Communication Services and Supports for Individuals With Severe Disabilities: FAQs
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Who are members of an interdisciplinary team? What is their role?
Depending on an individual's age and disability, the exact composition of the interdisciplinary team will vary. An interdisciplinary team consists of the family and professionals who are engaged in supporting the individual. The team typically includes at minimum the individual with severe communication disabilities, a family member or guardian, a speech-language pathologist, and a teacher (general or special education). Other members may include, but are not limited to, an occupational therapist, physical therapist, general education and/or special education teacher, direct care staff, employer/job coach, psychologist, and social worker.
The ideal interdisciplinary service delivery model requires that participants share a common perspective on communication. This shared perspective should include a broad understanding of communication including that it is a shared social skill and that it have effects on other people, and can be nonspoken or spoken and nonsymbolic or symbolic in its form (OSEP/TADS symposium, 1985). The role of the interdisciplinary team is to work cooperatively to provide discipline-specific assessment and intervention, although some cross-disciplinary activity may occur as team members collaborate in the delivery of communication services and supports. They discuss their findings and activities to seek consensus and to develop goals and plans as a team.
Sometimes members of the team may differ about the recommended communication intervention approach for an individual. In these cases, professionals should be guided by the scope of practice and the evidence base. The team must work together to resolve their differences and build consensus so that that individual receives the communication services and supports he or she needs. Sometimes the team may want to seek outside consultation when the team remains divided about an intervention approach or recognizes it doesn't have the requisite expertise represented within the group.
For more information:
See the NJC home page for information and links related to the professional organizations represented on the National Joint Committee for the Communication Needs of Persons With Severe Disabilities (NJC).
McCarthy, C., McLean, L., Miller, J., Paul-Brown, D., Romski, M. A., Rourk, J., & Yoder, D. (1998). Communication supports checklist for programs serving individuals with severe disabilities. Baltimore, MD: Brookes.
National Joint Committee for the Communication Needs of Persons with Severe Disabilities. (1992). Guidelines for meeting the communication needs of persons with severe disabilities. Asha, 34(Suppl 7), 2-3.
Snell, M.E., & Janney, R.E. (2005). Practices for inclusive schools: Collaborative teaming (2nd ed.). Baltimore: Brookes.
Snell, M. (2000). Collaborative teaming. Baltimore, MD: Brookes.
What does a speech-language pathologist (SLP) do?
Speech-language pathologists (sometimes referred to as "speech therapists") are professionals who evaluate, treat, prevent, and research human communication and its disorders. They work with individuals of all ages, from infants to adults who are aging. Speech and language professionals work closely with teachers, physicians, psychologists, social workers, and rehabilitation counselors, and other members of an interdisciplinary team. They evaluate and diagnose speech problems, such as fluency (e.g., stuttering), articulation, voice disorders; language problems, such as delayed language development and aphasia; and related disorders, such as dysphagia (e.g., swallowing difficulties).
Speech-language pathologists design and carry out comprehensive treatment plans to achieve the following:
- Help individuals learn correct production of speech sounds
- Assist with developing proper control of the vocal and respiratory systems or correct voice production
- Assist children and adolescents with spoken and written language problems, such as understanding and giving directions, answering and asking questions, understanding and using grammar, using appropriate social language and conveying ideas to others, comprehending stories they hear and read
- Assist individuals who stutter to increase the amount of fluent speech and to cope with their disorder
- Assist individuals following a stroke or other brain trauma to relearn language, speech, and swallowing skills
- Help individuals to use augmentative and assistive systems of communication (AAC)
- Counsel individuals with speech and language disorders and their families or care givers to understand their disorder and to communicate more effectively in educational, social, and vocational settings
- Advise individuals and the community on how to prevent speech, language, and swallowing disorders
Speech-language pathologists, certified by the American Speech-Language-Hearing Association, hold either a master's or doctural degree, complete a clinical fellowship, and pass a national exam to earn a Certificate of Clinical Competence (CCC-SLP). Most states also have individual licensing or state education certification requirements.
Browse the ASHA Web site for more information.
There is a general shortage of speech-language pathologists (SLPs) in my area; in particular, there are very few SLPs who are familiar with augmentative and alternative communication (AAC) and serve people with severe disabilities. Some other professionals from other disciplines, such as psychologists and physical therapists, are making recommendations about AAC and speech generating devices (SGDs). Is this okay?
This question involves the issues of team models (in which professionals from different specialty areas team to provide service) and scope of practice (i.e., the job responsibilities). The primary guiding concern among team professionals must always be the best interest of the client. While there are some things that only the SLP on a team is licensed to do, virtually all aspects of AAC service provision benefit from the insights of the other team members. In fact, ASHA (2008) explicitly recognizes the concept of "role release" among professionals operating within a transdisciplinary team model, allowing for primary service provision by a single individual who is not necessarily the SLP. In the case of AAC, the key is that the primary provider be an individual with a significant level of insight about language development, disorder, and evidence-based intervention practices.
Clearly, the SLP can play an important role in assessment and intervention for clients who will be using SGDs. Insurance reimbursements for purchase of SGDs require a formal written evaluation by an SLP; thus, if the family would like the device to be covered through insurance, a signature of an SLP is necessary (see Key Questions for Medicare Coverage & Funding for AAC Devices or CPT Coding for AAC/SGDs: Some Frequently Asked Questions ). In all other ways, however, service provision for someone learning to use an SGD should be interdisciplinary (i.e., across the disciplines)-as should services for all individuals. Recommended practice suggests that decisions should depend on what recommendations are being made, rather than the fact that those recommendations do or do not involve SGDs.
Development of AAC interventions requires expertise in communication development, disorders, evidence-based practice, and how to best match a client's communication skills to the features of different SGDs. Although by nature of their training SLPs are often the individuals with the greatest expertise in these areas, professionals from other disciplines (e.g., psychologists, occupational and physical therapists, assistive technology experts, and special educators) may have extensive knowledge in these areas as well. Even when the SLP is the primary provider, his or her recommendations for implementing intervention never occur without input from and collaboration with other members of the team. As noted in the technical report on AAC published by ASHA (2004, p. 9), "The SLP must acknowledge the need for expertise from other service providers who may include, but certainly not be limited to, physician, occupational therapist, physical therapist, vision specialist, rehabilitative engineer, teacher, psychologist, behavior consultant, and social worker. No less significant is input from parents, spouses, employers, and significant others."
There are a number of appropriate roles for team members. For instance, parents or caregivers can share insights about functional abilities and physical stamina across the course of a day; occupational and physical therapists will be critical in helping to determine best matches for motor control and/or positioning, relative to the features of the SGD and the client's abilities; and behavioral specialists and educators will aid in structuring procedures for the effective implementation of the SGD in a variety of settings, for a variety of functions.
For more information, see this other related FAQ:
Who are members of an interdisciplinary team? What is their role?
American Speech-Language-Hearing Association. (2004). Roles and responsibilities of speech-language pathologists with respect to augmentative and alternative communication: Technical report. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (2008). Roles and responsibilities of speech-language pathologists in early intervention: Guidelines. Available from www.asha.org/policy.