School Services Frequently Asked Questions
Roles of the SLP and SLPA
Caseload/Workload, Service Delivery, and Work Setting
Eligibility and Dismissal Criteria
Medicaid, Private Practice, and Independent Contracting
IDEA, IEPs, and Federal/State Laws
Roles of the SLP and SLPA
What are the roles and responsibilities of school-based speech-language pathologists (SLPs)?
ASHA's Roles and Responsibilities of Speech-Language Pathologists in Schools, guidelines that were developed in 2010, state that SLPs in schools have integral roles in education and are essential members of school faculties. They help students meet the performance standards of a particular school district and state by assuming a range of responsibilities: a) working in partnership with others to meet students' needs, b) providing direction in defining students' roles and responsibilities, and c) ensuring appropriate services to students.
What is the role of the SLP in literacy (reading and writing), and is literacy within the SLP 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 Roles and Responsibilities of Speech-Language Pathologists in Schools states that the practice of speech-language pathology includes "comprehension and expression in oral, written, graphic, and manual modalities; language processing; pre-literacy and language-based literacy skills, including phonological awareness." For more information, see the following resources:
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 in which teams engage include interpreting medical records, organizing continuing education, developing educational materials, and writing feeding treatment plans. Two ethical considerations are relevant to this area of practice:
Principle 1B: Individuals shall use every resource, including referral and/or interprofessional collaboration, when appropriate, to ensure that quality service is provided.
Principle 2A: Individuals who hold the Certificate of Clinical Competence shall engage in only those aspects of the professions that are within the scope of their professional practice and competence, considering their certification status, education, training, and experience.
For more information, see ASHA's Practice Portal page on Pediatric Dysphagia.
What is the role of the school-based SLP in serving students who are English language learners (ELLs)?
School-based SLPs play an integral role with students who are English language learners (ELLs) and have a speech-language disorder. SLPs evaluate and treat these students while using every resource available to ensure that the students are neither over-identified nor underserved. As indicated in the Code of Ethics, audiologists and SLPs are obligated to provide culturally and linguistically appropriate services to their clients and patients, regardless of the clinician's personal culture, practice setting, or caseload demographics. ASHA offers resources to guide SLPs; these resources cover topics such as bilingual assessment, the use of translators, second language acquisition, and the differentiation between communication difference and communication disorder. Some of these resources are listed below:
What are the roles of speech-language pathology assistants (SLPAs) in school settings?
A speech-language pathology assistant (SLPA) may conduct the following tasks under the supervision of an SLP:
- Assist the SLP with speech, language and hearing screenings (without clinical interpretation of results)
- Assist with informal documentation as directed by the SLP
- Follow documented treatment plans or protocols developed by the supervising SLP
- Document patient/client performance (e.g., tallying data for the SLP to use; preparing charts, records, and graphs; and reporting this information to the supervising SLP)
- Assist the SLP during assessment of patients/clients
- Assist with clerical duties such as preparing materials and scheduling activities, as directed by the SLP
- Perform checks and maintenance of equipment
- Support the supervising SLP in research projects, in-service training, and public relations programs
- Assist with departmental operations (e.g., scheduling, recordkeeping, safety/maintenance of supplies and equipment)
- Collect data for monitoring quality improvement
- Exhibit compliance with regulations, reimbursement requirements, and SLPA job responsibilities
State laws vary and may differ. Check specific state regulations to determine the tasks permitted by SLPAs in a particular state. Some states do not permit the use of support personnel. See ASHA's Practice Portal for more information on SLPAs.
What roles are NOT within the SLPA scope of practice?
According to the Speech-Language Pathology Assistant Scope of Practice document, an SLPA 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 SLP 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 supervisors who can sign any formal documents
- Select patients/clients for services
- Discharge a patient/client from services
- Disclose clinical or confidential information either verbally or in writing to anyone not designated by the supervising SLP
- Make referrals
- Communicate with the patient/client, family, or others regarding any aspect of the patient's/client's status or service without the specific consent of the supervising SLP
- Represent himself or herself as an SLP
State laws may differ. Check specific state regulations to determine which tasks fall outside the scope of responsibility for SLPAs in a particular state.
Why are school districts hiring "unqualified personnel" to fill the role of an SLP? Is this legally acceptable?
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. For additional information, see ASHA's Qualified Providers in Schools and Early Intervention webpage.
Caseload and Workload, Service Delivery, and Work Setting
What is ASHA's recommendation for caseload size in the schools?
ASHA does not recommend a 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 page on Caseload and Workload describes how to organize and document necessary SLP workload activities as well as strategies for implementing this approach. Caseload and workload data are available from the ASHA Schools Survey. In addition, this State Caseload chart [PDF] lists guidelines for caseload in each state.
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 from the family of documents titled Inclusive Practices for Children and Youths With Communication Disorders indicate that options should be chosen and combined according to the students' needs as determined by the school's multidisciplinary team. Service delivery models should be combined and/or changed as the students' needs 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 intervention programming, or self-contained intervention programming. See ASHA's web resource, School-Based Service Delivery.
What is ASHA's policy on making up missed sessions?
ASHA does not have a policy or position on making up missed sessions. However, we have sought input and guidance from the Office of Special Education Programs (OSEP) and the U.S. Department of Education (ED) on this matter. The issue of missed sessions is not addressed in the IDEA laws or regulations. OSEP indicated that each case should be considered to determine whether the impact of the missed sessions interferes with the student's progress toward his or her individualized education program (IEP) goals and access to a free appropriate public education (Free and Appropriate Public Education (FAPE). Read ASHA's IDEA Part B Issue Brief: Missed Sessions and the ASHA webpage that explains OSEP's guidance on missed services.
What type of work space should be provided for students who received speech-language services in schools?
The quality of work settings and equipment varies widely in schools around the country. ASHA's 2002 Technical Report, Appropriate School Facilities for Students With Speech-Language-Hearing Disorders, addresses issues such as hearing screening, confidentiality, classroom acoustics, and advocacy for appropriate facilities for services to students with speech, language and hearing disorders.
Should Applied Behavioral Analysis (ABA) therapy be the only treatment for students who are on the autism spectrum?
This 2016 ASHA Issue Brief [PDF] explains that all appropriate therapies should be provided to children with autism spectrum disorder (ASD) and that Applied Behavioral Analysis (ABA) should not be the sole means by which to treat children with ASD.
Eligibility and Dismissal Criteria
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 Eligibility and Dismissal Criteria and Cognitive Referencing.
Can a child be eligible for speech-language services from a private practitioner and not eligible for services in schools?
SLPs in private practice provide a broad spectrum of communication services based on their education and experience. These services range from treating disorders of language, speech sound production, voice, and fluency to addressing accent reduction and literary skills, to name a few. SLPs in private practice are not held to the same eligibility guidelines and can treat disorders that may not be addressed in a school setting.
In school settings, speech-language pathology services must conform to federal regulations created to implement the Individuals with Disabilities Education Act (IDEA), a law designed to ensure that all students receive a free appropriate public education (FAPE).
Determination of eligibility for services in schools is a multi-step process that includes screening, evaluation, observations from teachers, information from parents, and review of the student's work samples. The school-based individualized education program (IEP) team considers all of this information to answer these questions:
- Is there a disability?
- If so, is there an adverse effect on educational performance resulting from the disability?
- If so, are specially designed instruction and/or related services and supports needed to help the student make progress in the general education curriculum?
In some cases, parents may want services beyond what is determined appropriate in the school setting. Parents may obtain services from an SLP in private practice at their own discretion and cost. Read more about eligibility criteria for speech-language services in the schools.
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 are closely correlated, and still others are 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 offer an alternative approach that can be applied to identification of a language disorder.
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 the phrase "adversely affects educational performance"; however, they cannot deny IDEA-mandated services to a child with a speech or language impairment just because that child does not have a discrepancy in age/grade performance in an academic subject-matter area. If acquisition of adequate and appropriate communication skills is a required part of your school's academic standards and curriculum and is considered to be a basic skill necessary for all children attending school, then a child with a speech or language impairment has a disorder that adversely affects educational performance. Sound production errors may affect the way a student hears, speaks, reads, or writes phonemes, and thus can affect academic and social performance. For more information, see ASHA's Eligibility and Dismissal resource, "Adversely Affects Educational Performance" section.
Medicaid, Private Practice, and Independent Contracting
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 webpage.
Can an SLP employed in a school setting provide private services students on their caseload?
According to ASHA's 2014 Issues in Ethics statement, Obtaining Clients for Private Practice 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 or other practice environment 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 must inform the administrator at their primary employment setting of their intent.
- Practitioners must honor any non-compete contractual agreements stipulated by the employer.
This School Matters article from The ASHA Leader "Doing the Right Thing After School" provides additional information and insights on this topic.
How does an SLP work as an independent contractor in schools?
Contractual employment is a private arrangement between an 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 employment benefits 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 that employs the SLP. The Internal Revenue Service (IRS) 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; and
- purchase a malpractice or professional liability insurance policy.
ASHA offers coverage for members through Mercer Consumer. Learn more about business practices in this FAQ from ASHA.
Does ASHA have guidelines for establishing fees for services?
No, ASHA does not determine fee schedules because these schedules 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.
IDEA, IEPs, and Federal/State Laws
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 service providers;
- changes to the 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 webpage.
How are the requirements of the Individuals with Disabilities Education Act (IDEA) and the Americans with Disabilities Act (ADA) met when addressing the communication needs of students?
Three key pieces of legislation—the Individuals with Disabilities Education Act of 2004 (IDEA), Title II of the Americans with Disabilities Act of 1990 (ADA), and Section 504 of the Rehabilitation Act of 1973—all address public schools' obligations to meet the communication needs of students with disabilities but do so in different ways:
- IDEA requires schools to provide every student with a disability a free appropriate public education (FAPE) designed to provide meaningful educational benefit through an individualized education program (IEP).
- Title II of the ADA requires schools to provide, without charge, auxiliary aids and services to ensure that students with disabilities can communicate as effectively as all other students, with primary consideration of students' and parents' preferences.
- Section 504 is part of the Rehabilitation Act of 1973 that prohibits discrimination based on disability.
Compliance with one set of regulations may-or may not-meet the requirements of the other. This ASHA Leader article addresses this issue in depth and includes links to an FAQ from the U.S. Department of Justice and the U.S. Department of Education as well as a "Dear Colleague" letter.
What other laws and regulations impact the provision of services in the school setting?
The Every Student Succeeds Act (ESSA) became law in November 2015 and replaced the No Child Left Behind Act (NCLB). The 2015 law includes a number of important provisions:
- It repeals adequate yearly progress and replaces it with a state accountability system.
- It eliminates a federally mandated teacher evaluation system.
- It maintains annual reporting of data disaggregated by subgroups of children, including students with disabilities.
- It ensures that states may choose their challenging academic standards in reading and math but does not mandate a particular set of standards, including the Common Core State Standards.
- It requires consultation with specialized instructional support personnel (SISP) in the development of state and local plans.
- It updates the definition of professional development activities, a term that now includes SISP.
ASHA has developed an analysis of the Every Student Succeeds Act (ESSA) for members. The Every Student Succeeds Act: Key Issues for ASHA Members [PDF] will help guide state association leaders, education advocates, and school-based members as each state begins its own implementation of the new law.
Section 504 of the Rehabilitation Act of 1973 has a broader definition of disability than the Individuals with Disabilities Education Act of 2004 (IDEA). Section 504 of the Rehabilitation Act of 1973 is a federal civil rights law that prohibits discrimination against individuals with disabilities in programs and activities that receive federal financial assistance.
The Family Educational Rights and Privacy Act (FERPA) is the federal law that addresses student records, including who can have access to these records. This law ensures that parents/guardians have an opportunity to have the records amended and provides families some control over the disclosure of information from the records.
The Americans with Disabilities Reauthorization Act of 2009 was originally passed as the Americans with Disabilities Act in 1990 and requires "access to buildings, facilities, and transportation, and includes the provision of auxiliary aides and services to individuals with vision or hearing impairments".
The Health Insurance Portability and Accountability Act (HIPAA) is the law that pertains to protected health information (PHI). Originally enacted in 1996, the 2003 amendments addressed electronic transmission of records and increased restrictions on accessibility to health records.
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, to 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, whereas others do not. For example, Pro-Ed suggests guidelines ensuring that enough time has elapsed so that the student
- is in the next norm group;
- no longer remembers the test questions; and
- appears to have made progress.
This Pearson blog post by Tina Eichstadt, Test-Retest Reliability-The Good, The Bad, and The Judgment Calls, 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 if there are other factors that impact test validity, then the test 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—such lack of engagement may impact the outcomes. It may also be helpful to avoid administering tests on the day before and the day after a given holiday. Plural Publications provides an overview of many considerations regarding assessment of communication disorders in children [PDF].
Can a school-based SLP diagnose childhood apraxia of speech (CAS)?
ASHA's policy is that the diagnosis and treatment of childhood apraxia of speech (CAS) are the role of certified SLPs with specialized knowledge in motor learning theory, skills in differential diagnosis of childhood motor speech disorders, and experience with a variety of intervention techniques that may include augmentative and alternative communication and assistive technology. According to ASHA's 2007 Position Statement on CAS, the certified SLP is the one responsible for making the primary diagnosis of CAS, designing and implementing the individualized and intensive speech-language treatment programs that the child needs for optimum improvement, and closely monitoring progress.
Can a school-based SLP diagnose autism spectrum disorder (ASD)?
SLPs play a central role in the screening, assessment, diagnosis, and treatment of persons with autism spectrum disorder (ASD). The professional roles and activities in speech-language pathology include clinical/educational services (diagnosis, assessment, planning, and treatment); prevention and advocacy; and education, administration, and research. For more information, see ASHA's Scope of Practice in Speech-Language Pathology (2016).
Can a school-based SLP diagnose dyslexia?
ASHA's position is that SLPs play a critical and direct role in the development of literacy for children and adolescents with communication disorders, including those children with severe or multiple disabilities. The scope of practice for SLPs includes literacy assessment and intervention for children and adolescents as well as adults with developmental disabilities. See ASHA's 2001 position statement: Roles and Responsibilities of Speech-Language Pathologists With Respect to Reading and Writing in Children and Adolescents.
Additional questions? Contact [email protected].