Sam, age 6, is receiving services for a speech-sound disorder from a hospital-based speech-language pathologist. Upon the clinician's recommendation, Sam's mother calls the school to arrange for her son to receive speech-language services there. The eligibility team decides that Sam is not eligible for special education services with a disability of speech-language impairment.
Aaron, age 5, has parents who believe he should receive speech-language services in school and that they should obtain a prescription from his pediatrician for twice-weekly speech-language services. The school informs the parents that it will accept the referral but is not obligated to follow the physician's prescription.
Maria, age 6, arrived in the United States from Guatemala nine months ago. Her first-grade teacher has referred Maria for an evaluation for special education based on the difficulty she is having understanding and speaking English in the classroom. The eligibility team finds that she has vocabulary delays but that she is not eligible for special education.
The challenges faced by Sam, Aaron, and Maria and their families are not uncommon in school districts across the country, often to the dismay of speech-language pathologists, teachers, and family members eager to address a child's communication needs yet unfamiliar with the nuances of special education eligibility requirements. The rules governing special education, created by law in 1975 (the Educational of all Handicapped Children's Act) and periodically reauthorized by Congress, are set forth in the Individuals with Disabilities Education Improvement Act (IDEA). Special education law details precise procedures and criteria for establishing eligibility for special education.
The purpose of federal involvement in the public education of children with disabilities is to ensure that these children receive a free and appropriate public education that addresses the educational impact of the disability. The law establishes the criteria for receiving special education: the child must meet the definition of a "child with a disability." Because IDEA is a funding mechanism for special education, it is understandable that the funding source has the right to establish qualifying criteria, much like the criteria health insurance companies establish to provide coverage for services.
The determination that a child meets the federal definition of a "child with a disability" is two-pronged: Does the child meet the criteria associated with one of the disability categories established in the law (e.g., speech-language impairment) and does the child need special education and related services as a result of this disability? The definition of speech-language impairment highlights the importance of considering the child's performance in school when making the decision about eligibility: "...speech-language impairment means a communication disorder, such as stuttering, impaired articulation, a language impairment, or a voice impairment, that adversely affects a child's educational performance" (34 C.F.R. Section 300.8(c)(11)).
SLPs in all work settings would agree on the presence or absence of a speech-language impairment in children such as Sam, Aaron, and Maria. However, the presence of an impairment does not make the child eligible for services. The crux of an eligibility decision for special education is whether the impairment "adversely affects a child's educational performance." The determination of eligibility is made by an interdisciplinary team that includes the parents, based on an analysis of data from multiple sources. IDEA prohibits a single professional—an SLP, psychologist, or a physician, for example—from making the decision regarding eligibility. The evaluation reports completed by individual professionals should clearly identify the presence of an impairment. However, the presence of a speech-language impairment does not equal eligibility for speech-language services under IDEA. That decision is the sole purview of the eligibility committee, which considers the speech-language assessment information and other data.
The eligibility process begins after referral with a review of existing data by an interdisciplinary team (often termed a "child study committee"). If the team needs additional data to determine a child's eligibility, it recommends certain assessments. IDEA requires parental consent to assessments; if the parents refuse, the assessment does not move forward. (Based on the situation, some districts may elect to pursue the assessments through due-process procedures.)
The assessment must gather information to enable the team to determine if there is a disability and the educational impact of the disability. When a speech-language impairment is suspected, evaluation typically includes:
- Information obtained from the parents (medical, educational history; concerns regarding their child's communication).
- Hearing screening.
- Formal and informal assessment of articulation, language, voice, and fluency (e.g., standardized tests, language samples).
- Review of classroom performance (e.g., work samples, journals, narratives, criterion-referenced tests).
- Review of student record (e.g., performance on state or district assessments of pre-reading and reading abilities, attendance, discipline, health records, universal screening results).
- Observation in the classroom, using checklists to quantify student behaviors, ideally during diverse instructional activities.
- Information obtained from teachers.
To understand the educational impact of the speech-language difficulties—that is, to relate the child's communication needs to the academic curriculum—the SLP should have a thorough knowledge of state educational standards (Power-de Fur, 2010). In addition, the clinician should be familiar with the services provided in other special education programs in the school, as many of these services provide language-rich environments for children (e.g., early childhood special education, programs for children with autism).
The SLP similarly should be mindful of the communication standard within the child's community. Clinicians should review standardized assessments to ensure the standardization of the sample is comparable to the school community. If not, the assessment can be used for descriptive purposes, but standardized scores should not be used, as the scores may inappropriately penalize the child for using speech-language structures that were not accounted for in the standardization. Clinicians frequently must modify administration of the assessments (e.g., use of an interpreter, presentation in sign language, use of multiple sessions, or use of selected subtests). In these situations, the report must clearly describe how the administration varied from standard administration, and standardized scores may not be used.
IDEA increasingly has encouraged use of intervention prior to determination of eligibility, a process known as response-to-intervention (RTI). (Note that parents continue to have the right to request and receive an evaluation without delay under IDEA.) SLPs have provided a variety of RTI services, including language enrichment in the classroom or remediation of mild speech-sound disorders. These interventions provide the eligibility committee with rich data to use in its eligibility determination based on the dynamic assessment process incorporated into RTI (ASHA, 2006).
Determination of Eligibility
Once the assessment elements are completed and evaluation reports written, the interdisciplinary team meets to determine if the child is eligible for special education as a child with a disability. IDEA specifies that parents receive a copy of the evaluation report. Districts should give the report(s) to the parents far enough in advance of the meeting to enable the parents to be knowledgeable participants in the meeting.
The relationship between language and cognition has long been a challenging issue for interdisciplinary teams. "Cognitive referencing" has been widely used in the past, excluding students from eligibility when their language and cognitive scores are commensurate. There is no valid research comparing language and cognitive assessments; research indicates that language may surpass cognition (ASHA, 1999). When assessing students with intellectual disabilities, the interdisciplinary team should use non-standardized measures of functional communication to obtain an accurate picture of the effect of the speech-language impairment on the child's educational and functional performance.
Because the focus of special education is on children with disabilities, not on children needing additional services, IDEA has some exclusionary criteria. The team may find the child ineligible if the determining factor is limited English proficiency or lack of instruction in math or reading. As a result, the eligibility team must be versed in the child's educational history. For English-language learners, the eligibility team needs an understanding of the process of acquiring and mastering a second language and the language and phonological characteristics of the first language (ASHA, 2004).
IDEA defines special education as "specially designed instruction, at no cost to the parents, to meet the unique needs of a child with a disability." The focus is on instruction, highlighting the importance of enabling the child with a disability to succeed academically. The team may determine that a child with only a speech-language impairment is eligible for special education services (a "speech-only" student).
The establishment of services for a child who is eligible for special education is a separate step. Another interdisciplinary team (often with comparable membership) develops the Individualized Education Program (IEP), which identifies the educational goals and the services provided to meet those goals. IDEA specifies that the IEP team assigns related services.
Speech-language impairments are unique in that IDEA views speech-language services as both special education and as related services. A child may be eligible for additional services ("related services") if the services "are required to assist a child with a disability to benefit from special education..." (34 C.F.R. Section 300.34). Although a child may benefit from a related service, the child will not be eligible to receive that service if the child can perform academically without it.
For example, a child can benefit from instruction from an occupational therapist in holding a pencil, but if that instruction is not necessary to progress in his/her elementary classroom, the child is not eligible. Conversely, it is reasonable that a child whose primary disability is a learning disability receive speech-language services as a related service. Because of the close relationship between oral and written language, it is highly likely that the child will need a related service (speech-language services) to benefit from the learning disability services. Similarly, a child with an emotional disturbance who has difficulty with social communication also may need speech-language services to benefit from his or her primary special education service. These children are often referred to as receiving "speech as a related service."
Although the U.S. Department of Education counts children with disabilities by primary disability, it does not prohibit counting of secondary or tertiary disabilities (see sidebar p. 14). The presence of speech-language impairments as secondary and tertiary disabilities (typically children receiving "speech as a related service") account for approximately half of the children receiving speech-language services through special education.
The child's parent must consent to the identification of the child as a student with a disability who is in need of special education services. Although IDEA does not require parental consent to find a child no longer eligible for special education, some states and localities may require parents to agree before a child is exited from services.
When does the presence of a speech-language impairment determine that a student is a "child with a disability" under the provisions of IDEA? That requirement is met only if the special education eligibility team reviews the assessment data and finds an educational effect—that special education is needed to enable the child to receive an appropriate public education. By understanding the federal provisions (and those particular to one's state or district) and by having a strong understanding of the communication expectations of the curricula, SLPs can assist teams in making thoughtful decisions about children's