School Services Frequently Asked Questions

Assessment and Diagnosis

• According to IDEA, do I need parental consent to conduct a screening?
• What is ASHA's position on using the most recent version of a test?
• How often can a standardized test be re-administered to the same student?
• What are the necessary components of an evaluation according to IDEA 2004?
• Can an SLP diagnose childhood apraxia of speech (CAS)?
• Can an SLP diagnose autism spectrum disorder (ASD)?
• Can an SLP diagnose dyslexia?

Eligibility and Dismissal Criteria

• Does ASHA have recommended eligibility and dismissal criteria for educational settings?
• Does IDEA 2004 address a process for determining eligibility and educational need for special education and/or related services?
• Does IDEA support the use of a discrepancy model to determine eligibility?
• Are children who have commensurate IQ and language scores eligible for speech-language 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"?

Federal and State Laws

• How do public schools meet the requirements of IDEA and ADA when addressing their students' communication needs?
• What laws and regulations impact the provision of services in the school setting?

Individualized Education Programs (IEPs)

• Does IDEA specify who serves on an IEP team?
• Does IDEA specify who is required to attend an IEP meeting?
• What is a 504 plan and how does it compare with an IEP?
• What services should be provided through a 504 plan versus an IEP or RTI/MTSS?

Caseload/Workload, Service Delivery, and Work Setting

• What is ASHA's recommendation for caseload size in the schools?
• Does ASHA recommend using one service delivery model versus another when providing school-based speech-language pathology services?
• What is ASHA's policy on making up missed sessions?
• What type of work space should be provided for students who received speech-language services in schools?
• Should Applied Behavioral Analysis (ABA) therapy be the only treatment for students who are on the autism spectrum?

Roles of the SLP and SLPA

• What are the roles and responsibilities of school-based SLPs?
• What should SLPs do when asked to serve as classroom substitutes?
• What is the SLP's role in literacy (reading and writing), and is literacy within the SLP scope of practice?
• What is the school-based SLP's role in serving students with feeding and swallowing disorders?
• What are the school-based SLP's roles in serving students who are English language learners (ELLs)?
• What is the role of speech-language pathology assistants (SLPAs) in school settings?
• What roles are NOT within the SLPA scope of practice?
• Why are school districts hiring "unqualified personnel" to fill the role of an SLP?

Medicaid, Private Practice, and Independent Contracting

• Can public schools bill Medicaid for speech-language pathology services?
• Can an SLP employed in a school setting provide private services to students on their caseload?
• How does an SLP work as an independent contractor in schools?
• Does ASHA have guidelines for establishing fees for services?

Assessment and Diagnosis

According to IDEA, do I need parental consent to conduct a screening?

Parental consent is not required before administering screenings that are applied across the entire student population. Screening is not considered an evaluation under IDEA to determine eligibility for special education services,and parental consent is not required.

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 that you should use the most recent version of an assessment tool or test available. Test developers revise assessments to reflect changes in research, to improve validity and reliability, or to include populations that may not have been included in the 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 that you obtain from the publisher may be useful in helping you 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 particular standardized test that you are using. Some test manuals include test-retest schedules, and 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.

In the end, make these decisions on a case-by-case basis, using as much information as is readily available and thoroughly documenting all diagnostic procedures and outcomes. If the publisher offers no guidance, the qualified examiner should use their 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 you can repeat the test 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 or the day after a school holiday.

What are the necessary components of an evaluation according to IDEA 2004?

The Individuals With Disabilities Education Improvement Act of 2004 specifies that a public agency should

• "use a variety of assessment tools and strategies to gather relevant functional, developmental, and academic information about the child, including information provided by the parent that may assist in determining
  • whether the child is a child with a disability under Section 300.8; and
  • the content of the child’s IEP, including information related to enabling the child to be involved in and progress in the general education curriculum (or, for a preschool child, to participate in appropriate activities);

• not use any single measure or assessment as the sole criterion for determining whether a child is a child with a disability and for determining an appropriate educational program for the child; and
• Use technically sound instruments that may assess the relative contribution of cognitive and behavioral factors, in addition to physical or developmental factors."

Can an SLP diagnose childhood apraxia of speech (CAS)?

According to ASHA's 2007 Position Statement on CAS, the certified SLP is responsible for making the primary diagnosis of CAS, designing and implementing the individualized and intensive speech-language treatment programs. 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.

Can an 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.

Interdisciplinary collaboration and family involvement are essential in assessing and diagnosing ASD. The SLP is a key member of an interdisciplinary team that includes the child's pediatrician, a pediatric neurologist, and a developmental pediatrician. See ASHA's Scope of Practice in Speech-Language Pathology (2016).

Can an SLP diagnose dyslexia?

ASHA's position statement: Roles and Responsibilities of Speech-Language Pathologists With Respect to Reading and Writing in Children and Adolescents, states 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 Practice Portal page on Written Language Disorders; see also the U.S. Department of Education guidance on dyslexia [PDF].

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.

Does IDEA 2004 address a process for determining eligibility and educational need for special education and/or related services?

IDEA 2004 notes that each public agency must

• "draw upon information from a variety of sources, including aptitude and achievement tests, parent input, and teacher recommendations, as well as information about the child’s physical condition, social or cultural background, and adaptive behavior; and
• ensure that information obtained from all of these sources is documented and carefully considered".

Does IDEA support the use of a discrepancy model to determine eligibility?

The regulations specify that criteria for determination are conducted at the state level and

• "must not require the use of a severe discrepancy between intellectual ability and achievement for determining whether a child has a specific learning disability, as defined in Section 300.8(c)(10);
• must permit the use of a process based on the child’s response to scientific, research-based intervention; and
• may permit the use of other alternative research-based procedures for determining whether a child has a specific learning disability, as defined in Section 300.8(c)(10)."

In addition, the regulations specify that "a public agency must use the state criteria adopted pursuant to the information presented above in determining whether a child has a specific learning disability."

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. The results of research 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.

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.

Federal and State Laws

How do public schools meet the requirements of IDEA and ADA when addressing their students' communication needs?

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 (hereafter, “Section 504”)—all address public schools' obligations to meet the communication needs of students with disabilities.But they 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 document from the U.S. Department of Justice and the U.S. Department of Education as well as a "Dear Colleague" letter authored by both agencies.

What 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 the requirement that students make 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 whose designation now includes the consultation of SISP as part of such activities.

ASHA has developed an analysis of the 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 (hereafter, “Section 504”) has a broader definition of disability than the Individuals with Disabilities Education Improvement Act of 2004 (IDEA). Section 504 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 Act and its amendments (introduced in 2003) address electronic transmission of records and increased restrictions on accessibility to health records.

Individualized Education Programs (IEPs)

Does IDEA specify who serves on an IEP team?

IDEA regulations state that the IEP for each child with a disability includes:

• "the parents of the child;
• not less than one regular education teacher of such child (if the child is, or may be, participating in the regular education environment);
• not less than one special education teacher, or where appropriate, not less than one special education provider of such child;
• a representative of the local educational agency, who
  • is qualified to provide, or supervise the provision of, specially designed instruction to meet the unique needs of children with disabilities,
  • is knowledgeable about the general education curriculum, and
  • is knowledgeable about the availability of resources of the local educational agency;
• an individual who can interpret the instructional implications of evaluation results, who may be a member of the team described in clauses (ii) through (vi);
• at the discretion of the parent or the agency, other individuals who have knowledge or special expertise regarding the child, including related services personnel, as appropriate; and,
• whenever appropriate, the child with a disability."

Does IDEA specify who is required to attend an IEP meeting?

IDEA states:

1. " A member of the IEP team (i.e., regular education teacher, special education teacher, representative of the public agency, an individual who can interpret the instructional implications of evaluation results) is not required to attend an IEP team meeting, in whole or in part, if the parent of a child with a disability and the public agency agree, in writing, that the attendance of the member is not necessary because the member’s area of the curriculum or related services is not being modified or discussed in the meeting."
2. " A member of the IEP team may be excused from attending an IEP team meeting, in whole or in part, when the meeting involves a modification to or discussion of the member’s area of the curriculum or related services, if
• the parent, in writing, and the public agency consent to the excusal; and
• the member submits, in writing to the parent and the IEP team, input into the development of the IEP prior to the meeting."

What is a 504 plan and how does it compare to an IEP?

Section 504 is an anti-discrimination law that protects people who have a mental or physical disability that impairs one or more major life activity. The Individuals With Disabilities Education Improvement Act 2004 (IDEA) is an education law that requires the provision of specialized instruction to students with a disability in at least one of 13 qualifying categories.

Section 504 requires that students be provided with a reasonable accommodation, which is different than that of IDEA, which requires provision of specialized individualized instruction. This is commonly referred to as having a “504 plan.” Examples of reasonable accommodations include providing a student with a low-distraction work area, preparing a student for upcoming changes in routine, and allowing a person with attention-deficit/hyperactivity disorder (ADHD) or another learning disability extra time for test taking.

The 504 plan, unlike an individualized education program (IEP), does not have to be a written document, and rules for creation, review, and revision can be different between school districts and states.

See this chart for a detailed comparison between the IEP and the 504 plan. The chart was developed by Understood, an organization that serves parents whose children struggle with learning and attention issues.

What services should be provided through a 504 plan versuss an IEP or RTI/MTSS?

Technically, all special education services can be delivered through a 504 plan. However, Section 504 defines the term disability more broadly than IDEA—and, consequently, a child who does not qualify for an IEP may still be able to get a 504 plan. According to the U.S. Department of Education, “an appropriate education for a student with a disability under the Section 504 regulations could consist of education in regular classrooms, education in regular classes with supplementary services, and/or special education and related services.”

In cases where a student requires minimal support from the speech-language pathologist, then documenting and implementing these services through a 504 plan may be appropriate. For example, a student with a well-managed hearing loss who needs the SLP only to consult with teachers and/or troubleshoot equipment issues can receive this support through a 504 plan.

In some states, speech sound disorders, consisting of errors with only one or two sounds, are addressed through a 504 plan or through response to intervention (RTI) rather than through an IEP. The specific guidance under which speech-language supports and services are provided depends on state law. Consult with your state and school district for specific rules and regulations. See ASHA’s resource on Response to Intervention and Multi-Tiered Systems of Support.

Caseload/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 provides 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. You should not use only one service delivery model. ASHA's Position Statement and Technical Report from the family of documents titled "Inclusive Practices for Children and Youths With Communication Disorders" indicate that schools should choose and combine options according to the students' needs as determined by the school's multidisciplinary team. Schools should combine and/or change service delivery models 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 just 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 in Speech-Language Pathology.

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 and Rehabilitative Services that indicates that districts should consider each case to determine whether the impact of the missed sessions interferes with the student's progress toward their IEP goals and access to a FAPE. Read ASHA's IDEA Part B Issue Brief: Missed Sessions and the ASHA webpage that explains OSERS' 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 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 (students with autism)?

Applied behavior analysis (ABA) therapy is one of many therapy options available to children on the autism spectrum. The appropriate assessment and treatment of autism spectrum disorder (ASD) involves a multidisciplinary team of professionals collaborating with one another to ensure that these children receive all of the appropriate services necessary to achieve successful outcomes. All appropriate therapies should be provided to children with a diagnosis of ASD, and ABA should not be the sole means by which to treat children with ASD. SLPs are critical members of the interprofessional team.

Roles of the SLP and SLPA

What are the roles and responsibilities of school-based SLPs?

ASHA's guidelines document, Roles and Responsibilities of Speech-Language Pathologists in Schools, states 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:

• working in partnership with others to meet students' needs
• providing direction in defining SLPs' roles and responsibilities
• ensuring appropriate services to students

What should SLPs do when asked to serve as classroom substitutes?

There are several considerations that SLPs should address with administrators in response to being asked to serve as classroom substitutes (subs):

IEPs

• When SLPs are diverted from their caseload, they may be unable to implement the student's IEP as written, resulting in an interruption of services. This could result in denial of a free and appropriate public education (FAPE).
• Serving as a classroom sub may create the need to make up missed sessions and increase the SLPs's already burgeoning workload. See Missed Speech-Language Sessions in Schools and ASHA Workload Calculator for help with (a) explaining workload activities to school administrators and colleagues and (b) making a strong case that "extra" time truly is not available.
• Serving as a classroom sub may interfere with the SLP’s availability to (a) attend scheduled IEP meetings and (b) conduct necessary screenings and assessments.
• When SLPs miss sessions, it means that the school is not implementing RTI with fidelity.

Teaching Certification and State Licensure

• Are you in a state that requires a separate teaching certificate or teaching license? Review your contract, job description and bargaining agreement regarding roles and responsibilities. Understand the ED's requirements for teacher certification. Is acting as a substitute included? Help your administrator understand your responsibility to uphold ASHA's Code of Ethics and your state's code of ethics.
• Look closely at your state licensure laws. If you are licensed by the state, you must abide by your state’s speech-language pathology practice act, which includes the scope of activities that your state deems an SLP is qualified to perform. In general, SLPs will need to meet additional or separate qualifications.to function as a classroom teacher.
• Review ASHA's Issues in Ethics statement, Ethics and Delivery of Care in Public Health and Safety Emergencies, which includes considerations for when SLPs are asked to perform tasks that are in critical demand but are not clearly delineated in their contract, job description, and bargaining agreement.

Additional Considerations

• Determine how your school district funds SLP positions and if funding is tied to working with students with special needs, such as IDEA Part B.
• Also, your ASHA State Education Advocacy Leaders (SEALs) may help determine if SLPs are being used as classroom subs across your state.
• If you are requested to serve as a full or partial sub due to teacher vacancies, then check your bargaining agreement to determine whether you are eligible to receive an administrative premium or supplement.

What is the SLP's role in literacy (reading and writing), and is literacy within the SLP scope of practice?

SLPs' knowledge of normal and disordered language acquisition—and their clinical experience in developing individualized programs for children and adolescents—prepares them to assume a variety of roles related to the development of reading and writing. Appropriate roles and responsibilities for SLPs include but are not limited to

• preventing written language problems by fostering language acquisition and emergent literacy;
• identifying children at risk for reading and writing problems;
• assessing reading and writing;
• providing intervention and documenting outcomes for reading and writing; and
• assuming other roles, such as providing assistance to general education teachers, parents, and students; advocating for effective literacy practices; and advancing evidence-based knowledge of literacy.

These roles are dynamic and have implications for research and professional education. See ASHA's Practice Portal page on Written Language Disorders.

What are the school-based SLP's role in serving students with feeding and swallowing disorders?

SLPs play a central role in the assessment, diagnosis, and treatment of infants and children with swallowing and feeding disorders. The professional roles and activities in speech-language pathology include (a) clinical/educational services (diagnosis, assessment, planning, and treatment); (b) prevention and advocacy; and (c) education, administration, and research. See the following two ASHA resources: Scope of Practice in Speech-Language Pathology and ASHA's Practice Portal page on Pediatric Feeding and Swallowing.

What are the school-based SLP's roles in serving students who are English language learners (ELLs)?

As indicated in ASHA's 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. School-based SLPs play an integral role with students who are English language learners (ELLs) and who have speech-language disorders. SLPs evaluate and treat these students while using all available resources to ensure that the students are neither over-identified nor under-served. ASHA offers many resources to guide SLPs in serving students who are ELLs, including the following:

• Bilingual Service Delivery
• Collaborating With Interpreters, Transliterators, and Translators
• Cultural Competence
• Learning Two Languages
• Cultural Competence Check-Ins

What is the role of speech-language pathology assistants (SLPAs) in school settings?

According to ASHA's Scope of Practice for the Speech-Language Pathology Assistant, an SLPA should engage in the following activities when performing necessary tasks related to speech-language service provision:

Service Delivery

• self-identifying (e.g., verbally, in writing, signage, titles on name badges, etc.) as an SLPA to students, patients, clients, families, staff, and others;
• exhibiting compliance with federal, state, and local regulations including: The Health Insurance Portability and Accountability Act (HIPAA), the Family Educational Rights and Privacy Act (FERPA); reimbursement requirements; and state statutes and rules regarding SLPA education, training, and scope of practice;
• administering and scoring screenings for clinical interpretation by the SLP;
• assisting the SLP during assessment of students, patients, and clients (e.g., setting up the testing environment, gathering and prepping materials, taking notes as advised by the SLP, etc.);
• administering and scoring assessment tools that (a) the SLPA meets the examiner requirements specified in the examiner’s manual and (b) the supervising SLP uses to verify the SLPA’s competence in administration, exclusive of clinical interpretation;
• administering and scoring progress monitoring tools exclusive of clinical interpretation if (a) the SLPA meets the examiner requirements specified in the examiner’s manual and (b) the supervisor has verified the SLPA’s competence in administration;
• implementing documented care plans or protocols (e.g., individualized education plan [IEP], individualized family service plan [IFSP], treatment plan) developed and directed by the supervising SLP;
• providing direct therapy services addressing treatment goals developed by the supervising SLP to meet the needs of the student, patient, client, and family;
• adjusting and documenting the amount and type of support or scaffolding provided to the student, patient, or client in treatment to facilitate progress;
• developing and implementing activities and materials for teaching and practice of skills to address the goals of the student, patient, client, and family per the plan of care developed by the supervising SLP;
• providing treatment through a variety of service delivery models (e.g., individual, group, classroom-based, home-based, co-treatment with other disciplines) as directed by the supervising SLP;
• providing services via telepractice to students, patients, and clients who are selected by the supervising SLP;
• documenting student, patient, or client performance (e.g., collecting data and calculating percentages for the SLP to use; preparing charts, records, and graphs) and report this information to the supervising SLP in a timely manner;
• providing caregiver coaching (e.g., model and teach communication strategies, provide feedback regarding caregiver-child interactions) for facilitation and carryover of skills;
• sharing objective information (e.g., accuracy in speech and language skills addressed, participation in treatment, response to treatment) regarding student, patient, and client performance to students, patients, clients, caregivers, families and other service providers without interpretation or recommendations as directed by the SLP;
• programming augmentative and alternative communication (AAC) devices;
• providing training and technical assistance to students, patients, clients, and families in the use of AAC devices;
• developing low-tech AAC materials for students, patients, and clients;
• demonstrating strategies included in the feeding and swallowing plan developed by the SLP and share information with students, patients, clients, families, staff, and caregivers;
• assisting students, patients, and clients with feeding and swallowing skills developed and directed by the SLP when consuming food textures and liquid consistencies.

Administrative Support

• Depending on the setting, adequate training, and guidance from the supervising SLP, the SLPA may:
• assist with clerical duties and site operations (e.g., scheduling, recordkeeping, maintaining inventory of supplies and equipment);
• perform safety checks and maintenance of equipment;
• prepare materials for screening, assessment, and treatment services.

Prevention and Advocacy

• Depending on the setting, adequate training, and guidance from the supervising SLP, the SLPA may:
  • present primary prevention information to individuals and groups known to be at risk for communication disorders and other appropriate groups; promote early identification and early intervention activities;
  • promote early identification and early intervention activities;
  • advocate for individuals and families through community awareness, health literacy, education, and training programs to promote and facilitate access to full participation in communication—including the elimination of societal, cultural, and linguistic barriers;
  • provide information to emergency response agencies for individuals who have communication and/or swallowing disorders;
  • advocate at the local, state, and national levels for improved public policies affecting access to services and research funding;
  • support the supervising speech-language pathologist in research projects, in-service training, public relations programs, and marketing programs;
  • participate actively in professional organizations.

State laws vary. Check specific state regulations to determine the tasks that a particular state permits SLPAs to perform. For example, some states do not permit the use of support personnel. See ASHA’s Practice Portal page on Speech-Language Pathology Assistants for more information.

What roles are NOT within the SLPA scope of practice?

According to ASHA's Scope of Practice for the Speech-Language Pathology Assistant, an SLPA should NOT engage in any of the following activities:

• representing themselves as the SLP;
• interpreting assessment tools for the purpose of diagnosing disability, determining eligibility or qualification for services;
• administering or interpreting feeding and/or swallowing screenings, checklists, and assessments;
• diagnosing communication and feeding/swallowing disorders;
• developing or determining the feeding and/or swallowing strategies or precautions for students, patients, and clients;
• disclosing clinical or confidential information (e.g., diagnosis, services provided, response to treatment) either orally or in writing to individuals who have not been approved by the SLP to receive information unless mandated by law;
• writing, developing, or modifying a student's, patient's, or client's plan of care in any way;
• making referrals for additional services;
• assisting students, patients, and clients without following the individualized plan of care prepared by the ASHA certified SLP;
• assisting students, patients, and clients without access to supervision;
• selecting AAC systems or devices;
• treating medically fragile students, patients, and clients without 100% direct supervision;
• performing procedures that require specialized knowledge and training (e.g., vocal tract prosthesis shaping or fitting, vocal tract imaging);
• providing input in care conferences, case conferences, or any interdisciplinary team meeting without the presence or prior approval of the supervising SLP or other designated SLP;
• providing interpretative information to the student, patient, client, family, or others regarding the student’s, patient’s, or client’s status or service;
• signing or initialing any formal documents (e.g., plans of care, reimbursement forms, reports) without the supervising SLP’s co-signature;
• discharging a student, patient, or client from services.

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?

Significant changes were made in the reauthorization of IDEA 2004. Under this law, qualifications for related services personnel, including speech-language pathologists, must now be consistent with ANY state-approved or state-recognized certification, licensing, or other comparable requirement applicable to a specific professional discipline. States are now allowed to establish requirements for school-based personnel which may be significantly less rigorous than qualifications and credentials required for ASHA certification (CCC) and/or state licensure. 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 Frequently Asked Question: Qualified Providers in Schools.

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). 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. See ASHA's resources, Introduction to Medicaid and Medicaid in the Schools.

Can an SLP employed in a school setting provide private services to students on their caseload?

According to ASHA's 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 (a) 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 (b) 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.

See Everyday Ethics: Avoiding Conflict-of-Interest Situations in Your Practice and Doing the Right Thing After School.

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 the public 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 that you

• use 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 general, by consulting ASHA's Frequently Asked Questions About Business Practices.

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," which is a violation of antitrust laws. Read more about what to consider when determining fees for services.