Saturday, February 9, 2013
Making Sense of the Speech-Language Eligibility Process- A Guide for Caregivers
One of the most important aspects of my job as a Speech Language Pathologist is caregiver education. It's easy for professionals to take for granted understanding of the acronyms, evaluation time lines, and criteria for qualification of speech services. So, I thought I would take a moment to walk you through the process as it pertains to both the public and private school settings here in Illinois, while defining some key terminology along the way.
Some of the areas that a school Speech Language Pathologist addresses include: speech/articulation, vocabulary/language development, fluency, voicing, and social/pragmatics. First, caregivers and/or teachers express a concern about the students' communication. I find it best to have referral sources complete a one page screening request form. Keep in mind that before a screening can be completed, caregiver permission should be obtained. In the private school setting in IL, we only need an email or phone confirmation from caregivers. Sometimes, caregivers express a concern at parent-teacher conferences, at which time a referral form can be completed so a screening can take place once the speech therapist obtains the referral form.
Screening: an informal collection of information that typically takes 15-20 minutes. It is NOT an assessment, rather, a screening helps determine if an assessment is indicated. Here's where my request for a screening comes in very handy because it allows me to include screening questions pertinent to the concerns reported in the request. An example of a screening that would not lead to a formal evaluation would be if a kindergartner demonstrates errors on developmentally appropriate sounds such as /th,/ /s,/ and /L./
Developmentally appropriate sound errors: errors on sound targets that the student may not yet be able to produce due to age. Like all other areas of development, some children can master sound targets sooner than others. Much of this depends on growth of the oral cavity, hearing acuity, and exposure. The kindergartner in the above example with developmentally appropriate errors may not have experienced enough growth with his/her oral cavity, which in turn means the tongue still does not have enough room in the mouth to produce these refined moments. Another possibility is that the same kindergartner has had a history of recurring ear infections and missed crucial opportunities to hear certain sound targets due to excessive fluid in the ears. If we allow some time, the sound targets will naturally become clearer. Flow this link for a chart showing the wide range for specific sound development.
Speech Sound Development Chart by Age
Copyright © Graham Williamson 2011
Bear in mind that these rules do not apply for a highly unintelligible child. Typically, a child with a significant speech challenge is identified in early intervention, preschool, or kindergarten.
If a screening indicated more testing is necessary to make an informed decision about qualification, then caregivers are notified to attend a meeting. The meeting team should include the following: caregiver(s), speech pathologist, classroom teacher, and school representative (i.e., assistant principal.). The goal of this meeting is to determine if there are any additional areas of testing required, besides speech and language, and obtain caregiver signature to complete any indicated testing. The 60 school days clock starts ticking when consent is signed. All testing and reports need to be completed within that timeline.
Typically, we use tests that yield a standardized score. Standard Scores compare the student's results to a national average. These scores tell us if the student being tested falls above average, below average, or average in comparison to his or her same aged peers. Standard deviation is a formula that tells us about the average distance to the average range. Every 15 points represents one unit of standard deviation. The range of average for most tests is from 85-115. Students that receive a standard score of 70 are one standard deviation away from average and subsequently are demonstrating a mild delay. Those scoring more than 2.5 standard deviations from the norm are classified as having a severe-profound communication delay.
Adverse impact on student's educational performance: this line is the "Be all, end all," in the school system. The team that met for the initial meeting come together to report test scores and observations and then determine if a delay impacts the child's ability to learn in school. If a delay in any area of communication (speech, language, voice, fluency, social) impacts a child's ability to be understood by school staff and/or peers, then it is likely that the child will be found eligible for services. Below are the thirteen possible disability categories that are used to determine special education eligibility as it pertains to speech and language:
Speech or Language Impairment
Other Health Impairment: this includes ADHD, Diabetes, etc
Specific Learning Disability
After eligibility, the next step is to determine the least restrictive environment for services.
Least restrictive environment: the setting and occurrence for services that least restricts the child from educational learning in the classroom. For example, a child with a mild articulation delay would be too restricted from classroom learning if the speech therapist pulled him or her more than once a week for speech services.
In the public school setting, an Individualized Educational Plan (IEP) is developed while in the private school setting in Illinois, we write an abridged version of the IEP and refer to it as an Individualized Service Plan (ISP). Either way, the plan is good for a year, at which time the team meets to review goals, develop new goals, alter service times, or in some cases discharge services altogether. At any point in the year, caregivers can request a team meeting to edit goals and therapists can also call for a meeting if discharge appears appropriate. Every three years, the team meets at eligibility meetings to talk about all areas of development, determine what, if any, areas require updated testing, and discuss continued eligibility for speech services.
Remember to ask questions and take the IEP home to review it before signing if you need more time to process the information. Your team members are there to support you and your family every step of the way, so don't hesitate to ask questions!