Monday, October 14, 2019

Making the Case for Educational Impact in Articulation Therapy

Over the past nearly 40 years I've heard a lot of conversation around articulation therapy and "educational impact."  To this day the discussion continues to center around whether students who exhibit what may be considered mild speech sound disorders (SSD) like a lisp, are eligible for services because their difficulties don't impact academics. For instance, these children are not writing "thun" instead of "sun." Historically then, articulation therapy in the school setting may not be provided. The notion of not providing services because there is no "impact" on academics narrowly restricts the definition of educational impact. Personally, I consider any speech sound disorder as just that, a speech sound disorder, and have come to consider educational impact as a euphemism for “keeping caseloads low” and ignoring basic communication even as it relates to CCSS.  This distresses me. I am passionate about what we do and I don't like when we allow bureaucracy or misinterpretation to interfere with our responsibility. I'm taking a grave risk of overwhelming you, dear reader, and I understand the concerns around massive caseloads and staggering special education numbers, I'm sharing, nonetheless.
  1. When I graduated in 1983, I had to have certification to work in the schools in NJ. My certification was as a Speech Correctionist! Working on SSD was a huge part of our job, whether mild or severe.
  2. From 1985-87, when working as an itinerant SLP for Essex County Educational Services Commission, servicing the nonpublic schools, we ONLY worked on articulation.
  3. The criteria and interpretation for educational impact varies from state to state.
  4. Educational impact is subjective and too narrowly defined.
  5. Educational impact should include things like: calls attention to the student, socially isolates them, causes peers to comment or tease, interferes with establishing peer relationships, and causes embarrassment or frustration to the child
  6. Untreated speech sound disorders have the potential to impact individuals across the life span in terms of social stigma and economics as it relates to employment. 
  7. The following was included in a letter to Stan Dublinske, the ASHA Director of School Services in 1980, from the Department of Health, Education, and Welfare and explores the problem with the term educational impact"The broad issue raised in your inquiry is whether the definition of "speech impaired" in the regulations implementing the Education of the Handicapped Act, Part B (as amended by P.L. 94-142) is interpreted to mean that children with communicative disorders who have no other handicapping condition are ineligible for services as "handicapped children" unless educational assessments indicate concomitant problems in academic achievement. An interpretation is needed because "educational performance" is not specifically defined in the Part B regulations. However, the standard for determining whether a child fits into any of the categories of handicaps listed in the Act and regulations is that the impairment "adversely affects a child's educational performance." Under Section 602(1) of the Act, a child with one of the listed impairments must need special education to be a "handicapped child". For children who need a "related service" but no other. special education services, the Part B regulations in section 121a.14(a)(2) allow a State to consider that service as "special. education", bringing those children within the scope of the Act. . I agree that an interpretation which denies needed services to speech impaired children who have no problem in academic performance is unreasonably restrictive in effect and inconsistent with the intent of the Act and regulations." 
  8. In an article written in 2002 for ASHA's Perspectives for School Based Issues, Stan Dublinske wrote, "It was ASHA's position that local education agencies requiring such educational assessments and denying services to children with obvious speech or language impairments because they did not have a concomitant problem in academic achievement were using a very narrow definition of "educational performance." In various discussions with staff in the now Office of Special Education Programs (OSEP), ASHA explained that "educational performance" included performance in communication. At that time there was a big push to ensure that all school children acquire "basic skills." ASHA made the point that mastery of "effective oral communication" was a basic skill. As a result, a speech or language impairment necessarily adversely affects educational performance. Therefore, children needing speech-language pathology services should not be denied services just because they do not show discrepancies in age/grade performance in academic subject-matter areas."
  9. Students can receive articulation therapy if a school does due diligence via a multi-tiered system of support.
Enter Response to Intervention, (now merged with Positive Behavior Intervention and Supports; PBIS) and called a Multi-Tiered System of Support (MTSS).  MTSS is a three-tiered framework offering support for ALL learners, advanced and struggling alike. Tier 1 supports the entire child and is appropriate for all students and aligns with core standards. Tier 2 offers support for students who need supplemental services beyond what can be provided within the context of core instruction. It is specifically focused on an area of need and is more short-term. Tier 3 addresses unique needs and individualized support and typically is done via special education.

I provide therapy for mild SSD through tier 2. Students are offered articulation therapy with an emphasis on home and school collaboration for approximately 12 weeks. Speech sessions are only 15 minutes long two times per week and involve quick, motivating drills with 100 repetitions (phew). Parents are asked to come in for a brief meeting so I can explain their role and how they can help their child while supporting what I do at school. I do give students homework and ask that it is practiced four times per week for only 5-10 minutes.  If students are making progress and practicing with an adult partner at home, but haven't begun carryover, I will continue to a point I feel generalization can occur organically. 

This is my bottom line; any judgment of educational impact must factor in the whole child including social-emotional and the core standards of speaking and listening. In addition, the implications on future employment and social stigma cannot be ignored. As highly trained professionals it is on us to provide articulation therapy while fostering collaboration with parents to support our therapy. Speech therapy for mild SSD can be so rewarding as the outcomes are often favorable. I once received a note from a middle school student depicting me soaring through the air with my cape flowing behind me as I said, "Ssssssssss!" It was a thank you note. I knew what correcting that lisp meant to that child and I was pleased to do it.

1 comment:

  1. I definitely think some people confuse academic performance with educational performance. How can anyone say an articulation deficit does not affect a child socially, emotionally, or academically?
    This is a great post!