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.
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:
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.
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:
A speech-language pathology assistant (SLPA) may conduct the following tasks under the supervision of an SLP:
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.
According to the Speech-Language Pathology Assistant Scope of Practice document, an SLPA may not engage in the following tasks:
State laws may differ. Check specific state regulations to determine which tasks fall outside the scope of responsibility for SLPAs in a particular state.
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. Also see FAQ, Qualified Providers in 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.
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.
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.
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.
The ASHA Issue Brief 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.
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.
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:
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.
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.
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.
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:
This ASHA Leader Blog article, Everyday Ethics: Avoiding Conflict-of-Interest Situations in Your Practice by ASHA's former Director of Ethics, Donna Euben explains how to avoid conflict of interest in your practice. This ASHA Leader Schools Matters article "Doing the Right Thing After School" provides insights on providing private services to students.
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
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.
There are several key elements related to speech-language pathology services to consider in the legislation and regulations. These include
For detailed information concerning IDEA legislation or federal regulations, see ASHA's IDEA webpage.
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:
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.
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:
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.
IDEA notes that each public agency must
The guidelines note that the team should be composed of
The law makes the following specifications regarding attendance:
The law stipulates that "the screening of a student by a teacher or specialist to determine appropriate instructional strategies for curriculum implementation shall not be considered to be an evaluation for eligibility for special education and related services."
The Act specifies that a public agency should
The regulations specify that criteria for determination are conducted at the state level but
In addition, regarding consistency with state criteria, 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."
IDEA states the following:
"There is nothing in the Act that requires a state to, or prohibits a state from, developing and implementing policies that permit screening children to determine if evaluations are necessary. However, screening may not be used to delay an evaluation for special education and related services. If a child is referred for an evaluation to determine eligibility for special education and related services, the public agency must implement the requirements in Sections 300.301–300.311 and adhere to the 60-day or state-established time frame to complete the evaluation."
Screening should not be used to deny or delay an evaluation for services and students, and the same screening instruments should be used for screening so that students are not "singled out." Multi-tiered systems of support/Response to Intervention is a process that is used in some states to determine whether speech and language services are needed. Your state department of education may provide a screening policy in writing. The speech-language pathologist would determine the appropriate screening assessments to use, and he/she should use a combination of formal and informal assessments.
The requirements in Section 300.301(b) pertain to the initiation of an evaluation under Sections 300.301–300.305 and should not be confused with the state’s Child Find responsibilities in Section 300.111 and Section 612(a)(3) of the act. The Child Find requirements permit referrals from any source that suspects a child may be eligible for special education and related services. Child Find activities typically involve some sort of screening process to determine whether the child should be referred for a full evaluation to determine eligibility for special education and related services. Therefore, persons such as employees of the state education agency, local education agency or other public agencies responsible for the education of the child may identify children who might need to be referred for an evaluation. However, it is the responsibility of the child’s parent and the public agency to initiate the evaluation procedures in Sections 300.301–300.311 and Section 614 of the act.
IDEA states the following: An "evaluation," as used in Sections 300.301 through 300.311, refers to an individual assessment to determine eligibility for special education and related services. "Screening," as used in Section 300.302 and section 614(a)(1)(E) of the Act, refers to a process that a teacher or specialist uses to determine appropriate instructional strategies. Screening is typically a relatively simple and quick process that can be used with groups of children. Because such screening is not considered an evaluation under Section 300.301 through 300.311 to determine eligibility for special education services, parental consent is not required.
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 Act (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.
Technically, all special education services can be delivered through a 504 plan. However, Section 504 more broadly defines the term disability than does 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 (SLP), then documenting and implementing these services through a 504 plan may be appropriate. For example, a student who has a known hearing loss that is well managed and 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 RTI rather than through an IEP. The specific guidance under which speech-language supports and services are provided will depend on state law. Consult with your state and school district for specific rules and regulations.
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.
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
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.
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.
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).
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, ASHA's Portal page on Written Language Disorders, and the U.S. Department of Education Guidance on Dyslexia.