Who Wants Speech Forever?
"There's no chance for us
It's all decided for us
This world has only one sweet moment set aside for us"
- Brian May/ Michael Kame "Who Wants to Live Forever"-Queen
In another post, I touched on the Workload/Caseload showdown in the school district. One of the factors affecting this is that in some districts, SLPs carry on lifers. Lifers are the students who have service from day 1 of school till graduation, and maybe later. In some cases this is completely appropriate. I would be hard pressed to find a competent SLP who didnt believe that some students need our services their entire life. Either to help them grow and change in a communication device to increasing their ability to follow 2 or 3 step directions to help them with employment skills.
Lifers are different. They are the students that the SLP is not offering a skilled service to. In the school system, a student must meet a few predetermined levels, one being an adverse affect on their grades and that direct services from an SLP would be significantly different than the teaching in the classroom.
What does that mean?
Adverse affect in the classroom can be discussed by the team. A kindergarten or first grade student producing /w/ for /r/ as in "Caw" or car or "wat" for rat or maybe a preschool student backing sounds turning time into "kime" could adversely affect their ability to spell correctly. It can negatively impact their phonological ability in the classroom. They would need service. What if its a 9th grade student with a lateral lisp or the same /w/ for /r/, then you may have a harder time proving adverse affect. Adverse affect does not have to be limited to academic performance. It should be documented though.
Direct service by an SLP must be significantly different than what a classroom teacher can offer. If we have a student working on social language/pragmatic language skills and they need video models, multiple attempts to identify an appropriate response, visual/physical/verbal prompting for non-verbal communication, and flash cards of different responses then they would be a candidate for speech and language services. If the student needs a verbal reminder by the teacher to wait his turn or to look at the speaker and then is able to fully participate, then what is it that the SLP can offer that is significantly different.
Lastly, we must look at the one thing that makes the decision hard. If the student does not make progress can they be dismissed? If we have collected data and the goals are appropriate to the student then it is appropriate to dismiss. However, if the goal is not appropriate or was written in a way that it cannot be attained, then there is no proof for dismissal from speech and language services.
As always, the number 1 goal in therapy should be the betterment of our students. This means that our students receives therapy or interventions in the least restrictive environment. If the student needs our services then we must provide necessary therapy. If our students can succeed in the classroom with minimal prompting following therapy then it is our duty to discharge as well. We are part of a team when we meet around the table. The student, the parent, the district rep, the teacher, the intervention specialist, and the SLP can make up the team. As language experts, we must do our best to show the other team members what is best for our student and all expected outcomes, be that with direct services or dismissal from speech.
As always sound off below, let me know your thoughts, questions, comments, and/or concerns.