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Saturday, February 27, 2016

Speech-Language Pathologists in the Public School Setting

From Speech Teach Therapy

By Heidi Maloney
January 16, 2016

"Let us continue to put our best foot forward and make decisions for what is right. Advocate for the children who need it and stop being afraid of the repercussions. Always remember that we made a promise to “do no harm” and to use best practice."


Public School SLPs and Their Changing Roles

School Speech Language Pathologists’ roles have changed throughout the years, for sure. As the No Child Left Behind Act came into play in school settings and educators started being held accountable and the “paper trail” began, so have the roles of the SLP in the school.

An SLPs Master’s level education has not changed ~ we still learn about receptive and expressive language disorders, communication and assistive technology, swallowing disorders, stuttering, motor-speech disorders, genetically- and other medically-based speech disorders, in addition to phonetically-based difficulties. We know a TON of things about speech and language!

SLPs can work in medical, educational, private, and administrative settings and all get much the same Master’s level education, with some also moving on to specialize in specific areas.

There was a time (not so long ago), in a public school setting, that I could talk about (and also treat) things like drooling, swallowing issues, apraxia of speech, low-muscle tone that affected overall production of speech, and a full gamut of speech and language issues.

In a team IEP meeting, I was able to recommend three, individual, half-hour speech sessions per week for a child who needed it. And I knew they needed it, because I spent many years of my life in school, learning what was necessary to treat these issues.

Now, let me fast-forward to 2016.

School SLPs are given caseloads of 50+ children (and I’m being very frugal here) in a 40-hour work week. That means GROUP, GROUP, GROUP. See as many children as you can at one time, and better yet, go into the classroom and sit next to them if you can. You are working on speech sounds with this child and aren’t supposed to interrupt the classroom? Pull the children to a back table, but DO NOT distract the other students.



And, while you’re at it, keep an ear open for areas where you may be able to help the teacher to modify the lesson for your student. (By the way, the teacher does not really like it that you are giving her advice, she is highly qualified herself and does not need your help for her lesson. This is NOT a jab at teachers, this is an accolade. They know what they are teaching and how to teach it!)

And don’t forget about those new referrals, screenings, evaluations that need to be done, meetings to attend, case management, Medicaid forms, and data-keeping. Maybe you should go in and observe that new student when you have time, he is struggling and may need a referral.

Don’t forget about that district-wide meeting after school that you have to attend. Can you come in early for an IEP meeting on Monday? We know you aren’t supposed to start until 8, but we need you to be here at 7. I’m sorry that you have to score and type your evaluations at home at night, but the teachers do that kind of thing too.

We need coverage in the lunchroom for about half an hour today because we are short on staff, need you to step up, as you ARE an employee in this school. It is EXPECTED.

Okay, those are just some of the scenarios. But here comes the real topic at hand. Wait for it… Wait for it…

Are public school SLPS really able to provide the services that a child needs? 

The school SLP has really been backed into a corner. Our roles have been changed (by School districts, State education laws, etc.), yet our scope of practice has not. What we truly specialize in is not what we are now being forced to do in the public school system.

Here are some true concerns from school-based SLPs via a Facebook page:

“Is anyone to the point of being over-whelmed with the severity of disordered students entering public schools? I feel like so many kids need more than 45 minutes but due to my district assigning me to two elementary schools it is almost impossible. FYI: I am in an extremely high poverty/low socioeconomic school district. I also have gotten five new referrals in two days.”

“These students need us to advocate for them. If it is not treated early it may never be corrected. I believe that parents should be very assertive in getting services through the schools. Too often we pass the buck and what happens is detrimental to the child. I’m not sure that we are being truly ethical in not providing services….even if it’s RTI. What about our students who have no other option? I could not turn one away.”

“Honestly, in many cases, the kids need a heck of a lot more than what they are getting in schools…”

“I am also in the same situation with 2 districts, both in rural very low socioeconomic areas. I’m constantly feeling incredibly overwhelmed by the numbers of severe kids being referred and trying to figure and re-figure out how to schedule. This is my 5th year in this assignment and the need seems to increase every year. Thank you for helping me realize I’m not alone.”

“More medical issues, more low functioning children, more severe unintelligible kids, more syndromes, more non verbal kids and on and on. I feel like I fail my kids because each one needs so much. What is that saying …Jack of all trades, master of none. Sigh.”

“…the severity is overwhelming and they have so many problems. I am working with 6 spec. ed preschool classes, 14 Headstart classes and I travel to another preschool to see kids. I already see 65 kids and have 15 that I am in the process of evaluating. These kids need 90 minutes a week not 30.”

Yes, my SLP colleagues, I hear you. Loud and clear. And don’t think the parents aren’t aware either. There are plenty of parents who are vocal and who fight to get their kids what they need (and rightly so, because that’s what we are SUPPOSED to do for our children). But we are placed in a position where we have to make those parents our “enemy” instead of wholeheartedly agreeing with them.

Wouldn’t it be nice to say to a parent who is requesting more service time in an IEP meeting for their child, “You are absolutely right, your child WILL benefit from more therapy time. I will put him in for an extra half-hour individual session per week.” We know for SURE that this would not fly with administration. So we give them the answer we are now forced to give them. “We should keep him at twice a week, in a group setting, because it is MUCH better for him to be with his peers. I can train his assistant to do what I do for carryover”.

(HA!) (HA! HA! HA!)

Sorry, couldn’t hold it in. That is not to dismiss the awesome work that teaching assistants do, but I didn’t get my Master’s degree for nothing. We even had to come up with something called “5-minute Artic”. Although I am in total agreement with short sessions, more times a week, I think a minimum of 10 minutes to let the child sit down to breath for a minute or two would be nice. The model of 10-to 15-minutes INDIVIDUAL (or no more than two children), two to five times a week for articulation is a thing of beauty.

I would love to work more on swallowing, issues with drooling, real work on communication, functional vocabulary and skills, and to co-treat with OTs and PTs. Is that really too much to ask?

My frustration with the current “way things are” is only increasing. I am not sure that anyone is hearing us. Are they hearing us?

What the quotes from the real-life SLPs above say to me are “we are good at what we do, we want to help children more with what we specialize in, but we can only do so much.”

BUT…..WHY?

As I mentioned earlier, education (including special education) has changed and is changing. For the better? In some ways. For the worse? In many ways. Even teachers agree, because their hands are tied too. The Free and Public Education (FAPE) laws which state “children are not entitled to the best education that money can buy; they are only entitled to an appropriate education” are really not helping our children.

Some courts have required that the progress the child receives be “meaningful or more than the minimum”. The U.S. Supreme Court has ruled that “IDEA does not require states to develop IEPs that maximize the potential of handicapped children”. Administrators, who have to think of the budgets and are held accountable by tax-payers, are getting their direction from the top. And the top says “give them only what you absolutely have to”.

That does not mean, however, that they are allowed to put us in a position where we are unable to provide appropriate services.

My Hope for the Future

I know that most SLPs agree ~ this is not what we signed on for. Let us continue to put our best foot forward and make decisions for what is right. Advocate for the children who need it and stop being afraid of the repercussions. Always remember that we made a promise to “do no harm” and to use best practice.

I do think we are in a position to “fight back”. I’m not trying to get anyone fired, but I think if we consciously involve the right people in doing the right thing, we can make progress instead of continuing to go backwards. We are a crucial part of the system. We are needed. Letting them give us too many children on our caseloads is not okay. Too many children would mean we are not able to service them in an effective and ethical way.

Allowing them to bully us into standing down from our clinical opinion is wrong. Saying that aloud should be okay if we say it to the right people. Reminding them that we will be placing the district “out of compliance” in the child’s IEP. Letting lawmakers know about this struggle. Involving parents who are strong advocates. STANDING TOGETHER.

I do believe that we can make a positive change to this really messed up system, so we can have more time to do what we do best ~ provide the best services possible to children in need.

References
  • “Free Appropriate Public Education under Section 504”. Web. http://www2.ed.gov/about/offices/list/ocr/docs/edlite-FAPE504.html. Retrieved 2016-01-12
  • “Bd. of Educ. v. Rowley, 458 U.S. at 189”. Caselaw.lp.findlaw.com. Retrieved 2016-01-12 from https://en.m.wikidpedia.org/wiki/Free_Appropriate_Public_Education

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