Guidelines For The Roles And Responsibilities Of The .

III - 252 / 1999ASHA 2002 Desk Reference Volume 3 Speech-Language PathologyThe guidelines in this document are consistentwith ASHA’s Scope of Practice, Preferred Practice Patterns, and position statements, yet are specific to issuesrelating to school-based speech-language pathologists.Additional complementary documents, such as ASHAguidelines, technical reports, tutorials, and relevantpapers, are available through the ASHA National Office (see Appendix B).These guidelines reflect the Committee’s review ofcurrent law related to providing services to studentswith disabilities; policy and procedure documentsfrom a variety of geographic areas; current professionalliterature; contemporary practices from rural, suburban, and urban areas; and extensive feedback from peerreviewers in the profession. Likewise, the terminologyused within this document mirrors current widespread use; however, regional or geographical variations may occur. In the interest of clarity, the variousaspects of school-based speech-language pathologists’roles and responsibilities are discussed separately.However, school-based speech-language pathologyservices are interrelated, as are all aspects of communication.The field of speech-language pathology is dynamic and evolving, therefore the examples withinthis document are not meant to be all-inclusive. Additional emerging roles or responsibilities should not beprecluded from consideration if they are based onsound clinical and scientific research, technologicaldevelopments, and treatment outcomes data.DefinitionsThe range of the profession of speech-language pathology has been defined by many sources, includingASHA, federal legislation, and such other sources asthe World Health Organization.ASHA DefinitionSpeech-language pathologists are professionallytrained to prevent, screen, identify, assess, diagnose,refer, provide intervention for, and counsel personswith, or who are at risk for, articulation, fluency, voice,language, communication, swallowing, and relateddisabilities. In addition to engaging in activities to reduce or prevent communication disabilities, speechlanguage pathologists also counsel and educatefamilies or professionals about these disorders andtheir management (ASHA, 1996c).Federal DefinitionsThe Individuals with Disabilities Education Act(IDEA) includes speech-language pathology as both arelated service and as special education. As related services, speech-language pathology is recognized as“developmental, corrective, and other supportive ser-vices. . . as may be required to assist a child with a disability to benefit from special education. . .and includesthe early identification and assessment of disablingconditions in children” [Section 602(22)]. Speechlanguage pathology is considered special educationrather than a related service if the service consists of“specially designed instruction, at no cost to the parents, to meet the unique needs of a child with a disability, including instruction conducted in theclassroom, in the home, . . . and in other settings.” Statestandards may further specify when speech-languagepathology services may be considered special education rather than a related service.According to the IDEA definition, speechlanguage pathology includes: identification of children with speech and/orlanguage impairments appraisal and diagnosis of specific speechand/or language impairments referral for medical or other professional attention necessary for the habilitation of childrenwith speech or language impairments provisions of speech and/or language servicesfor the prevention of communication impairments or the habilitation of children with suchimpairments counseling and guidance for parents, children,and teachers regarding speech and/or language impairments.IDEA similarly identifies the early interventionservices provided by speech-language pathologists forchildren from birth to age 3 with communication orswallowing disorders and delays. In Part C of IDEA,early intervention services are defined as being “designed to meet the developmental needs of an infantor toddler with a disability in any one or more of thefollowing areas: physical, cognitive, communication,social or emotional and adaptive development” [Section 632(c)]. An infant or toddler with a disability mayalso include, at a state’s direction, at-risk infants andtoddlers [Section 632(5-8)].World Health Organization DefinitionsSchool-based speech-language pathologists prevent, identify, assess, evaluate, and provide intervention for students with speech, language, and relatedimpairments, disabilities, and handicaps. The WorldHealth Organization, in an effort to describe what mayhappen in association with a health condition, definesimpairment, disability, and handicap and differentiatesoutcome measures for each. See Table 1.

Guidelines Roles and Responsibilities of the School-Based Speech-Language Pathologist1999 / III - 253Table 1. World Health Organization (WHO) tionsAbnormality of structure orfunction at the organ levelFunctional consequencesof an impairmentSocial consequences of animpairment or disabilityExamplesSpeech, language, cognitive, or hearing impairmentsCommunication problemsin context of daily lifeactivitiesIsolation, joblessness, dependency, role changesOutcome MeasuresTraditional instrumentaland behavioral diagnosticmeasuresFunctional status measuresQuality of life scales,handicap inventories,wellness measuresSource: International classification of impairments, disabilities, and handicaps. (World Health Organization, 1980)School-based speech-language pathologists focuson all three aspects of a student’s communicationneeds: impairment, disability, and handicap. Theschool-based speech-language pathologist (a) prevents, corrects, ameliorates, or alleviates articulation,fluency, voice and language impairments; (b) reducescommunication and swallowing disabilities (the functional consequences of the impairment); and (c) lessens the handicap (the social consequences of theimpairment or disability).5Ultimately, the school-based speech-languagepathologist’s purpose in addressing communicationand related disorders is to effect functional and measurable change(s) in a student’s communication status so that the student may participate as fully aspossible in all aspects of life—educational, social, andvocational (ASHA, 1997e).HistoryThe roles and responsibilities of school-basedspeech-language pathologists have changed over theyears in response to legislative, regulatory, societal,and professional influences.Traditional RoleSchool-based speech-language programs have along history. Records indicate that in 1910 the Chicagopublic schools were the first schools to hire “speech5The World Health Organization (1997) has drafted a revision of its classification of impairments, disabilities, andhandicaps for field trials only. If finalized in currentform, the dimensions will include impairments of structure and impairments of function, activities (formerlydisabilities), and participation (formerly handicaps).correction teachers” (Darley, 1961). In the 1950s,speech-language pathologists who worked in a schoolsetting, formerly referred to as “speech correctionists,”“speech specialists,” or “speech teachers,” workedprimarily with elementary school children who hadmild to moderate speech impairments in the areas ofarticulation, fluency, and voice. Later, with increasedknowledge about language development, the “speechtherapist” developed skills in identifying andremediating language disorders, thereby expandingthe range of the profession (Van Hattum, 1982). Students were typically treated in large groups, contributing to caseload sizes that in most situationssignificantly exceeded those of today. The speech-language pathologist often employed a medical/clinicalapproach to treating students with communicationimpairments. With this approach the student’s problems were diagnosed, developmental tasks were prescribed, clinical materials were used for treatment, andthe individual was treated until the pathology was“corrected.” All of this was most often conducted bypulling students out of the classroom to receive services within a separate therapy resource room. Theemphasis was on correcting the specific speech or language impairment.Legislative InfluencesFederal and state governments have been instrumental in obtaining rights for children with disabilities through the authorization of public laws. Practicesdefining speech-language pathologists’ roles and responsibilities in schools today have been shaped inpart by the laws and regulations, administrative policies and procedures, and court rulings that govern theprovision of services to students with communicationdisorders. Relevant federal laws are noted in Table 2.

III - 254 / 1999ASHA 2002 Desk Reference Volume 3 Speech-Language PathologyTable 2. Federal Statutes Relating to Education of Students With DisabilitiesYearName of LawLaw #Highlights1973Section 504 of the Rehabilitation Act of 1973PL 93-112Civil rights law to prohibit discrimination on the basisof disability in public or private programs and activitiesreceiving federal financial assistance.1975Education for All Handicapped Children Act of 1975(EHA)PL 94-142Mandates a free, appropriate education for all handicapped students between the ages of 3 and 21. Providesfor Individualized Education Programs (IEPs), dueprocess, protection in evaluation procedures, and education in the least-restrictive environment.1986Education for All Handicapped Children ActPart H)PL 99-457Extends protections of the EHA to infants and toddlers(birth to age 3) through the establishment of a formulagrant program. An important component of early intervention is the comprehensive Individualized FamilyService Plan (IFSP).1990Americans with DisabilitiesAct (ADA)PL 101-336A civil rights law to prohibit discrimination solely onthe basis of disability by mandating reasonable accommodations across all public and private settings,including private and public schools.1990Individuals with DisabilitiesEducation Act of 1990(IDEA)PL 101-476(Includes birth through 21). Expands the discretionaryprograms, includes the additional categories of autismand traumatic brain injured as separate disabilitycategories. Adds the statutory definitions of assistivetechnology device and service. Expands transitionrequirements.1993Goals 2000: Educate America PL 103-85Act of 1993Describes inclusion of children with disabilities inschool reform effort. Develops eight National EducationGoals. Ensures that students with disabilities are educated to the maximum extent possible.1994Improving America’s Schools PL 103-382Act (IASA)Provides for professional development and listscompetencies for all persons providing services,including related services and special education.1997Individuals with DisabilitiesEducation Act Amendmentsof 1997Source:U.S. CongressEncourages participation of students with disabilitiesin the general education curriculum and state- anddistrict-wide assessments. Encourages parentalinvolvement in the IEP team placement decisions.Assures that communication and assistive technologyneeds of students are considered. Encourages use ofvoluntary mediation rather than attorneys and nocessation of services for disciplinary reasons if relatedto student’s disability.PL 105-17

Guidelines Roles and Responsibilities of the School-Based Speech-Language PathologistAs can be seen in Table 2, legislative changes haveinfluenced many aspects of speech-language programs. Before the Education for All HandicappedChildren Act of 1975 (EHA) and its focus on providing services in the least-restrictive environment, “onemillion of the children with disabilities were excludedentirely from the public school system and did not gothrough the educational process with their peers” [Section 601c (2C)]. Others with disabilities were in thepublic schools, but their disabilities were undetected;this prevented them from having a successful educational experience. With the lack of adequate serviceswithin the school system, families had to find servicesoutside the public school system, often far from homeand at their own expense [Section 601c (2D-E)]. EHAassured free, appropriate public education for all students. It also increased accountability and documentation, which consequently has directly affectedschool-based speech-language pathologists.Other legislation followed. With the enactment ofEHA-Part H in 1986, services were expanded to includeinfants and toddlers and more categories of disabilities. IDEA, in 1990, further broadened the range of theprofession with the addition of more discretionaryprograms. In 1993, Goals 2000: Educate America Actestablished eight national education goals (see Appendix C) and reinforced the notion that school reformlegislation was relevant to speech-language pathologyservices (see Appendix D and ASHA, 1994i).Goals 2000, Improving America’s Schools Act(IASA), and recent IDEA amendments all underscorethe importance of postsecondary initial preparationand continuing professional development to ensure ahigh quality of education for students with disabilities. And most recently, the IDEA amendments of 1997require that the IEP include information regarding theimpact of the student’s disability in terms of the general education curriculum.In addition to federal legislative mandates, speechlanguage pathologists must also be familiar with andfollow existing state regulations and guidelines andlocal policies and procedures in carrying out their rolesand responsibilities.Societal InfluencesExternal factors other than legislative changeshave influenced the roles of the school-based speechlanguage pathologist. America’s racial and ethnic profile is rapidly changing, with an attendant shift instudent demographics. By the turn of the millennium,nearly one of every three Americans will be AfricanAmerican, Hispanic, Asian American or AmericanIndian. As a group, minorities constitute an ever-largerpercentage of public school students. In addition, the1999 / III - 255limited-English-proficient population is the fastestgrowing population in America [Section 601 (7A-F)].The move toward pluralism—in which numerous distinct ethnic, religious, or cultural groups co-exist—hasproduced students who are culturally and linguistically more diverse. Hence, speech-language pathologists need to address such professional issues asnonbiased assessment and eligibility and interventionconsiderations related to a diverse population.The nature and complexity of disorders have intensified. Speech-language pathologists within generaleducation settings provide services for more studentswho are medically fragile and/or multihandicapped.The emphasis on least-restrictive environment onlypartially explains the increase. Medical advancementsare saving more lives, yet many who survive are physically or medically challenged. Additionally, withhealth care reform, many students are released earlierfrom hospitals or rehabilitation centers and enter publicschools requiring intensive speech-language services.Such other societal influences as an aging populationand squeezed budgets have often translated to fiscalcutbacks to K–12 and postsecondary education programs (ASHA, 1997h). These fiscal constraints havemade it more challenging to provide effective service.Professional InfluencesSchool-based speech-language pathologists possess a high degree of clinical competence by virtue oftheir professional study and experience. The field ofspeech-language pathology has developed a widenedscope of practice. Research and efficacy studies havebeen conducted and published to help determine bestpractices relating to speech-language pathology in allsettings and within schools in particular. Advancedtechnology has increased the scope and capabilitiesof speech-language pathologists.Personnel shortages and changes in state licensure or department of education certification have affected the roles and responsibilities of school-basedspeech-language pathologists in many states. The rolesof the speech-language pathologist may vary depending upon the composition or severity of the caseload,state or district mandates, and staffing needs.Current ModelAlthough the mission of the school-basedspeech-language pathologist—to improve the communication abilities of students—has remained constant, the manner in which the school-basedspeech-language pathologist addresses prevention,assessment, evaluation, eligibility determination,caseload management, and intervention has changedand will continue to evolve.

III - 256 / 1999ASHA 2002 Desk Reference Volume 3 Speech-Language PathologyToday’s school-based speech-language pathologists serve students who have complex communication disorders, many of which require intensive,long-term interventions. Many school speech and language caseloads consist of students with a wide rangeof disabilities and diverse education needs. Accordingto the Twentieth Annual Report to Congress on the Implementation of IDEA, students with speech or languageimpairments are the second largest category of students served (20.2%) after specific learning disabilities(51.2%) (U.S. Department of Education, 1998). Speechlanguage pathologists also provide services to students with related disability categories—includingmental retardation; emotional disturbance; multipledisabilities; hearing, orthopedic, visual, or other healthimpairments; autism; deaf-blindness; and traumaticbrain injury.conference time is needed during the school week toserve the student, educators, and parents appropriately.7 (See Caseload Management.)Several education reform initiatives have influenced and shaped the policies that we have today. Theregular education initiative (REI) proposed that asmany children as possible be served in the regularclassroom by “encouraging a partnership with regular education” (Will, 1986, p. 20). Full-inclusion advocates went a step further and supported completeinclusion of students with special needs in the regular education classroom. Legislative mandates andgeneral changes in philosophy have dictated thatspecial education be provided in the least restrictiveenvironment (LRE). Careful consideration of LRE andmeaningful curriculum modifications based on thestudents’ needs have led to expanded service-deliverymodels. Now, in addition to taking students out of theclassroom for services, the speech-language pathologist has an array of direct and indirect service-delivery options available to help students withcommunication disorders (see Table 6). To integratespeech and language goals with educational (academic, social/emotional, or vocational) objectives, direct intervention may take place in a variety of settings,including the general education or special educationclassroom, the speech-language treatment room, theresource room, the home, or community facility (ASHA,1996b). Indirect service is also provided for professional staff, parents, and families.6School-based speech-language pathologistskeep current with best practices in assessment andintervention. When providing services for studentswith impairments, disabilities, and/or handicaps,speech-language pathologists work with studentswith speech, language, hearing, and swallowing orrelated impairments; promote the development andimprovement of functional communication skills forstudents with communication and swallowing disabilities; and provide support in the general educational environment for students with communicationhandicaps to facilitate their successful participation,socialization, and learning. School-based speech-language pathologists’ roles and responsibilities haveevolved. They now include preparing students for academic success and the communication demands of thework force in the 21st century as well as alleviatinghandicapping conditions of speech and language disorders (ASHA, 1994i).Contemporary speech-language pathologists notonly provide assessment and intervention for studentsidentified as having communication disorders, theyalso may recommend environmental modifications orstrategies for communication behaviors of childrenwho have not been identified as being eligible for special education or related services (see Prevention).With the expanding consulting role, it is essentialfor school-based speech-language pathologists to havea manageable caseload size. Adequate planning andCurrently, the school-based speech-language pathologist is expected to fulfill a variety of roles (seeTable 3 in Section II). The roles and responsibilities willvary in accordance with the work setting (e.g., home,community, preschool, elementary or secondaryschool), with the types of communication impairmentsand disorders exhibited by children in these settings,and with the speech-language pathologist’s experience, knowledge, skills, and proficiency. The level ofexperience, knowledge, skills, and proficiency may beexpanded through additional training, such asmentoring, teaming, peer coaching, co-teaching, orthrough continuing education (CE) opportunities(workshops, seminars, institutes, and course work).In the future, research and outcomes data mostcertainly will alter assessment and interventiontechniques, influence models and theories of practice,and further expand ASHA’s Scope of Practice (1996c)and Preferred Practice Patterns for the Profession(1997e).6According to the results of the ASHA Schools Survey, 80%of the speech-language pathologist’s time is

standards may further specify when speech-language pathology services may be considered special educa-tion rather than a related service. According to the IDEA definition, speech-language pathology includes: identification of children with speech and/or language impairments appraisal and diagnosi