School Services Frequently Asked Questions
What is the role of the SLP in literacy (reading and writing), and is literacy within our scope of practice?
Children who have problems developing language are at a high risk for difficulty in learning to read and write. Literacy is a primary factor that contributes to academic, economic, and social success. SLPs' knowledge of communication processes and disorders and language acquisition provides them with the foundation for addressing problems related to literacy. ASHA's Scope of Practice in Speech-Language Pathology states that the practice of speech-language pathology includes: "comprehension and expression in oral, written, graphic, and manual modalities; language processing; preliteracy and language-based literacy skills, including phonological awareness." See ASHA's family of documents titled " Roles and Responsibilities of Speech-Language Pathologist With Respect to Reading and Writing in Children and Adolescents" and ASHA's Literacy Gateway for more information.
What is the role of the school-based SLP in serving students with dysphagia?
SLPs may be asked to assess and provide speech-language services for students with dysphagia. As noted in the Discussion Section of IDEA 2004 Part B final regulations, students may be eligible for dysphagia services under the disability category of "Other Health Impaired (OHI)." Recent ASHA surveys indicate that 10% of school-based SLPs now provide services to children with dysphagia. School districts are forming dysphagia management teams that include school nurses, SLPs, occupational therapists, physical therapists, and other school personnel. Some of the activities teams engage in include interpreting medical records, organizing continuing education, developing educational materials and writing feeding treatment plans. For more information see ASHA's Practice Portal page on Pediatric Dysphagia.
What is ASHA's recommendation for caseload size in the schools?
ASHA does not recommended maximum or minimum caseload number. Rather, schools should consider the total workload activities required and performed by school-based SLPs to ensure that students receive the services they need. ASHA's Practice Portal resource on Caseload and Workload describe how to organize and document necessary SLP workload activities as well as strategies for implementation of this approach. Caseload and workload data are available from ASHA Schools Survey.
Does ASHA recommend using one service delivery model versus another when providing school-based speech-language pathology services?
ASHA does not recommend using one service delivery model versus another. No one service delivery model should be used exclusively during treatment. ASHA's position statement and technical report, "Inclusive Practices for Children and Youths With Communication Disorders" indicate that options should be chosen and combined according to the needs of the students as determined by the school's multi-disciplinary team. Service delivery models should be combined and/or changed as the needs of students change during treatment. The traditional pull-out model for providing speech-language pathology services is still a viable choice, but is considered to be one of several options available. The SLP may choose to use other service delivery models which can include collaborative consultation, classroom-based, or self-contained intervention programming.
Does ASHA have recommended eligibility and dismissal criteria for educational settings?
ASHA does not recommend specific criteria for eligibility or dismissal of services for educational settings. Federal, state and/or local guidelines determine criteria. For additional information see ASHA's on-line resources: Eligibility and Dismissal Criteria and Cognitive Referencing.
Can public schools bill Medicaid for speech-language pathology services?
To date, most states have implemented or plan to implement Medicaid billing in the schools. There are provisions in Federal and state law requiring state and local education agencies to seek sources other than those available under Part B or Part C of IDEA to pay for services for students with disabilities. Schools are increasingly tapping other sources to help finance special education programs. Covered Medicaid benefits include speech-language pathology services identified in the child's individualized education program (IEP) or individualized family service plan (IFSP). Federal law dictates that private insurance must be pursued first by local education agencies (LEAs) using Medicaid funds because Medicaid is the "payer of last resort." This means that a reasonable effort must be made to collect from all potential payers before Medicaid can be billed. Parents retain the right to refuse consent for the use of their private insurance funds. There are a number of legal, ethical and professional issues that SLPs who are providing services and submitting claims to Medicaid for reimbursement should review. For more information see ASHA's Introduction to Medicaid Web page.
Can an SLP employed in a school-based setting also provide services to one of the students on his/her caseload as a private practitioner?
According to a 2001 ASHA Issues in Ethics statement, Drawing Private Cases from Primary Place of Employment, it is possible for practitioners to accept cases for their private practice from the primary place of employment if the following guidelines are observed:
The persons served professionally must be fully informed of services available from the practitioner's primary employment setting as well as those from the private practice and given freedom to choose whether and from whom they will obtain professional services. The costs associated with obtaining services from the practitioner's primary employment setting versus those associated with the private practice must be made clear. Practitioners accepting cases in a private setting from their primary place of employment should inform the administrator at their primary employment setting of their intent. For further information see ASHA's Ethics in Schools Practice professional consultation packet.
How does an SLP work as an independent contractor in schools?
Contractual employment is a private arrangement between a speech-language pathologist (SLP) and a school or school district to provide services to students. In a traditional arrangement, the SLP is hired by the district to work full or part time as a staff member receiving benefits of employment from the district. As an independent contractor, the SLP works under an agreement or contract with the school district or agency that contracts with school or charter school. In some cases, SLPs may work for companies who have established contracts with schools. The terms and benefits of these arrangements are determined by the company the SLP works for. The Internal Revenue Service defines independent contracting [PDF] for tax purposes.
Becoming an independent contractor requires several steps that will ensure both success and compliance with relevant state regulations. You must be licensed to practice in the state where you will be providing services. Check your state's licensing regulations. Also, apply for an Employer Identification Number (EIN). It is also recommended to:
- have printed letterhead and business cards
- track expenses using software and open a checking account for your business transactions and expenses
- consult an accountant to determine which expenses are deductible
- become familiar with business tax laws, including those published by the IRS
- purchase a malpractice or professional liability insurance policy. ASHA offers coverage for members through Marsh USA.
- learn more about business practices in this FAQ from ASHA.
How do I develop a contract to provide speech-language services to schools?
Seek the advice of an experienced employment or small business attorney. Remember, contracts can be negotiated, and you may want to include compensation for planning, attending meetings, report writing, and consultation with school staff and parents. Other considerations include, but are not limited to, student caseload number, how to handle missed sessions, paid holidays, forms required for billing, schedule of payment, access to online data, charges for services, confidentiality, access to records or files, and cancellation policy. It be helpful to imagine yourself as the client and think about what you would like to know.
Does ASHA have guidelines for establishing fees for services?
No, ASHA does not determine fee schedules as they can vary widely across the country and are subject to possible allegations of "price fixing," a violation of antitrust laws. Read more about what to consider when determining fees for services.
Can a school district deny speech-language pathology services to a student with a "mild" articulation disorder if the district decides that the disability does not "adversely affect educational performance"?
State and/or local school education agencies may apply different interpretations to "adversely affects educational performance," however, they cannot deny a child with a speech or language impairment services under IDEA just because they do not have a discrepancy in age/grade performance in an academic subject-matter area. If acquisition of adequate and appropriate communication skills are a required part of your school's academic standards and curriculum and considered to be a basic skill necessary for all children attending school, then children with a speech or language impairment have a disorder that adversely affects educational performance. Also see ASHA's Eligibility and Dismissal resource page for more information.
What are some key elements of IDEA 2004 legislation and regulations as related to the provision of speech-language services in the schools?
There are several key elements related to speech-language pathology services to consider in the legislation and regulations. These include:
- qualified related services providers;
- changes to the Individualized Education Program (IEP);
- changes to the identification of specific learning disabilities; and
- early intervening services.
For detailed information concerning IDEA legislation or Federal regulations see ASHA's IDEA website Web page.
Are children who have commensurate IQ and language scores eligible for speech-language services?
Comparing IQ and language scores as a factor for eligibility for speech-language intervention is frequently referred to as cognitive referencing. Cognitive referencing is based on the assumption that language functioning cannot surpass cognitive levels. According to researchers, the relationship between language and cognition is not that simple. Some language abilities are more advanced, others closely correlated, and others less advanced than general cognitive level. Research results in recent years have demonstrated that cognitive prerequisites are neither sufficient nor even necessary for language to emerge. Therefore, ASHA does not support the use of cognitive referencing. For additional information see ASHA's Cognitive Referencing resource. New provisions in IDEA 2004 permitting identification of specific learning disabilities based on a student's response to instruction offers an alternative approach that can be applied to identification of a language disorder.
What are the roles of speech-language pathology assistants in school settings?
A speech-language pathology assistant may conduct the following tasks under the supervision of an SLP:
- assist the speech-language pathologist with speech-language and hearing screenings (without clinical interpretation of results)
- assist with informal documentation as directed by the speech-language pathologist
- follow documented treatment plans or protocols developed by the supervising speech-language pathologist
- document patient/client performance (e.g. tallying data for the speech-language pathologist to use; preparing charts, records, and graphs and reporting this information to the supervising speech-language pathologist
- assist the speech-language pathologist during assessment of patients/clients
- assist with clerical duties such as preparing materials and scheduling activities as directed by the speech-language pathologist
- perform checks and maintenance of equipment
- support the supervising speech-language pathologist in research projects, in-service training and public relations programs
- assist with departmental operations (scheduling, record keeping, safety/maintenance of supplies and equipment)
- collect data for monitoring quality improvement
- exhibit compliance with regulations, reimbursement requirements, and speech-language pathology assistant's job responsibilities
State laws vary and may differ. Check specific state regulations to determine the tasks permitted by assistants in a particular state. Some states do not permit the use of support personnel. See ASHA's Practice Portal for more information on Speech-Language Pathology Assistants.
What is outside of speech-language pathology assistants' scope of responsibilities?
A speech-language pathology assistant may not engage in the following tasks:
- perform standardized or non-standardized diagnostic tests, conduct formal or informal evaluations, or interpret test results
- screen or diagnose patients/clients for feeding /swallowing disorders
- use a checklist or tabulate results of feeding or swallowing evaluations
- demonstrate swallowing strategies or precautions to patients, family or staff
- participate in parent conferences, case conferences, or any interdisciplinary team without the supervising speech-language pathologist present
- provide patient/client or family counseling
- write, develop, or modify a patient/client's individualized treatment plan
- assist with patients/clients without following the individualized treatment plan or without access to supervision sign any formal documents
- select patients/clients for service
- discharge a patient/client from services
- disclose clinical or confidential information either orally or in writing to anyone not designated by the supervising speech-language pathologist
- make referrals
- communicate with the patient/client, family, or others regarding any aspect of the patient/client status or service without the specific consent of the supervising speech-language pathologist
- represent himself or herself as a speech-language pathologist
State laws vary and may differ. Check specific state regulations to determine which tasks are outside the scope of responsibilities for assistants in a particular state.
Why are school districts hiring "unqualified personnel" to fill the role of a speech-language pathologist? Is this allowable according to the law?
Significant changes were made in the reauthorization of IDEA 2004. In short, it may be permissible for a district to hire personnel who do not meet ASHA's requirements to practice speech-language pathology. See ASHA's online resource Qualified Providers in Schools and Early Intervention for additional information.
What are the guidelines for best practice when working with multicultural populations in the school setting?
ASHA has a variety of resources available which addresses bilingual assessment, use of translators, second language acquisition, and communication difference vs. communication disorder.
ASHA's position statement, Clinical Management of Communicatively Handicapped Minority Language Populations discusses appropriate use of translators and interpreters. Read this document to learn more about working with bilingual students who are limited in both languages.
Speech-Language Pathology in Culturally and Linguistically Diverse Populations - learn about assessment and intervention with culturally and linguistically diverse students.
Serving Culturally and Linguistically Diverse Populations - There is a wide variety of culturally and linguistically diverse populations in the United States. Speech-language pathologists and audiologists are expected to be skilled in working with all of these populations. It is important to be aware of the cultural/linguistic background of your client in order to provide appropriate services.
Communication Difference vs. Disorder - In the school setting proper diagnosis and identification are essential for students who have communication differences vs. those who have a disorder.
Acquiring English as a Second Language: What's Normal and What's Not - Find out more about the typical patterns of second language learning and how that may influence the child in the classroom setting.
Are you culturally competent? Use this self-help tool to determine your level of cultural competence.
What is ASHA's position on using the most recent version of a test?
ASHA does not have an official position or policy on this issue. However, best practice indicates using the most recent version of an assessment tool or test available. Revisions are typically made to reflect changes in research, improve validity and reliability or to include populations that may not have been included the in previous version. If the most recent version is not available to you, contact the publisher to learn about the changes in the revised edition. The information obtained from the publisher may be useful to advocate and gain support for purchasing the most current version.
How often can a standardized test be re-administered to the same student?
The answer varies according to the standardized test that is being used. Some test manuals include test-retest schedules, while others do not. For example, PRO-ED suggests guidelines that ensure enough time has elapsed so that the student
- is in the next norm group,
- no longer remembers the test questions,
- appears to have made progress.
This Pearson blog post, Test-Retest Reliability—The Good, The Bad, and The Judgment Calls by Tina Eichstadt, explains the issue in depth and includes a chart with nine commonly used assessments that specify test-retest time intervals.
In the end, these decisions are made on a case-by-case basis using as much information as is readily available and thoroughly documenting all diagnostic procedures and outcomes. If no guidance is offered, the qualified examiner should use his or her clinical judgment and allow 6–12 months between administrations. If a student appears sick or anxious during the session, or there are other factors that impact the validity of the test, it may be repeated right away.
It is important to consider the school's testing schedule whenever possible. During periods of high stakes classroom testing, students may be less engaged in additional testing, which may impact the outcomes. It may also be helpful to avoid days before and after holidays. Plural Publications provides an overview of many considerations regarding assessment of communication disorders in children [PDF].
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