Decision Making in Termination of Services
Reasons for Discharge
The ideal circumstance for discharge would be when the team—consisting of the individual with the communication disorder, the family, and the speech-language pathologist–comes to a mutual decision. The main reasons for discharge are:
- the communication disorder has been remediated or compensatory strategies have been successfully established;
- the individual or family chooses not to participate in treatment, relocates, or seeks another provider;
- treatment no longer results in measurable benefits after multiple modifications have been attempted.
Each program should have established policies and procedures for following the individual after discharge. Follow-up is necessary because an individual's circumstances may change, new treatments may become available, or the individual may respond differently due to maturational changes or new life transitions (ASHA, 2004).
Termination Due to Lack of Progress
An apparent "lack of progress" is based on the assumption that the prescribed treatment goals, methods, data collection, and use are all appropriate for the individual with disabilities and his/her family. However, it is possible that the perceived lack of progress is actually an indication that the procedures being implemented are not well-suited to the individual with disabilities. In other words, lack of progress might indicate that the intervention is a poor fit. It is important to examine whether the intervention itself is optimal for the individual, his/her family, and his/her other caregivers and educators.
Assuming treatment directions and methods are appropriate, it may be necessary to attempt some training and direct support for family members. The objectives of this training would likely be to make family members aware of the potential benefits of treatment participation and to clarify any confusion related to the methods used and the role of families as agents of change.
Schepis and Reid (2003) provided a possible resource to assist with training families and other stakeholders. These authors discussed competency- and performance-based training built on adult learning principles and derived from applied research. Adopting this training approach could be an initial step in promoting the comprehensive application of communication-based treatment across settings and could lead to a dramatic change in support.
Termination of Service Based on Parent Preferences
One issue concerns dismissal of a student when the family no longer desires treatment. If this is the case, ASHA suggests that discharge is appropriate. According to ASHA (2004), discharge is defensible when "the individual, family, and/or guardian requests to be discharged or requests continuation with another provider" (p. 5). If the discharge is motivated by a lack of progress, questions such as the following should be carefully considered before a final decision is made:
- How appropriate have the intervention goals been?
- Has treatment occurred with appropriate intensity and over a sufficient amount of time?
- Have appropriate methods been implemented?
- Has intervention been guided by careful data collection and analysis?
- Have sufficient supports been provided to optimize opportunities for successful outcomes?
Bottom Line: There are a number of reasons for discharging a person from treatment. If there is a lack of progress in functional communication on the part of the individual and/or resistance of the family, however, the appropriateness of the treatment for that individual and his or her family should be reviewed.
- American Speech-Language-Hearing Association. (2004). Admission/discharge criteria in speech-language pathology [Guidelines]. Available from www.asha.org/policy.
- Schepis, M. M., & Reid, D. H. (2003). Issues affecting staff enhancement of speech generating device use among people with severe disabilities. Augmentative and Alternative Communication, 19, 59–65.