bysubstitutions, omissions, additions or distortions thatmay interfere with intelligibility” (ASHA, 1993a, p. 40).Children with phonological disorders exhibit errorpatterns in the application of phonological rules forspeech. Intervention is conducted to achieve improved,altered, augmented or compensated speech (ASHA,1997e).

Orofacial-myofunctional treatment is conductedto improve or correct the student’s orofacialmyofunctional patterns and related speech patterns.Orofacial myofunctional intervention may include al-teration of lingual and labial resting postures, muscleretraining exercises, and modification of processingand swallowing solids, liquids, or saliva and may beconducted concurrently with speech-language inter-vention (ASHA 1991d, p 7; 1997e).

Fluency. There are numerous theories concerningthe development of fluent speech. Ramig and Shames(1998) provide a historical review and summarize vari-ous theories about the causation of stuttering. Interven-tion approaches for reducing disfluency address oneor all of the affective, behavioral, and cognitive com-ponents represented in Table 9.

“A fluency disorder is an interruption in the flowof speaking characterized by atypical rate, rhythm, andrepetitions in sounds, syllables, words, and phrases.This may be accompanied by excessive tension,


struggle behavior, and secondary mannerisms”(ASHA, 1993a, p. 40). Stuttering may be viewed as asyndrome characterized by abnormal disfluencies ac-companied by observable affective, behavioral, andcognitive patterns (Cooper & Cooper, 1998).

ASHA’s Preferred Practice Patterns for the Professionof Speech-Language Pathology (1997e) contains informa-tion regarding the roles of the school-based speech-language pathologist in the assessment of studentswho stutter. ASHA’s Guidelines for Practice in Stutter-ing Treatment (1995b) provide additional informationconcerning the assessment and treatment of stuttering.

Responsibilities for students with fluency disordersinclude planning and implementing intervention to:

• reduce the frequency of stuttering• reduce severity, duration, and abnormality of

stuttering behaviors• reduce defensive behaviors• remove or reduce factors that create, exacerbate,

or maintain stuttering behaviors• reduce emotional reactions to specific stimuli

when they increase stuttering behavior• transfer and maintain these and other fluency

producing processes (ASHA, 1995b)

Voice and resonance. Physical, functional, and emo-tional factors are integrated to produce vocal compe-tence (see Table 10). An adequate voice is one that isappropriate for the student’s age and sex and does notcreate vocal abuse.

“A voice disorder is characterized by the abnor-mal production and/or absence of vocal quality, pitch,loudness, resonance, or duration, which is inappro-priate for an individual’s age and/or sex” (ASHA,1993a, p. 40). Intervention for students with voice dis-orders is conducted to achieve improved voice produc-

tion, coordination of respiration and laryngeal valvingto allow for functional oral communication (Andrews,1991; ASHA, 1997e).

All students with voice disorders must be exam-ined by a physician, preferably in a specialty appro-priate to the presenting complaint. The examinationmay occur before or after the voice evaluation by thespeech-language pathologist (ASHA, 1997e).

Students affected by resonance and airflow defi-cits are treated to achieve functional communication.Structural deficits related to these deficits include con-genital palatal insufficiency and/or velopharyngealinsufficiency or incompetence.12 Other resonance andairflow deficits include neuromuscular disorders,faulty learning, or sound specific velopharyngeal in-competence.

The responsibilities related to intervention forvoice and resonance disorders include:

• giving information and guidance to students,teachers and other professionals, and familiesabout the nature of voice disorders, alaryngealspeech, and/or laryngeal disorders affectingrespiration

Table 9. Fluency Factors.

Affective Behavioral Cognitive

Feelings about speaking Respiration Language/linguisticcompetencies

Self-esteem Articulation Accuracy of perceptions

Feelings in response to Phonation Attitudes about speakingenvironmental and situationalinfluences

Feeling of fluency control Rate of speaking Attitudes regarding fluency

Concomitant factors

12Velopharyngeal describes structures or disorders betweenthe soft palate and the back wall of the nasopharynx.When the structures in this area close, it is known asvelopharyngeal closure. This closure takes place duringspeech and swallowing so that the oropharynx is sepa-rated from the nasopharynx by the raising of the softpalate and the moving inward of the walls of the phar-ynx. A failure of this closure is known as velopharyngealincompetence. If the soft palate or vellum fails to reachthe back wall of the pharynx because of damage orbecause it is too short to reach the wall, it is known asvelopharyngeal insufficiency (Morris, 1993).


• providing appropriate voice care and conser-vation guidelines, including strategies that pro-mote healthy laryngeal tissues and voiceproduction and reduce laryngeal trauma orstrain

• discussing goals, procedures, respective re-sponsibilities and the likely outcome of inter-vention

• instructing in the proper use of respiratory,phonatory, and resonatory processes to achieveimproved voice production

Swallowing. Safe swallowing and eating areessential activities of daily living and are needed toensure effective communication. As noted in Table 11,a combination of physical, functional, and healthfactors are considered when determining if interven-tion is appropriate.

“Swallowing function treatment is conducted toimprove the student’s oral, pharyngeal, and laryngealneuromotor function and control and coordination ofrespiratory function with swallowing activities”(ASHA, 1997e, p. 63). The school-based speech-language pathologist may facilitate the student’sability to efficiently chew and swallow more safelyand more efficiently. School-based speech-languagepathologists may integrate swallowing function inter-

vention with communication function intervention(ASHA, 1990b).

Intervention for swallowing disorders mayinclude:

• providing information and guidance to stu-dents, families, and caretakers about the natureof swallowing and swallowing disorders

• consulting and collaborating with medical pro-viders throughout planning and intervention

• training caregivers and educational staff onsafe eating and swallowing techniques

• instructing families, caregivers, and educatorson the social-emotional relationship betweenfeeding/swallowing and educational success.

Intervention for Students With Communication VariationsCultural and/or Linguistic Diversity

“Our nation’s need for multicultural infusionis gaining importance as its population continuesto diversify” (Cheng, 1996). America’s educators aredeveloping alternative strategies to supplement tradi-tional instructional methods for meeting the needs ofculturally and linguistically diverse students (ASHA,1983; 1985a). ASHA recognizes the role of the speech-language pathologist as a resource or consultant to the

Table 10. Voice/Resonance Factors.

Physical Functional Emotional

Respiration: lungs, diaphragm Loudness/intensity, sustained Confidencephonation

Phonation: larynx, vocal folds Pitch, onset of phonation Self-esteem

Resonance: velopharyngeal, Resonance and airflow Stressoral, and nasal resonancestructures

Table 11. Swallowing Factors.

Physical Functional Health

Oral, pharyngeal, esophageal Safe and efficient eating Pulmonary complicationsfunction

Respiratory function Developmental skills for eating Nutritional implications

Gastrointestinal consideration Pleasure of eating, social Modified dietinteraction


classroom teacher. The speech-language pathologistwho has a thorough knowledge of the linguistic rulesof a student’s dialect can assist the classroom teacherin taking the child’s dialect into account in instruction(Cole, 1983).

“Communication difference/dialect is a variationof a symbol system used by a group of individuals thatreflects and is determined by shared regional, social,or cultural/ethnic factors. A regional, social, or cul-tural/ethnic variation of a symbol system should notbe considered a disorder of speech or language”(ASHA, 1993a, p. 41). Responsibilities relating to stu-dents with social dialects include:

• consultation with preschool and elementaryteachers and the student’s family in efforts tobridge the gap between home and school lan-guage for students with social dialect variants

• collaboration with other school personnel todevelop a school environment in which culturaland linguistic diversity are respected and ad-dressed within the curriculum

• consultation with school instructional staff topromote an understanding of social dialects asserving communication and social solidarityfunctions

• consultation with classroom teachers to pro-mote an understanding of specific dialects asrule-governed linguistic systems with distinctphonological and grammatical features as wellas semantic and pragmatic variants

• collaboration with the education staff to assurethat instructional approaches, materials, andactivities are appropriate for the child’s culturaland linguistic differences

• providing in-services to education staffregarding language difference versus languagedisorders (Also see the Office of MulticulturalAffairs related reading list [ASHA, 1997a].)

Limited English Proficiency

Recommendations for classroom and curriculummodifications vary depending on the student’s profi-ciency on the continuum from nonfluent to fluent forboth English and the native language. It is importantfor the speech-language pathologist to understand thebilingual as well as the monolingual language acqui-sition process. It is also important for the school-basedspeech-language pathologist to be familiar with cur-rent norms for the morphological, semantic, syntactic,pragmatic, and phonological development of childrenfrom limited-English proficient backgrounds. Consul-tation with a bilingual speech-language pathologistand other professionals (e.g., ESL instructors, inter-preter/translators, etc.) is recommended (ASHA,

1985a; 1989a; 1998f; see also the Office of MulticulturalAffairs related reading list [ASHA, 1998a]).

Responsibilities relating to intervention forstudents with a primary language other than Englishinclude:

• assisting the classroom teacher in taking thestudent’s language skills into account for in-struction

• assisting the classroom teacher in understand-ing communication style differences in limited-English-proficient populations

• helping students who are eligible for servicesdevelop a command of the structure, meaning,and use of English

• assisting parents with appropriate modelingand use of language stimulation activities

• referring students for additional services orprograms, as appropriate

Students Requiring Technology Support

The school-based speech-language pathologistrecommends support services to classroom teachersin the form of assistive technology and classroomadaptations that will improve communicationopportunities for students and allow them to morefully participate in classroom discourse. “Augmenta-tive and alternative communication systems attemptto compensate and facilitate, temporarily or perma-nently, for the impairment and disability patterns ofindividuals with severe expressive and/or languagecomprehension disorders. Augmentative/alternativecommunication may be required for individuals dem-onstrating impairments in gestural, spoken, and/orwritten modalities” (ASHA, 1993a, p. 41). Augmenta-tive and alternative communication systems, as wellas computer technology, may improve school perfor-mance. The speech-language pathologist often teamswith allied professionals, such as occupational thera-pists and physical therapists, to evaluate and imple-ment adaptations for specific needs of students withphysical limitations.

Responsibilities related to assistive technologyintervention and services include:

• providing input on the effect of physical orga-nization of the classroom in fostering commu-nication development and interaction

• monitoring the technology needs of the studentgiven curriculum expectations

• recommending and selecting augmentative orassistive technology devices or services to pro-mote communication and participation in theregular classroom of the technology device orservices (ASHA, 1997e, 1998d).


CounselingCounseling facilitates recovery from or adjustment

to a communication disorder. The purposes of coun-seling may be to provide information and support, re-fer to other professionals, and/or help developproblem-solving strategies to enhance the interventionprocess. Requests for information and support as wellas strategies for achieving goals should be determinedin collaboration with students and families.

Counseling may be considered an interventiontechnique; however, it is a particular type of interven-tion appropriate in dealing with all language, speech,and communication disorders. Counseling may beappropriate for parents, families, and/or students,depending on the age of the student. The process ofcounseling improves two-way communication. Im-proved communication affects the ability to make de-cisions regarding cause/effect (etiology), appropriateintervention, and transfer and maintenance (carryover)(Johnston & Umberger, 1996). Johnston and Umburgeralso list three methods of counseling:

• interpersonal communication• indirect counseling• direct counseling

Counseling for students and families includes:• assessment of counseling needs• assessment of family goals and needs• provision of information• strategies to modify behavior or environment

relating to speech and language• development of coping mechanism and systems

for emotional support• development and coordination of self-help and

support groups relating to speech and language

It is the responsibility of the speech-language pa-thologist to:

• develop open and honest communication• collaborate with students and families to deter-

mine and meet counseling/information sup-port needs

• determine when it would be appropriate to pro-vide direct or indirect counseling relating tospeech and language issues

• refer students or families with counseling issuesto licensed and certified professionals when ap-propriate

Re-EvaluationRe-evaluation needs are addressed by the IEP team

for all students eligible for special education or related

service at least once every 3 years to determine if thereis a need for re-evaluation regardless of whether thestudents are served in a direct or an indirect interven-tion model. A student may be re-evaluated more fre-quently to ensure that the goals and objectives of thecurrent program and setting meet the needs of the stu-dent. This more frequent re-evaluation may be initiatedat teacher or parent request [Sections 614(a)(2)(A),614(a)(4)(A)].

Informed parental consent is required before con-ducting a re-evaluation, except when the local educa-tion agency (LEA) can demonstrate that it has takenreasonable measures to obtain consent and the parenthas not responded [Section 614 (c)(3)].

Re-evaluation may include:• re-evaluations conducted as required by IDEA13

(This comprehensive evaluation includes as-sessment results as well as consideration of allpertinent information: classroom-based assess-ments, observations, and information providedby the parent.)

• annual reviews conducted to evaluate and re-vise the IEP to ensure that goals and objectivesreflect the student needs. (Progress is docu-mented, outcomes are reviewed, and goals areaffirmed or revised.)

• ongoing/periodic evaluation of student re-sponses observed and documented during in-tervention (e.g., dynamic assessment andobserving improvements with scaffolding14)

Revisions to the intervention plan and to the IEPare made when necessary.

Re-evaluation leads to:• continuation or modification of the current spe-

cial education program or related service• referral to additional special education pro-

grams or appropriate related service agencies• dismissal

13 If the IEP Team determines that no additional data areneeded to determine whether the student continues tobe a student with a disability, the LEA may notify theparent of that determination and the reasons for it andthe right of the parents to an assessment to determinewhether the student continues to be a student with adisability. Unless the parent requests such an assess-ment, a reevaluation is not required [Section 614(c)(4)].

14 The concepts of dynamic assessment and scaffolding areaddressed in Wallach and Butler (1994) by several au-thors: Nelson; Palincsar et al.; Silliman and Wilkinson;and van Kleeck


TransitionSpeech-language pathologists participate on plan-

ning teams to assist students in successful transition.Transition may entail a change: from special educa-tion to general education; between such levels as earlyintervention (infant and toddler), preschool, elemen-tary, and secondary school programs; or from highschool to post-secondary destinations including em-ployment, vocational training, military, communitycollege, or 4-year college.

Students who have been in self-contained, special-ized classes require encouragement and support dur-ing transition to a less-restrictive environment. Fortransition to be successful, it is important to commu-nicate with parents, teachers, and other professionalsin order to integrate speech and/or language goals intothe home, classroom, other programs, and the commu-nity. Progress and outcomes are documented in eachsetting.

The school-based speech-language pathologist isa member of the team that supports a student’s effec-tive transition. Both “sending” and “receiving”speech-language pathologists are involved in the IEPdevelopment process as well as in program planningat the time of transition.

The school-based speech-language pathologistprepares students for the anticipated communicationdemands of vocational or post-secondary settings.Promoting transition readiness at each level enhancesthe student’s and parent’s level of comfort, confidence,and success in the new environment (see further [Sec-tion 614(d)]).

DismissalThe discussion of dismissal actually begins dur-

ing the eligibility staffing meeting when prognosticindicators and guidelines for dismissal are discussedwith the parent.15 Although the prognosis may changeover time, consideration should be given to:

• potential to benefit from intervention• medical factors• psychosocial factors• attendance• parent involvement• teacher involvement• other disabling conditions• student motivation

• progress with previous services (Florida StateDepartment of Education, 1995)

A local education agency shall evaluate a stu-dent with a disability before determining the studentis no longer a student with a disability [Section 614(c)(5)]. An IEP review team convenes to review allstandardized and nonstandardized assessmentinformation, and a formal meeting is scheduled ifdismissal is indicated.

Dismissal occurs when a student no longer needsspecial education or related services to take advantageof educational opportunities. Reasons for dismissaland the interdisciplinary team’s recommendation fordismissal are documented. State regulations andguidelines vary as to when dismissal is appropriate.The Illinois State Board of Education (1993) specifiesthat students must meet one of three exit criteria:

• The need for specialized services to address theadverse effect(s) on educational performance isno longer present.

• The disability no longer has an adverse effecton the student’s educational performance.

• The disability no longer exists.

Numerous states and some districts have devel-oped dismissal standards for each language andspeech disorder based on a matrix of severity ratingsto be used as general guidelines for assisting speech-language pathologists with dismissal decisions (seeAppendices J and K).

The speech-language pathologist considers thefederal mandates, state regulations and guidelines,and local education agency dismissal criteria. ASHA’sReport on Admission/Dismissal Criteria (1994a) isalso available to assist with dismissal decisions.

SupervisionThe speech-language pathologist may, given his/

her position, provide supervision to speech-languagepathologists, and/or support personnel, when super-visory requirements have been met. The term clinicalsupervision refers to the tasks and skills of clinicalteaching related to the interaction between the speech-language pathologist and the client. Clinical supervi-sion in speech-language pathology is a distinct areaof expertise and practice requiring specific competen-cies (ASHA, 1985b, 1989d). Supervisors are often rolemodels for the beginning professional or support per-sonnel. Clinical supervision within the school settingrelates to supervision of:

• colleagues who are completing their clinicalfellowship requirement for ASHA’s certificateof clinical competence (CCC; ASHA, 1994b;1997b; 1997g)

.15 According to ASHA’s Code of Ethics, “Individuals shall

not guarantee the results of any treatment or procedure,directly or by implication; however, they may make areasonable statement of prognosis” (ASHA, 1994d, p. 1).


• speech-language pathology assistants in accor-dance with ASHA’s Code of Ethics (1994d); theGuidelines for the Training, Credentialing, Use andSupervision of Speech-Language Pathology Assis-tants (ASHA, 1996a); and state regulations andguidelines for the use of support personnel

• university practicum students according tospecific university guidelines, state regulationsand guidelines, and ASHA (1994h)

• school-approved volunteers who assist withclerical and materials management within thespeech-language program

An administrator/supervisor of a school programshould have the expertise and competencies required

of a supervisor (e.g., knowledge of the law, budgets,ethics and performance appraisals). These competen-cies may be obtained through continuing education op-portunities, additional coursework, and other programsin the supervisory process. The administrator/ supervi-sor may be the person who supervises and conducts theperformance appraisal of the speech-language patholo-gist. (See performance appraisal below).

Documentation and AccountabilityDocumentation and accountability are required

for each of the core roles of the school speech-languagepathologist (see Table 12). Documentation is neededfor the student; family; federal, state, and local require-ments; and third-party insurance payers.

Table 12. Core Roles and Required Documentation.

Core Roles Examples of Documentation

Prevention Team meetings, schedules, plans, regular education classroom program

Identification Observation notes, anecdotal records, cumulative file, medical history, teacher checklists,referral form

Assessment/ Standardized test protocols, nonstandardized interview and observation notes,Evaluation portfolios, assignment reports, parent input

Eligibility Federal, state or local education agency (SEA, LEA) eligibility criteriaDetermination Severity ratings and interdisciplinary team report (when applicable)

IEP/IFSP Individualized education program (IEP)Development Individualized family service plan (IFSP)

Parent, teacher and other professional input

Caseload IEP/IFSP, schedule, attendance records, progress reportsManagement

Intervention Standardized and descriptive assessment information, treatment outcomes measures,third-party documentation, goals and objectives, benchmarks, lesson plans, treatmentnotes, progress reports

Counseling Assessment data, anecdotal records, progress notes, release of information forms,record of referrals

Re-evaluation Federal, SEA, or LEA documentation

Transition Federal, SEA, or LEA documentation

Dismissal Federal, SEA, or LEA dismissal criteriaSeverity ratings and interdisciplinary team report (when applicable)

Supervision Performance appraisals, observation notes


Clear and comprehensive records are necessary tojustify the need for intervention, to document the effec-tiveness of that intervention, and for legal purposes.Professionals in all positions and settings must beconcerned with documentation. ASHA requires that“accurate and complete records [be] maintained foreach client and [be] protected with respect to confiden-tiality” (ASHA, 1992b, p. 64; see also ASHA, 1994c;1994f).

Federal, State, Local Compliance and ProceduralSafeguards

It is the role of the speech-language pathologist toadhere to federal mandates, state regulations andguidelines, and local education agency policies andprocedures related to parent/guardian notification,compliance documentation, and procedural safe-guards [Section 615(a-d)].

Progress Reports/Report Cards

Parents must be informed of their child’s progress“at least as often as nondisabled children’s progress”[Section 614(d-A)viii]. The progress report includes:

• the student’s progress toward the annual goals• the extent that progress is sufficient to enable

the child to achieve the goals by the end of theyear

Third-Party Documentation

Speech-language pathology services are a coveredbenefit under many private medical insurance plansas well as the Medicaid program. State and local edu-cation agencies are authorized to use whatever federal,state, local, and private funding sources, includingfamily insurance, are available to pay for services in-cluded on a student’s IEP. School districts may seekMedicaid payment for speech-language pathologyservices provided to Medicaid-eligible students. Agree-ments governing payment and procedures must be es-tablished between the applicable school district andthe state Medicaid agency.

Speech-language pathologists providing servicesunder Medicaid or other third-party insurance com-panies are responsible for:

• investigating and understanding the state’sMedicaid policies and procedures

• meeting minimum qualified personnel stan-dards as defined by federal and state regula-tions

• being aware of the parent’s right to informedconsent

• providing the parent with sufficient informa-tion about third-party reimbursement processes

• documenting treatment sessions

• following billing and supervision procedures• being familiar with health insurance and man-

aged care• being familiar with professional liability issues

(ASHA, 1991e; 1991f; 1994e; 1994g)

Treatment Outcomes Measures

Treatment outcomes measures document evidenceof the effectiveness of intervention on communicationabilities. They are typically based on skills that maybe observed and recorded, and are not dependent onthe treatment approach or method of service delivery.Within the school setting, outcomes may reflectperformance that relates to the student’s educationalfunctioning within the classroom and with peersduring a school day. ASHA is developing a NationalOutcomes Measurement System (NOMS) for speech-language pathology in pre-K and K–12 educationalsettings (ASHA, 1998g, 1999). Additional componentsof NOMS are being developed in health care settingsand audiology.

Responsibilities relating to collecting treatmentoutcomes data are to:

• collect and record data for eligibility, caseloadplanning and management, and dismissal pur-poses

• collect and record data that reflect functionalskills and performances

• use functional communication measures orfunctional status measures that reflect commu-nication/educational change and consumersatisfaction

• integrate functionally based goals or bench-marks into intervention programs

• use data collected to promote changes in servicedelivery (ASHA, 1997c, 1998g)

Performance Appraisal

Documentation is an important task of the super-visor in schools. Supervisors are responsible for conduct-ing performance appraisals of those being supervised.Performance appraisal is the practice of evaluating job-related behaviors. Professional performance appraisal isan important factor in facilitating a growth process thatshould continue throughout an individual’s profes-sional career (ASHA, 1993c; Dellegrotto, 1991). Perfor-mance appraisal is conducted to:

• assist the person being supervised in the devel-opment of skills as outlined in the core roles

• assist the person being supervised in the de-scription and measurement of his/her progressand achievement


• assist the person being supervised in develop-ing skills of self-evaluation

• evaluate skills with the person being supervisedfor purposes of grade assignment, completionof the clinical fellowship requirements, and/orprofessional advancement (ASHA, 1985b)

Risk Management

School speech-language pathologists must beknowledgeable about risk management procedures inrelation to chronic communicable disease preventionand management. Speech-language pathologistsshould follow safety and health precautions that:

• ensure the safety of the patient/client and cli-nician and adhere to universal health precau-tions (e.g., prevention of bodily injury andtransmission of infectious disease)

• ensure decontamination, cleaning, disinfec-tion, and sterilization of multiple-use equip-ment before reuse according to facility-specificinfection control policies and procedures andaccording to manufacturer’s instructions(ASHA, 1990a, 1991a, 1994f, 1997e)

III. Additional Roles and OpportunitiesThis section describes additional roles and oppor-

tunities for school-based speech-language patholo-gists. Table 13 provides an outline for those roles.

Community and Professional PartnershipsSchool-based speech-language pathologists estab-

lish community and professional partnerships beyondthe school setting to meet student and program needs.These partnerships include cooperation with audiolo-gists, community-based speech-language patholo-gists, health care providers, the media and community,parents and parent groups, preschools, professionalorganizations, and universities. The partnerships in-volve frequent, extensive, and open communication.Speech-language pathologists often coordinate alli-ances and seek ongoing input from participating part-ners. Cooperative partnerships enhance the quality ofservices provided for students with communicationdisorders and contribute to the success of school-basedspeech and language programs.

Audiologists

The role of speech-language pathologists in pro-viding services to students with hearing loss, deafness,and/or central auditory processing disorders isunique, and special considerations apply. Many stu-dents with hearing loss and/or central auditory pro-cessing disorders served by speech-languagepathologists may benefit from hearing aids, cochlearimplants, an assistive listening device or system,environmental modification, large area amplificationsystems, and/or instructional modification. In addi-tion to communication with audiologists fromeducation settings, a close association with commu-nity-based audiologists is essential in providing ser-vices for students receiving their care.

Table 13. Additional Roles & Opportunities for School-Based Speech-Language Pathologists.

Additional Roles Opportunities

Community and AudiologistsProfessional Community-based speech-language pathologistsPartnerships Health care providers

Media/communityParents/parent groupsPreschool personnelProfessional organizationsUniversities

Professional SpecializationLeadership MentorOpportunities Research

Schoolwide participation

Advocacy StudentsProgramsFacilities


Speech-language pathologists collaborate withaudiologists to:

• provide or review hearing screenings and moni-tor the audiologic findings of students, includ-ing those on the speech-language pathologist’scaseload

• make referrals for audiologic evaluations• collaborate with audiologists to promote im-

proved acoustic environments and accessibil-ity of classrooms and other school settings thatfacilitate communication and prevent noise-induced hearing losses

• assist the audiologist in monitoring hearingaids, cochlear implants, group/classroom am-plification (FM auditory trainers), and assistivelistening devices or sound field systems in or-der to maximize acoustic accessibility of stu-dents with hearing loss or other auditorydisorders

• assist the audiologist and educators of studentswith hearing loss in providing consultationwith other education staff to develop instruc-tional modifications and/or to encourage useof technology, interpreters, and other accommo-dations to meet the needs of students with hear-ing loss or deafness

• share pertinent information with educationstaff regarding language levels and communi-cation needs as related to the student’s hearingloss

• facilitate an understanding by nondisabledpeers of the nature of hearing loss and deafnessand the communication styles or modes of stu-dents with hearing loss and deafness

Community-Based Speech-Language Pathologists

School-based speech-language pathologists estab-lish communication links with area speech-languagepathology private practitioners and with employees ofdiagnostic and treatment facilities that provide com-munication disorders services to preschool and school-age children to:

• coordinate services for mutual clients, assuringopportunities for optimal benefits for the stu-dents and their families

• form alliances for mutual referral resources• share professional information and expertise

among colleagues• facilitate transition of services from community

to public school speech-language programs

Health Care Providers

Speech-language pathologists collaborate withhealth care providers and agencies to:

• prevent communication impairments throughpreschool interdisciplinary screening programsand early awareness initiatives

• coordinate diagnostic and interventionprograms for children whose communicationdevelopment or swallowing is affected byhealth-related conditions and disorders

• consult with professionals serving on diagnos-tic and treatment recommendation teams orclinics developed for specific physiologicallybased conditions or disorders (e.g., cleft palateor cerebral palsy)

Media/Community

Speech-language pathologists work with the me-dia and the community to:

• initiate public awareness programs viapromotional announcements, public radioand television presentations, school Internetcommunications, and in the print media

• collaborate with other speech, language, audi-ology, and hearing professionals in cooperativepublic information projects such as Better Hear-ing and Speech Month, health or career fairs,and departmental open houses and visitationprograms

• establish communications with communityservice groups, nonprofit charity organizations,allied agencies, and the business communityfor the purpose of informing, educating, andseeking grants for communication disordersprograms in the schools

• create and distribute public information bro-chures that describe speech-language pathol-ogy programs in the schools and the referralprocedures for those programs

Parents/Parent Groups

Speech-language pathologists develop partner-ships with parents, families, and parent supportgroups to:

• provide information on the prevention ofcommunication disorders

• promote communication development and lit-eracy skills of infants and young children

• provide information and recommendations forpositive speech and language development andhome intervention strategies

• advocate for the communication needs of stu-dents


• gain information about how the school speech-language program can best meet the needs ofstudents and families

Preschool Personnel

Alliances with personnel from preschool childcare centers, nursery schools and Head Start programsare promoted by the speech-language pathologist atsites that provide services to early childhood students.The partnership is established to:

• consult with professional and paraprofes-sional staff members to facilitate educationalsuccess and social communication skills

• collaborate with families and preschool centerstaff members to enhance the communicationskills of young children before school entry

• monitor the progress of children identified asat risk for and/or exhibiting communicationimpairments who are enrolled at the commu-nity preschool sites

• establish procedures for appropriate referralsto school-based speech-language pathologistsfor children exhibiting communication prob-lems

• facilitate appropriate transition to public schoolprograms

Professional Organizations

Speech-language pathologists are actively in-volved in national, state, and local professionalorganizations to:

• promote professional growth through attend-ing and presenting at national, state, and localcontinuing education programs, workshops,and conferences

• read, author, or edit articles for professionaljournals and other publications

• participate on committees, boards, councils,and task forces to advocate for the professionand for students with communication disor-ders

• volunteer for leadership roles at the local,state, and national levels

• participate in ASHA Special Interest Divisionsor other professional groups to network withcolleagues regarding specific areas of profes-sional interest or expertise, thereby enrichinggrowth opportunities and participatory contri-butions (see Appendix B).

Universities

Speech-language pathologists may collaboratewith universities to:

• provide practicum experiences in the schoolsetting

• serve as adjunct faculty members• lecture to promote understanding of the scope

of practice and the roles and responsibilities ofthe speech-language pathologist within theschool setting

• recruit upcoming graduates by encouraginguniversity students to consider school-basedcareer options

• provide input for university program directorsand faculty regarding knowledge and skillsneeded to be an effective school-based speech-language pathologist

• form alliances with university diagnostic andtreatment clinics for mutual referral resourcesand supplemental treatment options for stu-dents

• encourage regular and continuing educationcourse work offerings and professional devel-opment opportunities that focus on the needsof the school-based speech-language patholo-gist

• develop cooperative research projects relatingto school-age populations

Professional Leadership OpportunitiesSchool-based speech-language pathologists have

multiple professional opportunities beyond coreroles and responsibilities. These opportunities allowspeech-language pathologists to assume leadershiproles, to develop initiatives, and to use their personalattributes and professional expertise to provide posi-tive and significant contributions to students, educa-tors, families, and the community. The decision toparticipate in these professional activities is made byeach individual, after considering professional respon-sibilities, time constraints, personal interests and ex-pertise.

Specialization

Speech-language pathologists who have acquiredspecialized training in a particular area can serve asspecialists or mentors to other school-based providers.Some school districts have designated specialistswithin their speech-language departments to meet theneeds of various individuals, especially those withlower-incidence disabilities. The need for specialistsdepends on the school’s unique population of studentswith communication disorders as well as the exper-tise of the speech-language pathologist(s) on staff.

Examples of specialty positions and their relatedduties follow. The list is not meant to be all-inclusive.


• Assistive Technology Specialist: provides as-sessments for students, support to parents andclassroom teachers, and technical assistance tostaff responsible for students identified as re-quiring alternative communication systems;recommends assistive devices that will enablestudents to communicate and participate inregular classrooms

• Autism Specialist: provides technical assistanceto staff responsible for students identified asautistic or exhibiting behaviors characteristic ofthe syndrome; provides assistance to speech-language pathologists, classroom teachers,parents, students, and administrators

• Bilingual Specialist: provides evaluations forbilingual students (e.g., English/ Spanish); as-sists in scheduling a bilingual interpreter/translator for parent communication and/orassessment purposes; assists school-basedspeech-language pathologists regarding pro-gramming for these students, or may providedirect intervention

• Cleft Palate Specialist: works with a team ofmedical and dental specialists; provides evalu-ation and management of velopharyngeal func-tion related to hypernasality and nasal air flowdisorders; provides in-services to schools re-lated to cleft lip/palate, craniofacial anomaliesand related disorders of velopharyngeal dys-function, consults regarding management ofmaladaptive/compensatory articulation habitsrelated to disorders of velopharyngeal dysfunc-tion and other resonance disorders

• Diagnostic Specialist: provides comprehensiveevaluations for students referred for, or enrolledin, specialized language programs; assistsspeech-language pathologists with difficult-to-test students

• Fluency Specialist: provides technical assis-tance to speech-language pathologists, teach-ers, and parents or provides direct services tostudents with fluency disorders

• Resource Specialist: provides guidance fornewly hired speech-language pathologists toassist in the transition from academia to prac-tice or provides support for speech-languagepathologists who transferred to a new level orsetting

• Voice Specialist: provides assessments and/ortechnical assistance for students with sus-pected or confirmed voice disorders

Mentor

Mentoring can be a critical element in building acareer and attaining job satisfaction. It is effectivelyused in many organizations as a way to develop a newprofessional’s knowledge of values, beliefs, and prac-tices. It can help in learning to apply clinical judgmentin a variety of scenarios. This translates into a moreproductive, efficient, and effective professional andhas been reported to contribute to successful retentionand career satisfaction, better decision making, andgreater perceived competence (Horgam & Simeon,1991; Huffman, 1994).

The speech-language pathologist has the oppor-tunity to:

• serve as a mentor to newly practicing school-based speech-language pathologists

• provide assessment information and/or tech-nical assistance in specific disorder areas orservice delivery options

• encourage advocacy efforts or provide adviceon administrative issues (ASHA, 1992a)

Research

Speech-language pathologists collect treatmentoutcomes data in the school-based setting. School-based speech-language pathologists provide data toadministrators, parents, and teachers on the outcomesof services to students with communication disabili-ties. The general education environment offers theopportunity to participate in research that can ad-vance the professions (ASHA, 1997c; O’Toole,Logemann, & Baum, 1998).

The speech-language pathologist may:• promote opportunities for university faculty

and students to develop research projects withschool populations

• assist in obtaining cooperation from schooladministration, staff, and parents to implementresearch initiatives

• seek funding for research opportunities• conduct research or collaborate with education

staff on research projects• participate in treatment outcomes projects

Schoolwide Participation Opportunities

The role of the school-based speech-language pa-thologist as an integral member of the total school staffis realized by active participation in school activitiesand committees. Many opportunities exist for thespeech-language pathologist in the schools to makepositive contributions as a cooperative, visible teamplayer.


Recognizing that each school situation is unique,the speech-language pathologist may have the oppor-tunity and may choose to become involved inschoolwide initiatives that will benefit the communi-cation skills of all students in the school. Initiativesmay include:

• participating with professional colleagues inthe development and revision of curricula topromote greater emphasis on communicationskills within the general education environment

• participating in district- and schoolwide pro-fessional activities, such as committees andcouncils designated for curriculum develop-ment, problem solving, conflict mediation andviolence prevention teams, professional devel-opment, parent support and volunteer groups,recruitment, community relations, and hand-book/guidelines development

• participating in school events, projects, andmeetings, such as student performances, assem-blies, field trips, literacy and reading projects,and prekindergarten orientation programs

• volunteering for leadership roles within theschool district and community relating to edu-cational and communication enhancementgoals with students

• representing speech-language pathologists incontract negotiations regarding salary scale,positive working conditions, and program de-velopment

AdvocacyThe school-based speech-language pathologist is

a strong advocate for students enrolled in the speech-language program and works cooperatively to achievethe program goals and objectives. A student’s achieve-ment is enhanced when speech-language pathologistsand school administrators cooperatively team for ef-fective planning, coordination, and implementation ofspeech-language programs as part of the total educa-tion system. School-based speech-language patholo-gists communicate with local, state, and federalpolicymakers as well as regulatory and legislativebodies about issues important to students with com-munication disorders.

To assure quality service conditions for their stu-dents, school-based speech-language pathologistsadvocate for:

• adequate administrative support to carry outtheir roles and responsibilities

• sufficient time within the workday and week forplanning, diagnostics, observations, reportwriting, supervisory responsibilities, required

paperwork, consultations with parents andteachers, interdisciplinary meetings, and regu-larly scheduled direct and indirect services forstudents on the caseload (ASHA, 1993b)

• an array of services to address differences intype and severity of disorders

• adequate staffing levels to maintain manageablecaseloads and for the financial resources nec-essary to provide a sufficient number of quali-fied personnel

• professional development opportunities tomaintain a high-quality program throughaccess to in-service training, professionalconferences, site visits to observe other speech-language pathologists and students, and aprofessional library of current journals, books,and videotapes

• adequate facilities for student evaluation andintervention that meet federal, state, and localsafety and instructional standards (ASHA,1992b; U.S. Congress, 1990a)

• proper work conditions (e.g., lighting, naturaland artificial ventilation, acoustical treatment,heating/air conditioning)

• financial resources for appropriate equipment,materials, and diagnostic instruments to pro-vide services for students of varying ages, abili-ties, and disorders

• availability of computer hardware and softwarenecessary for instruction, assessment, records,reports, and program management

• policies and procedures consistent with theschool’s mission and goals

• the communication needs of students in thetotal school environment

Advocacy training materials, including theM-Power Box: The Power of One (School Version), areavailable from ASHA for school-based speech-language pathologists (ASHA, 1998e).

IV. SummaryThe roles and responsibilities specific to school-

based speech-language pathologists have been shapedby national and state legislation and regulations; so-cietal factors; and by the scope, standards, and ethicsof the profession. These ASHA guidelines were devel-oped to clarify the speech-language pathologist’s rolesand responsibilities within the school setting. Speech-language pathologists, school and district administra-tors, lobbyists, and legislators may use theseguidelines to develop, modify, and/or describe high-quality, school-based speech-language programs.


Students with communication disorders, theirfamilies, and the community benefit from the speech-language pathologist’s professional expertise in thefield of speech, language, and communication. Thespeech-language pathologist is an essential memberof the interdisciplinary, IEP, and education teams.The core roles of the school-based speech-languagepathologist are prevention, identification, assessment,evaluation, eligibility determination, IEP/IFSP devel-opment, caseload management, intervention, counsel-ing, re-evaluation, transition, and dismissal forstudents with language, articulation/phonology, flu-ency, voice/resonance, or swallowing disorders.Documentation/accountability and supervision arealso considered core roles. Specific responsibilities foreach of these core roles are further delineated withinthese guidelines.

Evolving roles for the school-based speech-language pathologist are discussed. The speech-language pathologist’s knowledge of normal versusdisordered communication is valuable in (a) distin-guishing language differences from disorders forbilingual students; (b) promoting understanding ofsocial dialects for students from culturally and lin-guistically diverse populations; and (c) evaluatingstudents with cognitive, sensory, neurological, ortho-pedic, or other health impairments who may also havecommunication disorders. The speech-languagepathologist’s knowledge is an asset to the educationteam when creating teaching strategies to enhanceliteracy or social and behavioral communicationskills for all students.

Involvement in additional professional opportu-nities are increasingly important to the integrity ofschool-based speech-language pathology programs.These opportunities include community and profes-sional partnerships, leadership initiatives, and advo-cacy efforts.

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Appendix B: ASHA School-Related Resources

American Speech-Language-Hearing Association10801 Rockville Pike, Rockville, MD 20852

301-897-5700ACCESS ASHA

Action Center Toll Free Numbers: Answer Line (IVR) 1-888-321-ASHAConsumers 1-800-638-8255 Members 1-800-498-2071Product Sales 1-888-498-6699 Voice Mail (Long Distance) 1-800-274-2376Fax-on-Demand 703-531-0866

• ASHA Web site — http://www.asha.or g

• ASHA School Services

• ASHA Special Interest Divisions (SIDs)1. Language Learning and Education2. Neurophysiology and Neurogenic Speech and Language Disorders3. Voice and Voice Disorders4. Fluency and Fluency Disorders5. Speech Science and Orofacial Disorders6. Hearing and Hearing Disorders: Research and Diagnostics7. Aural Rehabilitation and Its Instrumentation8. Hearing Conservation and Occupational Audiology9. Hearing and Hearing Disorders in Childhood10. Issues in Higher Education11. Administration and Supervision12. Augmentative and Alternative Communication13. Swallowing and Swallowing Disorders (Dysphagia)14. Communication Disorders and Sciences in Culturally and Linguistically Diverse Populations15. Gerontology16. School-Based IssuesNote: Some Special Interest Divisions have listservs.

• State Speech-Language-Hearing Associations

• School Allied and Related Professional Organizations (ARPOs)* Council of Language, Speech and Hearing Consultants in State Education Agencies* Public School Caucus* Council of School Supervisors and Administrators

Contact ASHA for further information on the above resources, other related professional contacts or resources suchas position papers, guidelines, technical reports and relevant papers.

Appendix A: ASHA Code of Ethicssee the ASHA Desk Reference, volume 1, and the ASHA Web page


Appendix C: Goals 2000: Education America Act: National Education Goals

GOAL 1: “By the year 2000, all children in America will start school ready to learn.

GOAL 2: “By the year 2000, the high school graduation rate will increase to at least 90 percent.

GOAL 3: “By the year 2000, all children will leave grade 4, 8, and 12 having demonstrated competencyover challenging subject matter including English, Mathematics, Science, Foreign Languages,Civics and Government, Economics, Arts, History, and Geography, and every school in Americawill ensure that all students learn to use their minds well, so that they may be prepared forresponsible citizenship, further learning, and productive employment in our nation’s moderneconomy.

GOAL 4: “By the year 2000, the nation’s teaching force will have access to programs for the continuedimprovement of their professional skills and the opportunity to acquire the knowledge and skillsneeded to instruct and prepare all American students for the next century.

GOAL 5: “By the year 2000, United States students will be first in the world in Mathematics and ScienceAchievement.

GOAl 6: “By the year 2000, every adult American will be literate and will possess the knowledge and skillsnecessary to compete in a global economy and exercise the rights and responsibilities ofcitizenship.

GOAL 7: “By the year 2000, every school in the United States will be free of drugs, violence, and theunauthorized presence of firearms and alcohol and will offer a disciplined environmentconducive to learning.

GOAL 8: “By the year 2000, every school will promote partnerships that will increase parental involvementand participation in promoting the social, emotional, and academic growth of children.”

Source: National Education Goals Panel. (1996). The National Education Goals Report. Washington, DC.

Appendix D: School Reform Issues Related to Speech-Language PathologyAnalysis of recent and proposed changes in education policies and practices at national, state, and local lev-

els:

1. Language and communication skills are the foundation of all learning.

2. Effective communication and language skills are fundamental for achievement of the eight nationaleducation goals.

3. Speech-language pathologists and audiologists are uniquely trained to enhance students’ languageskills. Such professionals provide a valuable contribution to learning, in general, and school reforminitiatives, more specifically.

4. Improved outcomes for consumers should be fundamental in school reform initiatives.

5. The rights and protections of individuals with disabilities must be maintained as education policies andpractices change.

6. Providing initial preparation and continuing education to speech-language pathology and audiologyprofessionals affects the quality of education that students with communication disorders receive.

7. The availability of qualified service providers affects each school district’s ability to meet thecommunication needs of its students.

8. Service delivery for students with communication disorders is undergoing significant change.

9. Technology will play an increasingly dominant role in education, affecting learners of all types, ages,and needs.

10. The effectiveness of school reform initiatives will depend on the availability and efficient use of resources.Source: American Speech-Language-Hearing Association. (1997). Trends and issues in school reform and their effects on speech-

language pathologists, audiologists, and students with communication disorders. ASHA Desk Reference (Vol. 4, 310–310i).


Appendix E: Advantages and Disadvantages of Types of Assessments

Advantages Disadvantages

Norm-referenced Designed for diagnosis Not designed for identifying specificlanguage tests Allow comparison with age or intervention objectives

grade peer group on an Norm group is representative ofobjective standard national samples, but may not beFacilitate comparisons across representative enough of theseveral domains to assess student’s backgrounddiscrepancies and broadstrengths/weaknesses

Criterion- Test for regularities in Not designed for use in makingreferenced performances against a set of criteria program placement or eligibilitytests Useful for designing interventions, decisions

interfacing with curriculum objectives,and describing where a student isalong a continuum of skills

Checklists Easy to administer and practical Not designed to evaluate peer-Can give a broad evaluation in or age-group levelareas judged importantAddress crucial academic skillson which referral is often based

Structured Permit guided evaluations of Can be time consumingobservations communication in context Presence of observer may alter

Can focus on several aspects behavior, especially in teensat onceOccur on-site; are based on reality

Source: Ohio Department of Education (1991). Ohio handbook for the identification, evaluation, and placement ofchildren with language problems. Columbus, OH: Author. Reprinted by permission.

Note. Other types of assessments are described in the assessment section of this Guidelines document.


Appendix F: Developmental Milestones for Speech and Language

Age Language and Speech Behaviors

1 year recognizes his or her nameunderstands simple instructionsinitiates familiar words, gestures, and soundsuses “mama,” “dada,” and other common nouns

1 ½ years uses 10 to 20 words, including namesrecognizes pictures of familiar persons and objectscombines two words, such as “all gone”uses words to make wants known, such as “more,” “up”points and gestures to call attention to an event and to show wantsfollows simple commandsimitates simple actionshums, may sing simple tunesdistinguishes print from nonprint

2 years understands simple questions and commandsidentifies body partscarries on conversation with self and dollsasks “what” and “where”has sentence length of two to three wordsrefers to self by namenames picturesuses two-word negative phrases, such as “no want”forms some plurals by adding “s”has about a 300-word vocabularyasks for food and drinkstays with one activity for 6 to 7 minutesknows how to interact with books (right side up, page turning from left to right)

2 ½ years has about a 450-word vocabularygives first nameuses past tense and plurals; combines some nouns and verbsunderstands simple time concepts, such as “last night,” “tomorrow”refers to self as “me” rather than nametries to get adult attention with “watch me”likes to hear same story repeateduses “no” or “not” in speechanswers “where” questionsuses short sentences, such as “me do it”holds up fingers to tell agetalks to other children and adultsplays with sounds of language


3 years matches primary colors; names one colorknows night and daybegins to understand prepositional phrases such as “put the block under the chair”practices by talking to selfknows last name, sex, street name, and several nursery rhymestells a story or relays an ideahas sentence length of three to four wordshas vocabulary of nearly 1,000 wordsconsistently uses m, n, ng, p, f, h, and wdraws circle and vertical linesings songsstays with one activity for 8 to 9 minutesasks “what” questions

4 years points to red, blue, yellow, and greenidentifies crosses, triangles, circles, and squaresknows “next month,” “next year,” and “noon”has sentence length of four to five wordsasks “who” and “why”begins to use complex sentencescorrectly uses m, n, ng, p, f, h, w, y, k, b, d, and gstays with activity for 11 to 12 minutesplays with language (e.g., word substitutions)

5 years defines objects by their use and tells what they are made ofknows addressidentifies penny, nickel, and dimehas sentence length of five to six wordshas vocabulary of about 2,000 wordsuses speech sounds correctly, with the possible exceptions being y, th, j, s/z, zh, and rknows common oppositesunderstands “same” and “different”counts 10 objectsuses future, present, and past tensesstays with one activity for 12 to 13 minutesquestions for informationidentifies left and right hand on selfuses all types of sentencesshows interest and appreciation for print

6–7 years identifies most sounds phoneticallyforms most sound-letter associationssegments sounds into smallest grammatical unitsbegins to use semantic and syntactic cues in writing and reading


begins to write simple sentences with vocabulary and spelling appropriate for age;uses these sentences in brief reports and creative short storiesunderstands time and space concepts, such as before/after, second/thirdcomprehends mathematical concepts, such as “few,” “many,” “all,” and “except”

8, 9, 10, 11 years by second grade, accurately follows oral directions for action and thereby acquires newknowledge

substitutes words in oral reading, sentence recall, and repetition; copying and writingdictation are minimal

comprehends reading materials required for various subjects, including story problemsand simple sentences

by fourth grade, easily classifies words and identifies relationships, such as “cause andeffect”; defines words (sentence context); introduces self appropriately; asks forassistance

exchanges small talk with friendsinitiates telephone calls and takes messagesgives directions for games; summarizes a television show or conversationbegins to write effectively for a variety of purposesunderstands verbal humor

11, 12, 13, 14 years displays social and interpersonal communication appropriate for ageforms appropriate peer relationshipsbegins to define words at an adult level and talks about complex processes from an

abstract point of view; uses figurative language; organizes materialsdemonstrates good study skillsfollows lectures and outlines content through note takingparaphrases and asks questions appropriate to content

Adolescence and interprets emotions, attitudes, and intentions communicated by others’ facialyoung adult expressions and body language

takes role of other person effectivelyis aware of social space zonesdisplays appropriate reactions to expressions of love, affection, and approvalcompares, contrasts, interprets, and analyzes new and abstract informationcommunicates effectively and develops competence in oral and written modalities

Source: Ohio Statewide Language Task Force. (1990). Developmental milestones: Language behaviors. In Ohio Handbookfor the Identification, Evaluation and Placement of Children with Language Problems (1991). Columbus: Ohio Department ofEducation. Reprinted by permission.

Editor’s Note. These milestones are variable due to individual differences and variance in the amount of exposure to oraland written communication.


Appendix G: Example of a Severity/Intervention Matrix

Clinical judgment may necessitate modification of these guidelines.

Mild—1 service delivery unit Moderate—2 service delivery unitsMinimum of 15–30 minutes per week Minimum of 31–60 minutes per week

Severity of Impairment minimally affects the Impairment interferes with the individual’sDisorder individual’s ability to communicate ability to communicate in school learning

in school learning and/or other social and/or other social situations as noted bysituations as noted by at least one other at least one other familiar listener.familiar listener, such as teacher, parent,sibling, peer.

Articulation/ Intelligible over 80% of the time in Intelligible 50–80% of the time inPhonology connected speech. connected speech.

No more than 2 speech sound errors Substitutions and distortions and someoutside developmental guidelines. omissions may be present. There isStudent may be stimulable for error limited stimulability for the errorsounds. phonemes.

Language The student demonstrates a deficit in The student demonstrates a deficit inreceptive, expressive, or pragmatic receptive, expressive or pragmaticlanguage as measured by two or more language as measured by two or morediagnostic procedures/standardized diagnostic procedures/standardizedtests. Performance falls from 1 to 1.5 tests. Performance falls from 1.5 to 2.5standard deviations below the mean standard deviations below the meanstandard score. standard score.

Fluency 2–4% atypical disfluencies within a 5–8% atypical disfluencies within aspeech sample of at least 100 words. speech sample of at least 100 words.No tension to minimal tension. Noticeable tension and/or secondary

characteristics are present.Rate and/or Prosody: Rate and/or Prosody:Minimal interference with 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 isinappropriate for the student’s age is not appropriate for age and sex of theof minimal concern to parent, teacher, student.student, or physician.Medical referral may be indicated. Medical referral may be indicated.


Appendix G: Example of a Severity/Intervention Matrix (cont.)

Severe—3 service delivery units Profound—5 service delivery unitsMinimum of 61–90 minutes per week Minimum of 91+ minutes per week

Impairment limits the individual’s ability to Impairment prevents the individual fromcommunicate appropriately and respond communicating appropriately in schoolin school learning and/or social and/or social situations.situations. Environmental and/or studentconcern is evident and documented.

Intelligible 20–49% of the time in connected Speech is unintelligible without gesturesspeech. Deviations may range from and cues and/or knowledge of the context.extensive substitutions and many omissions Usually there are additional pathologicalto extensive omissions. A limited number or physiological problems, such asof phoneme classes are evidenced in a neuromotor deficits or structural deviations.speech-language sample. Consonantsequencing is generally lacking.Augmentative communication systems Augmentative communication systemsmay be warranted. may be warranted.

The student demonstrates a deficit in The student demonstrates a deficit inreceptive, expressive or pragmatic language receptive, expressive or pragmatic languageas measured by two or more diagnostic that prevents appropriate communicationprocedures/standardized tests (if in school and/or social situations.standardized tests can be administered).Performance is greater than 2.5 standarddeviations below the mean standard score.Augmentative communication systems Augmentative communication systems maymay be warranted. be warranted.

9–12% atypical disfluencies within a More than 12% atypical disfluencies withinspeech sample of at least 100 words. a speech sample of at least 100 words.Excessive tension and/or secondary Excessive tension and/or secondarycharacteristics are present. characteristics are present.

Rate and/or Prosody: Rate and/or Prosody:Interferes with communication. Prevents communication.

Voice difference is of concern to parent, Speech is largely unintelligible due toteacher, student or physician. Voice is aphonia or severe hypernasality. Extremedistinctly abnormal for age and sex of effort is apparent in production of speech.the student.Medical referral is indicated. Medical referral is indicated.

Notes. By the age of 7 years, the student’s phonetic inventory is completed and stabilized (Hodson, 1991). Adverse impacton the student’s educational performance must be documented. If the collaborative consultation model of interventionis indicated at the meeting, the student receives one additional service delivery unit.

Source: Illinois State Board of Education. (1993). Speech-language impairment: A technical assistance manual. Springfield: Au-thor. Reprinted by permission.

Editor’s Note. The state or district matrix may be used as a general guideline, but the amount of service per week is deter-mined by the IEP team to meet the individual needs of the students.


Appendix H: Signs and Effects of Communication Disorders

Type of Disorder Signs Effects

Social Learning

Language Student may show Student may be Student may fail toimpaired comprehen- excluded from play understand instruction.sion and poor verbal and group activities. This may have theexpression. Student may withdraw same result as missing

from group situations. school altogether.“Learning problems”may result.

Articulation/ Abnormal production of Student may be ridiculed Student may haveSound Sequencing speech sounds; “speech or given“cartoon decoding or compre-

impairment”; speech character”nickname; hension problems withsounds not typical for may be ignored or respect to specificstudent’s chronological excluded from group words.age. activities.

Fluency Abnormal flow of verbal Student may be ridiculed Student may do poorlyexpression, characterized by others. Student may on reports, oralby impaired rate or begin to avoid speaking assignments, andrhythm and perhaps in group settings. reading. Student may

“struggle behavior.” withdraw from grouplearning activities.

Voice Abnormal vocal quality, Student may be Student’s self-pitch, loudness, ridiculed, ignored, or confidence may suffer.resonance, and excluded from play or This may lead toduration may be group activities. withdrawal fromevidenced. Child’s voice participation in class,does not sound “right.” and grades may fall.

Hearing Student may give Student may appear to Student may fail toevidence of not be isolated. Student follow directions or failhearing speech. may not participate in to get information

group activities as a from instruction.matter of course.

School Meeting Kit (ASHA, 1989). Document out of print. Permission granted to reproduce.


Ap

pen

dix

I:

Exa

mp

le o

f an

Ed

uca

tion

al R

elev

ance

Ch

art

_

____

____

____

doe

s /d

oes n

ot d

emon

stra

te a

com

mu

nica

tion

dis

ord

er th

at n

egat

ivel

y im

pac

ts th

e ab

ility

to b

enef

it fr

om th

e ed

uca

tion

al(N

ame o

f stu

dent

)pr

oces

s in

one

or m

ore

of th

e fo

llow

ing

area

s:•

Aca

dem

ic —

abi

lity

to b

enef

it fr

om th

e cur

ricu

lum

•So

cial

— a

bilit

y to

inte

ract

wit

h p

eers

and

ad

ult

s•

Voc

atio

nal —

abi

lity

to p

arti

cip

ate

in v

ocat

iona

l act

ivit

ies

Aca

dem

ic Im

pac

tS

ocia

l Im

pac

tV

ocat

ion

al Im

pac

t

Aca

dem

ic a

reas

aff

ecte

d b

y co

mm

unic

atio

nSo

cial

are

as a

ffec

ted

by

com

mun

icat

ion

(App

licab

le fo

r sec

ond

ary

stud

ents

)pr

oble

ms:

prob

lem

s:Jo

b-re

late

d sk

ills/

com

pete

ncie

s stu

den

t can

not

__ R

ead

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___

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mun

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prob

lem

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rfer

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ith

dem

onst

rate

due

to co

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ms:

__

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a

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y to

be

und

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by

adu

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or__

_ In

abili

ty to

und

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and

/fo

llow

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_ L

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age

Art

s

p

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d

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s. _

_ O

ther

: ___

____

____

____

____

____

__

Stu

den

t has

dif

ficu

lty

mai

ntai

ning

and

___

Inap

pro

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ate

resp

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to co

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pact

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umen

ted

by:

term

inat

ing

verb

al in

tera

ctio

ns.

su

per

viso

r’s c

omm

ents

. _

_ A

cad

emic

s bel

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rad

e le

vel.

___

Pee

rs te

ase

stu

den

t abo

ut c

omm

uni

cati

on__

_ U

nabl

e to

ans

wer

/as

k qu

esti

ons

__

Dif

ficu

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wit

h la

ngu

age-

base

d a

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s.

p

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em.

i

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rent

/co

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anne

r. _

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iffi

cult

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mpr

ehen

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g in

form

atio

n__

_ St

uden

t dem

onst

rate

s em

barr

assm

ent

___

Oth

er: _

____

____

____

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_

p

rese

nted

ora

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and

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info

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oral

ly.

com

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ion

prob

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. _

_ O

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:___

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ther

: ___

____

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:

_

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ents

:

___

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___

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

___

____

____

____

____

____

____

____

____

____

____

____

____

____

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____

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____

___

____

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____

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____

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____

____

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_

***

**

***

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***

**__

_ N

o ac

adem

ic im

pact

repo

rted

. _

__ N

o so

cial

imp

act r

epor

ted

.__

_ N

o vo

cati

onal

impa

ct re

port

ed.

Sou

rce:

Lee

Cou

nty,

Flo

rid

a. (1

995)

. In

A r

esou

rce

man

ual f

or th

e de

velo

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t and

eva

luat

ion

of s

peci

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rogr

ams

for

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nal s

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nts

(p. 2

0). T

alla

hass

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lori

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Dep

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men

t of E

du

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dap

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wit

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ount

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da

Dep

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f Ed

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tion

.N

ote.

Exa

mp

le o

nly;

sta

te a

nd lo

cal p

roce

du

res

may

var

y.


Appendix J: Example of Entry/Exit Criteria for Caseload SelectionsWorksheet

Student’s Name: ______ Date:______ Speech-Language Pathologist: _____________________________Section I. The student HAS/DOES NOT HAVE a communication disorder.

The disorder is in articulation/___ language/___ voice/___ fluency/___. (Circle and indicate severity.) Factorspreventing designation of a communication disorder are: _________________________________________

Section II. The communication disorder DOES/DOES NOT impact educational performance and IS/IS NOT aneducational disability.____ The problem affects social/emotional development or adjustment in the school setting.____ The problem affects participation in the school program.____ The problem affects academic achievement (i.e., the acquisition of skills basic to learning: reading, writing,

math, etc.).____ The problem interferes with effective communication (opinions from others who interact with the student

must be sought).Section III. The student SHOULD/SHOULD NOT be considered for speech/language intervention.

Entry/continuation: Recommendation is based on Exit/dismissal: Recommendation is based onexistence of all of the following as determined by the existence of one or more of the following as determinedspeech-language pathologist: by the speech-language pathologist:

___ Student has a communication disorder that is ___ Student has met terminal goals and objectivesamenable to intervention. in deficit areas. OR

___ Student’s cognitive/developmental level ___ Student’s communication disorder is relatedappears sufficient to acquire targeted skill(s) to a medical/physical or emotional problembased on information available at this time. and is not considered amenable to

___ Student’s deficit areas require the intervention intervention at this time.(direct or indirect) of a speech-language ____ Student’s cognitive/developmental level doespathologist. not appear to be sufficient to acquire

___ Student does not demonstrate adequate targeted skill(s) at this time.compensatory skills for deficit areas. ____ Student’s deficit areas can be managed through

classroom modifications or by another serviceprovider.

____ Student has developed compensatory skills thatare functional in the deficit areas.

____ Student does not have regular school and/ortherapy attendance pattern.

____ Student does not demonstrate motivation toparticipate.

____ Student does not have the attentional andbehavioral skills appropriate for intervention(adaptations and other models of interventionhave been tried).

____ Student has made little or no measurableprogress in ___ months or ___ years ofconsistent intervention.


Ap

pen

dix

K: E

xam

ple

of

a D

ism

issa

l Cri

teri

a C

har

tSt

ud

ent N

ame

___

____

____

____

____

____

____

____

____

____

____

____

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ate

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____

____

____

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Scho

ol

____

____

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____

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eech

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____

____

____

____

____

____

____

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he st

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s elig

ible

for d

ism

issa

l whe

n re

eval

uat

ion

doc

um

ents

that

one

or m

ore

of th

e ge

nera

l or s

peci

fic d

ism

issa

l cri

teri

a is

met

:

Gen

eral

Dis

mis

sal C

rite

ria

___

Spee

ch-l

angu

age

prob

lem

no

long

er e

xist

s.__

_ St

uden

t is n

o lo

nger

ben

efit

ing

from

spee

ch-l

angu

age i

nter

vent

ion.

__

_Sp

eech

-lan

guag

e pr

oble

m is

no

long

er a

dis

abili

ty.

___

Giv

en cu

rren

t med

ical

, neu

rolo

gica

l, ph

ysic

al, e

mot

iona

l, or

___

Spee

ch-l

angu

age

prob

lem

no

long

er in

terf

eres

wit

h th

e st

ud

ent’

s

dev

elop

men

tal f

acto

rs, t

he st

ud

ent’

s spe

ech-

lang

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e pe

rfor

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ce is

e

du

cati

onal

per

form

ance

incl

ud

ing

soci

al, e

mot

iona

l, ac

adem

ic, o

r

w

ithi

n th

e ex

pec

ted

lang

uag

e p

erfo

rman

ce ra

nge.

v

ocat

iona

l fu

ncti

onin

g.__

_ T

he st

ud

ent h

as a

chie

ved

app

ropr

iate

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pens

ator

y be

havi

ors.

Sp

ecif

ic D

ism

issa

l Cri

teri

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P

hon

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L

angu

age

F

luen

cy

Voi

ce

__

The

stu

den

t mai

ntai

ns a

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he st

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ent s

core

s les

s tha

n 2.

0__

The

stud

ent d

emon

stra

tes f

luen

cy__

The

mod

al p

itch

is o

pti

mal

, the

m

inim

um

of 7

5 p

erce

nt

stan

dar

d d

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tion

s bel

ow th

e

tha

t is w

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n no

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lim

its f

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lary

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l ton

e is

cle

ar, t

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te

cor

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duc

tion

of e

rror

ex

pect

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ge p

erfo

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ce

age

, sex

, and

spea

king

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ns

is a

t an

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mal

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pho

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es o

n T

AL

K p

robe

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ap

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stan

dar

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r exh

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s som

e tr

ansi

tory

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asal

ity

is w

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n no

rmal

lim

its

a

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inis

tere

d a

t 8 a

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6

ized

test

s tha

t eva

luat

e ar

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cies

. The

re is

min

imal

a

min

imu

m o

f 80

per

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of t

he

wee

k in

terv

als

of

rem

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tion

.

or n

o ad

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e ef

fect

on

ti

me

und

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ndit

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__ T

he st

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s lan

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ills a

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erfo

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edia

ted

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ge, o

r au

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ory

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a

s det

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ined

by

info

rmal

m

easu

res.

__ T

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ent w

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a d

isab

ility

that

p

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lang

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e is

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issa

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whe

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/sh

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mm

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cate

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sing

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augm

enta

tive

co

mm

uni

cati

on s

yste

m.

Com

men

ts

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

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____

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SLP

11

W

hite

Cop

y: S

tud

ent F

old

er

Yel

low

Cop

y: S

pee

ch-L

angu

age

Pat

holo

gist

P

ink

Cop

y: P

aren

t (A

ttac

h to

the

app

rop

riat

e re

por

t of

the

Ad

mis

sion

,R

evie

w, D

ism

issa

l mee

ting

.)So

urc

e: H

owar

d C

ount

y P

ubl

ic S

choo

ls, E

llico

tt C

ity,

Mar

ylan

d, (

1997

). R

epri

nted

by

per

mis

sion

.N

ote:

Exa

mp

le o

nly.

Sta

te a

nd lo

cal d

ism

issa

l cri

teri

a va

ry. F

ollo

w s

tate

reg

ula

tion

s an

d lo

cal p

olic

ies

and

pro

ced

ure

s.

guidelines for the roles and responsibilities of the school-based speech-language...

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