Can speech/language therapy services be provided outside of special education? Is parent permission required? What are the paperwork requirements? Can an implementer provide these services?

Speech therapy can be provided either as special education or as regular education. However, if a disability is suspected, then IDEA requirements kick in and must be followed, so it becomes a special education issue unless the child is found ineligible. There is no requirement for signed parent permission since it is a regular education service; however, most schools feel more comfortable obtaining a signed permission. There are no set paperwork requirements. For many schools the signed parent permission is the only required paperwork. Best practice would dictate, of course, that the SLP keep data as s/he does with every student and that a system of informing parents of progress be established, but this is up to the school district.

An implementer is practicing under a Special Education model, the implementer model. Implementers cannot provide services that are not special education.

Can speech/language therapy services which are part of regular education be provided in the “speech” room?

Regular education speech services can be provided anywhere other regular education services are provided. Since speech can be either regular or special education, DESE does not view the “speech” room as a special education room. So, students receiving speech therapy as a regular education service can be seen by the SLP in the “speech” room. They can be seen individually, with other regular education students, or with students who have IEPs. They cannot be seen in a Special Education room because in this setting no regular education services are provided.

Does a child have to demonstrate reduced grades or achievement test scores in order to qualify as Sound System Disordered in Missouri Public Schools in order to meet the "adverse educational impact" requirement?

The U.S. Department of Education has provided clear interpretation of the phrase "adversely affects educational performance" as it applies to children with speech-language impairments. This interpretation clearly states that a child who has a disability cannot be denied services because she or he does not demonstrate concurrent academic problems (ASHA, 2005). Following is a quote from a letter from Edwin Martin, Acting Assistant Secretary of Special Education and Rehabilitation of the U.S. Department of Health, Education, and Welfare (Office of Education in Washington, D.C.):

"The meaning of educational performance" cannot be limited to showing of discrepancies in age/grade performance in academic subject-matter areas. The extent of a child's mastery of the basic skill of effective oral communication is clearly includable within the standard of "'educational performance' set by the regulations. Therefore, a speech/language impairment necessarily adversely affects educational performance when the communication disorder is judged sufficiently severe to require the provision of speech pathology services to the child." "It is clear that, in establishing the existence of a speech/language impairment that is 'handicapping' in Part B (IDEA), a professional judgment is required. The basis for that judgment is the child's performance on formal and/or informal measures of linguistic competence and performance, rather than heavy reliance on the results of academic achievement testing. The impact of the child's communicative status on academic performance is not deemed the sole or even the primary determinant of the child's need for special education services. It is the communicative status - and professional judgments made in regard to assessments of communicative abilities - which has overriding significance.

In the event that the speech-language pathologist establishes through appropriate appraisal procedures the existence of a speech/language impairment, the determination of the child's status as a 'handicapped child' cannot be conditioned on a requirement that there must be a concurrent deficiency in academic performance."

Although the current Missouri Compliance Plan does not define the term "educational performance," an excellent explanation was included in previous state plans as follows: Educational performance shall be interpreted as not only classroom applications of academic skills and concepts, but also as generalization of skills and behaviors such as social interaction, functional communication, and prevocational and vocational skills and behaviors in other environments.

Is it necessary to obtain written permission in order to do speech/language screening?

The key question is, “Why is the child being screened?” Each district must have a child find system in place so routine screening done when no disability is suspected does not require permission. Once a disability is suspected, then IDEA is triggered and written notice and consent is required. If you are screening to get information for regular education services such as RtI, EIS, tutoring, etc. permission is not required. If you screen all transfer-in students then no permission would be required. If a child is on a “watch” list, probably do not need permission. As soon as a disability is suspected, then you need to proceed to a Review of Existing Data and, if evaluation is required, obtain written consent.

Can professional judgment be used in making a determination of eligibility for Sound System Disorder?

Because of the nature of communication disorders, it is not possible to remove the element of professional judgment from eligibility decisions. The old phrase “tests don’t diagnose, people diagnose” is absolutely true and we should probably say that “test SCORES don’t diagnose”. Although critical in our work, very seldom are formal test results a true and complete picture of an area as complex as communication. Nearly every eligibility criteria includes a requirement for information which either supports or does not support test scores. The information gathered during the Review of Existing Data, screening, observations, interviews, work samples, etc. should be used in conjunction with standardized test results to make the best eligibility decisions possible.

Is it okay for a Special Education teacher to provide the services to a student with a language disorder,
instead of the SLP?

It depends on what the IEP team determines is needed for the child. If the IEP says that the child needs speech/language therapy, then the only acceptable models in MO to provide this therapy are from an SLP or through the approved implementer model. If the IEP has goals and objectives addressing language skills and the team determines that those needs can be addressed in the regular education program or through specialized instruction, then the IEP would not indicate speech/language therapy and those identified needs could be addressed by someone other than the SLP. In this case, the IEP team would determine who would implement that portion of the IEP.

I would like some different views on the roles and responsibilities for SLP's and dysphagia in the school setting. Is the school responsible for the nutrition of the student or is it a medical issue? Who pays for the swallowing evaluation? Are there any official guidelines through DESE?

Often tongue-thrust and swallowing issues are viewed as medical issues and typically are not considered applicable to educational outcomes. However, if an IEP team determines that the child needs speech therapy designed to address either of these issues in order to receive FAPE, the district would be required to provide the therapy or to see that it is provided. Eligibility in the category of Speech Impairment based on either of these conditions alone would likely not meet the definition in the Missouri State Plan for Special Education. If the child demonstrates other communication difficulties as outlined in the State Plan and has accompanying tongue thrust or swallowing problems, the team should consider how these conditions impact the child’s overall communication skills and if intervention is necessary to provide FAPE. A good resource is the ASHA guidelines for SLPs providing swallowing and feeling services in schools at http://www.asha.org/docs/html/GL2007-00276.html.

If it is determined that swallowing needs to be addressed, would the school district be required to pay for a modified barium swallow at a hospital or would informal assessment of swallowing be sufficient to diagnose
the problem?

Part of the decision-making process would be a review of existing information available to the team from the medical doctor’s assessment of the child. It is doubtful that a school-based team would be the first to determine that the problem exists. However, a school team may have to respond to the condition and the need for services as they write the IEP. Some children have disabilities that impact swallowing and interventions for this may be included in the IEP when the team determines they are necessary for the child to receive FAPE. An example may be a child with excessive drooling stemming from cerebral palsy and a determination that oral-motor interventions would reduce or eliminate the problem and improve communication. In those cases the team may decide that the therapy is necessary and the need directly related to the long term goals for the child in communication. If a team determines that an assessment of the child’s swallowing function is necessary in order to appropriately program for the child, then yes, the district could pay for the testing or access other funding sources.

Can SLPs use Substitute Teachers?

The only individual that can substitute for an SLP is another appropriately credentialed SLP. DESE has never approved the use of nonqualified substitutes which includes all but a few rare individuals from the regular substitute teacher list. In the past DESE instructed districts that any missed therapy sessions were to be made up. On 3/8/07, the federal Office of Special Education Programs (OSEP) responded to a request by ASHA for interpretation of the need for substitutes for SLPs based on the IDEA Amendments of 2004.

ASHA’s question was about the need to use substitutes and to schedule make up sessions when speech/language sessions are missed as a result of the child’s absences, the SLP’s absences, or other causes such as school activities. OSEP replied that these issues are not addressed in the federal law or the federal regulations and it is up to each state to ensure a Free Appropriate Public Education (FAPE). Therefore, each school entity needs to consider the effect of absences (child’s or SLP’s) or other causes of missed sessions on the child’s progress toward IEP goals. If the goals are not likely to be met, missed sessions may be a denial of FAPE. In that case a qualified substitute may be located or compensatory therapy could be provided. How that will be done is the decision of the school district.

Where can I find the SLP caseload formula? Can I make my director of special education use the formula instead of 40-60 students? Can SLPs use the special education teacher formula?

Information about caseloads can be found in the State Plan for Special Education on pages 113-120 at http://www.dese.mo.gov/divspeced/stateplan/documents/Regulation_VII_2010.pdf. When the Foundation Formula was changed and Exceptional Pupil Aid eliminated, mandatory caseloads for all special education including Speech/Language were also eliminated. You will note that the Plan indicates a number of factors to be considered when caseload is determined. These include ages and grade levels of the students served, severity of the disabilities of the students served, the unique needs of the students as identified in their IEPs, the number of IEPs case managed, assessment/evaluation responsibilities, and other duties assigned to the teacher. The caseload formula page is still included and can be used, but even then suggested guidelines for caseloads are only recommendations. You will note the Plan gives numbers which are “maximum” and “desirable”. Using a simple head count, the “maximum” numbers are those which are considered to be what the provider could serve. However, when the above factors (and possibly others) are taken into consideration, the “maximum” may need to be lowered for that caseload. For example, an SLP who is providing some therapy in a regular education setting or providing some resource services for language impaired students could obviously not handle the “maximum” caseload. The “desirable” number is what is considered, before the above conditions are factored in, to be the best estimate of the most students for that caseload. It is up to the director to approve the caseload, hopefully with the input of the SLP, since the SLP will know specifics about other duties and student needs.

Can a speech implementer register and provide services as an SLP assistant?

Yes -- if they meet the SLP assistant requirements including training and supervision, an implementer can register as an SLP assistant. However, the education and supervision requirements for an SLP assistant are substantially different from those for a speech implementer. The SLP assistant must have a bachelor’s degree in communication disorders and one of every three therapy sessions provided by the assistant must be directly supervised by a licensed SLP. The speech implementer may hold a bachelors degree in communication disorders or hold a teaching certificate “preferably” in special education or elementary education. Direct supervision may be provided by either a licensed or DESE certificated SLP and the supervision is “periodic” at the school’s discretion. It is advisable for an implementer to check with their school district to see if the level of supervision necessary for an SLP assistant can or will be available. For the requirements to be registered as a Speech-Language Pathology Assistant go to Missouri Licensure Rules and Statutes.

When will schools know if speech implementers must be registered and meet the requirements for SLP assistants or another registration?

The Missouri Board of Healing Arts, Speech-Language Pathology and Audiology (SLP/A) Commission has been reviewing information in an attempt to determine if speech implementers should be registered and meet the requirements for SLP assistants. As of January 2007, the Board and Commission asked the Attorney General’s office for an official opinion on the matter. Until that opinion is available, the issue remains unresolved.

Is there a problem with speech implementers becoming a fully licensed SLP?

Some speech implementers with bachelor’s degrees in communication disorders have a desire to become fully licensed SLPs. If it is determined that implementers are practicing in violation of state licensure law, it may be difficult for individuals who served as implementers to obtain their SLP licensure. Until a decision is made by the Attorney General, the Advisory Commission for SLPs has decided that implementers will not be penalized for violating state licensure laws.