Language and Learning Disabilities in School Age Children

Issues in School-Based Clinical Practice

CSD 7010

A quick look at the numbers

>80% of children with disabilities in schools are diagnosed with:
46%: Learning Disabilities (LDs) 20%: Speech/Language Impairments 9%: Intellectual Disability 8%: Emotional Disturbance

Consider
What are the implications of these numbers in terms of a school-based caseload?

Language Learning Disability

Term that implies difficulty with various aspects of communication that interfere with ability to succeed in school Trouble progressing past a certain point of language development to higher levels of language performance in oral/written modalities, such that they have language, learning, and literacy problems e.g., have mastered basic vocabulary, etc

Brainstorm: What are some of issues SLPs in the schools face?

Roles and Responsibilities of SLPs in Schools

ASHA (2010)

Provide the basis for speechlanguage services in schools to promote efficient and effective outcomes for students

Why the revision of the 2000 Roles/Responsibilities???

Much has changed in education since 2000 Ever-increasing demands are placed on school-based SLPs, with an expanded scope of practice Necessary that roles and responsibilities be redefined in light of changes that have taken place in schools, as well as in the SLP discipline 3 main areas provide a rationale for the ASHA statement (see ASHA, 2010):
Educational reform Legal mandates Evolving professional practices

Four Categories of Roles and Responsibilities

Critical Roles in Education

Range of Roles and Responsibilities Collaboration

Leadership

Critical Roles in Education

(integral roles in education and essential members of school faculties)

Working Across All Levels (Pre-K to high school) Serving a Range of Disorders Ensuring Educational Relevance (does the disorder have an impact on the education and attainment of education goals?) Providing Unique Contributions to Curriculum (based on expertise in language)

Critical Roles in Education

(integral roles in education and essential members of school faculties)

Highlighting Language/Literacy (SLPs contribute significantly to literacy achievement of students with communication disorders, and others at risk for school failure) Providing Culturally Competent Services (SLPs have expertise to distinguish a language disorder from something else e.g., cultural and linguistic differences, socioeconomic factors, lack of adequate prior instruction, and the process of acquiring the dialect of English used in the schools)

Range of Responsibilities
(helping students meet performance standards)
Prevention of academic failure (e.g., RTI) Assessment to identify students with communication disorders and inform instruction intervention that is appropriate to the age and learning needs of each individual student

Range of Responsibilities
(helping students meet performance standards)
Program Design to configure programs that employ a continuum of service delivery models in the LRE for students with disabilities, and other students as appropriate Data Collection and Analysis gathering and interpreting data with individual students, as well as overall program evaluation Compliance meeting federal and state mandates as well as local policies (e.g., IEP, report writing)

Collaboration
(working in partnership with others to meet students' needs)

Collaborate with:

Leadership
(providing direction in defining roles/responsibilities & ensuring delivery of appropriate services)

Advocacy (for children and self/other SLPs) Supervision and Mentorship Professional Development Parent Training Research

Top 10 Consensus
Ax/tx of a wide range of disabilities using evidence-based practice Knowledge of curriculum/core standards Collaboration/team player Delay/Difference, cultural differences, etc. Time Management, organizational skills Educational laws/policies (all levels-federal, state, district, local) Behavior management Professional education requirements, district policies and offerings Service delivery models (and supporting evidence) Literacy

Essential Factors in Implementing Roles/Responsibilities

Realignment of roles and responsibilities if needed Reasonable workloads Professional preparation Lifelong learning continuing education

A Workload Analysis Approach for Establishing Speech-Language Caseload Standards in the Schools: Guidelines
ASHA (2002). Available from www.asha.org/policy.

ASHA Workload Analysis Approach

Developed to address member concerns that many school service programs require caseloads for SLPs that are too high in number to provide quality services

Major goal: to increase the number of states and school districts that use total SLP workload time and activities to determine the number of children who can be appropriately served on a caseload

ASHA Workload Analysis Approach

Traditional conceptualization: workload=caseload

Caseload vs Workload
Caseload
The number of students who receive services from an SLP through a variety of delivery models (direct, indirect)

Workload
All the professional activities that you do with, for, or on behalf of the students on a caseload that are mandated by law

A note about caseloads

Caseload size = controversial issue Between 1990 and 1999, the number of children with speech-language impairments grew by more than 10% (ASHA, 2002)

What should caseload size be for school-based SLP?

Brainstorm: What are some responsibilities that workload may include?

IEP meetings

Administrative tasks
Evaluation time Paperwork Consultation Planning time

Direct and indirect intervention services

How Does Caseload Relate to Workload?

Increases in caseload are directly related to workload

 Workload (and caseload size) is a difficult issue to understand and resolve because of the complex interaction of many factors that influence the number of children and adolescents the SLP must serve

Five Major Premises Embodied in Workload Concept

1. Every student added to caseload increases workload 2. Workload is affected by the severity of disability 3. Caseloads must be of a size that allows SLPs to carry out all mandated duties 4. Education Agencies must implement a workload analysis approach 5. Workload analysis approach gives SLP and administrators a common ground by which caseload can be analyzed
1. SLP is seen as professional concerned about being in compliance with mandates and dedicated to meeting all of the needs of students

Factors That Affect School SLP Workloads

Just a few:
State and local policies for determining eligibility and dismissal criteria The age and severity of disabilities of students on caseload Student service team recommendations on where and how services can most effectively be delivered (e.g., pullout, classroom, consultation, etc)

Workload Analysis Approach

The total workload activities required and performed by school-based SLPs must be taken into account to set appropriate caseload standards Approach to determine the number of children who can be adequately and appropriately served

Example of Workload Activity Clusters

Direct Services Indirect Services (support ed services)
Identification, evaluation Direct intervention/instruction
Classroom observations, pre-referral Ix Teacher interviews Staff training (e.g., for assistive tech) Communication with nonpublic teachers Evaluation reports, writing IEPs Professional development; faculty mtgs

Indirect Services (support LRE) Activities that support compliance with laws

12 Steps to a Workload Analysis

1. Examine required workload activities, instead of focusing exclusively on caseload (requires paradigm shift) 2. With this conceptual shift, analyze the current work week and job responsibilities (with state and federal mandates in mind). Ask: Where am I spending my time? Where should I be spending my time?
Schraeder (2008). Guide to School Services in SLP.

12 Steps to a Workload Analysis

3. Determine whether there is a match or mismatch between time and workload, and document concerns with concrete examples. Fill time slots with fixed tasks (e.g., administrative) 4. Determine activities necessary to provide appropriate intervention services for each student on the caseload (e.g., most appropriate service delivery model, activities spent on behalf of the student consultation, etc)
Schraeder (2008). Guide to School Services in SLP.

12 Steps to a Workload Analysis

5. Start filling available time slots with necessary student services 6. Strive for balance based on your caseload and needs of individual students. Working to balance:
direct intervention associated student-centered activities (e.g., designing AAC tools, teacher training) administrative tasks curriculum-related activities (e.g., consultation, prevention)

Schraeder (2008). Guide to School Services in SLP.

12 Steps to a Workload Analysis

7. Identify when all time slots are filled. When workload responsibilities do not fit into available time slots, SLP and school district must explore options for change. 8. Identify the problem and design a solution (multiple possible options) 9. Consider writing a brief summary of problems, initiatives already taken, and additional steps to be taken to achieve success. Identify and meet with policy makers

Schraeder (2008). Guide to School Services in SLP.

12 Steps to a Workload Analysis

10.Develop advocacy plan of action, which will provide a framework for a process to calculate workload activities and ensure student success 11.Pilot the new plan for one year through a collaborative team effort 12.Stay flexible, self-monitor, solicit feedback make additions, deletions, corrections, etc as needed
Schraeder (2008). Guide to School Services in SLP.

Workload Solutions
Does the workload analysis approach seem a little daunting???
ASHA (2004) Schools Survey revealed 61% (of survey respondents) found the workload analysis approach to be helpful

Schraeder (2008). Guide to School Services in SLP.

Workload Solutions: Solutions used by SLPs in the schools

Service Delivery Options Changing the way service is delivered may result in lighter workload Administrative Options Some districts may opt to use a district-wide workload policy For workload solutions, see Schraeder (2008); ASHA Workload Guidelines (2002)

Note: Implementation of any solution will require cooperative effort among teachers, administrators, parents, etc
Schraeder (2008). Guide to School Services in SLP.

Small Group Activity: Describe Some Workload Solutions

Service Delivery Options Administrative Options

Supportive Teaching Complementary Teaching Consultation Team Teaching Resource Room Diagnostic SLP Services Teaming for Reading Instruction

Early Release Day Program Support Teachers Diversified Roles

Schraeder (2008). Guide to School Services in SLP.