communication and speech/language services at metro school stephanie dorton, slp 9/16/14
TRANSCRIPT
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 [email protected]
(980) 343-5450