COMMUNICATION AND SPEECH/LANGUAGE SERVICES AT METRO

SCHOOL

Stephanie Dorton, SLP9/16/14

SLPs’ Role in the School Setting

Over the past 5 years, the traditional role of the speech/language pathologist in the school system has shifted.

Traditional focus: articulation, stuttering, language processing.

Current focus: access to curriculum, emergent literacy, comprehension, visual supports.

Comparison of Guidelines for Students with Multiple/Severe

Needs North Carolina DPI- Many students, including those with

intellectual disabilities, and in particular those classified with moderate and severe impairments, exhibit limitations with expressive and/or receptive communication skills. Not all such students are considered to have a speech-language impairment that requires therapeutic intervention from the speech-language pathologist. The speech-language pathologist and other members of the IEP Team should consider the efficacy of the therapeutic intervention for each student, and in determining such, should consider whether or not specially designed individualized instruction for a student in speech-language services is likely to significantly improve his/her ability to communicate and/or improve his/her ability to fully access the general curriculum. Students should not be excluded from a speech-language program based solely on the severity of the disability. Cognitive referencing (comparing language scores to intelligence quotient scores) is not permissible for determining eligibility for speech-language impaired services.

(2008-2009 Guiding Practices: Implementing Policies Governing Services for Children with Disabilities, Public Schools of North Carolina.)

Comparison of Guidelines for Students with Multiple/Severe

Needs ASHA- The current best practices in facilitation and enhancement of

communication among persons with severe disabilities reflect six major tenets:

communication is social behavior; effective communicative acts can be produced in a variety of modes; appropriate communicative functions are those that are useful in enabling

individuals with disabilities to participate productively in interactions with other people;

effective intervention must also include efforts to modify the physical and social elements of environments in ways that ensure that these environments will invite, accept, and respond to the communication acts of persons with severe disabilities;

effective intervention must fully utilize the naturally occurring interactive contexts (e.g., educational, living, leisure, and work) that are experienced by persons with severe disabilities; and

service delivery must involve family members or guardians and professional and paraprofessional personnel.

These six tenets have resulted in assessment, intervention, and service delivery models that offer maximum responsiveness to the need to establish communication repertoires that will allow persons with severe disabilities to function effectively in least restrictive environments—in productive interactions with others.

(Guidelines for Meeting the Communication Needs of Persons With Severe Disabilities- ASHA.org; available: http://asha.org/docs/html/GL1992-00201.html)

Clarification?

Unlike more traditional models, providing services for individuals with severe/profound or multiple disabilities is a much less clearly defined task.

School-based services are typically driven by access to curriculum, whereas clinic-based services may be driven by guidelines for eligibility for insurance purposes.

Clinic-based services not provided by the schools include feeding, swallowing, and/or oral motor exercises that must be supervised by a physician.

So where do we begin?

Assessment is crucial in determining the communication needs of students with severe/profound or multiple disabilities.

Therapists must first determine what assessments to use, and what areas to assess.

Most assessments are informal- checklists, collaboration with teachers, etc.

Standardized assessments are often not normed for students with significant disabilities, and accommodations cannot be made for assessment (no repetition of task, etc.)

Is there a solution to assessment?

A combination of all assessment approaches is currently the best way to measure the language abilities of students with severe/profound or multiple disabilities.

It involves a team effort- classroom teacher, therapists, caregivers, and the student to accurately measure levels of performance, strengths, and needs.

So what EXACTLY are we assessing?

Modes of Communication Communication Interaction Functions of Communication Expressive Language abilities Receptive Language abilities How this impacts students in the

classroom- functionally and academically

Questions to Ask During Assessment

Does the student initiate interaction? Can a student get their wants and needs

met? Does a student demonstrate awareness

of the activity, engagement with the activity, cause/effect, or choice-making skills?

Can a student use their language skills to respond to an activity?

Impact of Assessment in the Classroom How do we take this information and

incorporate it into daily instruction? How to present information (smaller

chunks, multiple repetitions, visual supports- picture symbols/objects).

How to assess skills (yes/no questions, WH questions, eye gaze, switch use, number of choices).

Total Communication

To provide support in the classroom, SLPs encourage the use of a “Total Communication Approach”.

This basically comes down to using any means available to assist students’ language in the classroom.

Total communication (often referred to as TC) includes, but is not limited to picture symbols, objects, low-tech AAC devices, signs, gestures, physical manipulations, high-tech AAC devices, and strategies to support language skills.

Total Communication and IEP goals

To address the academic needs of students with severe/profound or multiple disabilities in the IEP, teachers often include the use of a Total Communication Approach in their academic goals.

Just because TC is used in a goal DOES NOT mean that an SLP has to be integrated on the goal, but integration on some goals CAN be beneficial!

In many cases, SLPs *are* able to integrate with classroom IEP goals instead of creating separate goals.

Since the SLP’s role is to provide support for the teacher to use on a daily basis with students, integrated goals are a way for both teachers and therapists to keep data on targeted skills.

Supports in the Classroom

So now that students have been assessed, and the framework for supporting academics has been created with the IEP, what support can SLPs provide in the classroom? Devices (low tech to high tech) Consultation- adaptation of materials and

concepts Visual supports

Picture symbols, objects, what about CVI?

AAC Devices in the Classroom

Devices that are used in the classroom can range from the simple: Low/no tech- picture symbols, etc. Light tech- voice output devices (BIGmack)

or a sequential message device (Step-By-Step)

To the high-tech: A dynamic display device, often referred to

as a Speech Generating Device (SGD)

Examples of Light-Tech Devices

BIGmack Rocker Switch Step-by-Step Switch Modules Partner 4 Cheap Talk 4 / Cheap Talk 8 GoTalk 9 Tech-Speak 32

Examples of High-Tech Devices

Dynavox (V-Max, Maestro, T-10) Prentke-Romich/PRC (Vantage,

Vanguard, Springboard, ECO) TOBII (C-Series, I-Series) iPads, iPods with communication

apps (Proloquo2Go, SonoFlex, etc.) Saltillo NovaChat

Cautions When Using AAC

AAC is always a tool, not a solution Make sure we are asking students to

complete the activity, not just “hit the switch”.

If possible, leaving devices/switches in front of students instead of presenting just during the activity- otherwise, they are only activating because it’s placed in front of them, not because they are aware of timing.

Visual Supports

To build upon language concepts presented in the classroom, visual supports are often provided.

These may include picture symbols, objects, or real pictures depending on a student’s level of awareness.

Visual Supports and CVI

One challenge that is growing is the number of students with severe/profound or multiple disabilities who have Cortical Visual Impairments (CVI).

CVI occurs when eye functioning is normal, but the brain does not process what the eyes see.

CVI, contd.

Students with CVI often have color preferences (red or yellow);

are light-seeking Will look at an object, then look away

(sneaky peeks) May put their head down when they are

listening- looks like they aren’t paying attention.

CVI, contd.

So how do you use visual supports for language with a student who has CVI?

Representational or Multi-Sensory Objects

Reduce complexity Black background Simplified picture symbols with

red/yellow Textured objects Light boxes

So what does it all mean?

In conclusion, it takes a collaborative effort between classroom staff and SLPs to ensure that a student’s language needs are taken into consideration when looking at access to curriculum.

Collaboration with school-based SLPs can enrich the classroom and provide support for students in ways that traditional models were not able to provide!

Links/Helpful Websites

VERY in-depth look at AAC from Boulder, CO school district: http://www.swaaac.com/Files/AssessandImp/

AACBasicsandImplementationBook.pdf Teaching Learners With Special Needs:

http://teachinglearnerswithmultipleneeds.blogspot.com

http://teachinglearnerswithmultipleneeds.blogspot.com/2008/02/free-boardmaker-boards-and-activities.html (last updated March 2013)

Pre-made picture symbols: http://picturesymbols.cmswiki.wikispaces.net/

Questions / Comments?

Contact Information:

Stephanie Hoyle Dorton, M.S., CCC-SLP

Metro School- a CMS Schoolstephanie.hoyle@cms.k12.nc.us

(980) 343-5450