Question
The school I work at has a unit where the students have severe to profound communication disabilities and are dependent for total care. Cognition is very poor and expressive abilities are left to the care-givers' inferencing abilities. Students have been
Answer
This is a challenging question that many school based speech-language pathologists' face more often than one may think. The dilemma described is one that does not have a clearly defined answer. For one reason, the speech-language pathologist may be dependent on other's interpretation of no positive prognosis for academic progress in the school setting, what is appropriate, and what meets individual needs. School-based speech-language pathologists have state education regulations that may mandate certain guidelines that may indirectly conflict with ASHA's code of ethics. Providing clinical services in today's schools requires professionals to be cognizant of outcomes, service delivery models, and accountability while meeting the individual needs of students.
The ASHA (1991) discussed accountability "as requiring educators to be responsible for ensuring that appropriate educational programs are provided to meet the individual needs of the students". Nelson (1998) posed questions to determine dismissal or intervention: is more change needed?; is more change possible?; and, can more change be achieved without costs that outweigh its benefits? As cited in Paul (2001, p. 27) Fey (1986) summarized three reasons for dismissal from treatment: a child has reached all the goals designed from the diagnostic, has reached a plateau, or progress is being made but not because of the intervention plan. Eger (1998) stated, "It is time that we know where we are going in school-based speech and language services, produce the outcomes data to prove when we get there, and use the data to demonstrate that it made a difference" (pg 451). If the treatment program designed to meet an individual's needs is not effective, then the speech-language pathologist needs to consider treatment modification and/or dismissal.
References:
American Speech-Language-Hearing Association. (1992a). Code of ethics. American Speech-Language-Hearing Association, 34 (3, suppl.9), 1-2.
American Speech-Language-Hearing Association. (1991). A model for collaborative service delivery for students with language-learning disorders in the public schools. Asha<.i>, 33 (Suppl.5), 44-50.
Eger, D. (1998). Outcomes Measurement in the schools. In C. Frattali (Ed.), Measuring Outcomes in Speech-Language Pathology (pp. 438-452). New York, NY: Thieme.
Fey, M. (1986). Language intervention with young children. San Diego, CA: College-Hill Press.
Nelson, N. (1998). Childhood language disorders in context: Infancy through adolescence (2nd ed.). Columbus: OH: Merrill.
Paul, R. (2001). Language Disorders from Infancy through Adolescence: 2nd ed. St. Louis: Mosby.
Angela F. Sherman, SLP.D., CCC-CLP has been a speech-language pathologist for over 10 years. She is an Assistant Professor and Clinic Coordinator at Louisiana Tech University in Ruston, LA. Teaching and research areas are in dysphagia, adult language, medically fragile, and professional issues. She has presented at local, state, and national conferences and meetings. She has been elected to the licensure board in Louisiana and has served on the Board of Directors for the Louisiana Speech, Language, and Hearing Association.
