Over the course of my thirty year career, many things have changed about the Speech Language Pathologist (SLP) scope of practice and role in education and medical field….when I graduated the idea of SLPs addressing dysphagia and childhood apraxia had just been introduced. One thing that hasn’t changed much in the world of the school-based SLP is service delivery.  Research suggests that SLPs tend to take one scheduling option and apply it across their entire caseload despite individualized factors. The majority of services are provided 2-3 times a week in a pull out group outside of the general education setting (Brandel &  Frome Loeb, 2011).  The reason for this uniform approach? Some studies suggest that it is related to habit and large caseloads numbers (Chiang & Rylance) but I believe that traditional scheduling prevails because it best fits the block scheduling of the school day. The push of bell-to bell instruction with uninterrupted reading and math blocks has narrowed daily student availability to roughly 40 minutes per grade level.  This limited availability is manageable for SLPs as long as they are assigned to one building and have 6 or fewer students with identified needs that benefit from small group intervention per grade level.  Are you thinking that this perfect situation is unlikely to occur in schools with caseloads over 65 and a growing enrollment?  You aren’t alone; the SLP Department at Earlywood Educational Services (EES) is thinking the same thing.  

With service delivery in mind, this year’s SLP Professional Development has targeted the idea of Inclusive Therapy with help of two former Earlywood SLP employees: Kristy Wright, a consultant from Indiana IEP Resource Center and Christina Bradburn, a national seminar leader from Shelbyville Community School Corporation. These professionals shared information regarding Co-Teaching and Inclusive Services through a Workload Model, respectively. These professional development opportunities were a good way to get the conversation regarding alternative service delivery started, identify therapists’ comfort level, and determine the need for additional information/training.  As this a major shift in thinking and practice for the SLPs and subsequently school personnel, the process will be slow; partnerships and practices will need to be established over time. Many therapists already provide whole group intervention such as, The Sound System to promote phonological awareness or The Expanding Expression Tool kit to build oral and written language skills as a general education initiative but do not view these whole class activities as therapy. SLPs that feel comfortable and have established relationships with teaching staff may trial a new service delivery model for a portion of their students by starting with one classroom or one grade level to determine what works best for their building. 

What might these inclusive services look like? As services are based on individualized student need, services will not be uniform; instead they vary by student, school, and therapist.  Based on the material presented and therapist feedback, here are some ways that inclusive therapy may be implemented:

Classroom therapy based on a continuum Co-Teaching Model.  The use of Co-Teaching is an effective model with a wide service delivery variance. Under the Co-Teaching umbrella there are many levels of shared responsibility. One foreseeable model may find the SLP in the classroom supplementing instruction or reteaching previously presented content with a group of students on their speech caseload or a group of identified  students and typical peers via a learning station.  Another potential model may have the SLP leading an intervention lesson targeting oral and written vocabulary development for an entire class.  A team teaching approach is beneficial as the teacher will be exposed to the SLP’s  use of  visuals, specific models, and level of cues/prompts associated with IEP goals during instruction and the SLP will become more familiar with classroom content and rigor.

Another inclusive service is the use of short, frequent articulation drills such as, 5-Minute Kids versus longer sessions on a more infrequent basis.  This service can be conducted in or out of the classroom using curriculum material such as, spelling and vocabulary lists and curriculum reading material. Research regarding service delivery supports individual sessions. A study by Willingham (2002) compared mass practice (the studying of material in one long session) vs distributed practice (the learning of new material in short sessions over several days)  and the effect on student achievement.  The results of the study indicated distributed practice was more effective than mass practice for retention of new information. An additional study by Kamhi (2006) suggested that more treatment time, especially in individualized sessions, will result in more student gains, which may in turn, shorten the duration of or need for speech therapy. Another benefit of the shorter session is less time out of the general education setting which will help maintain the least restrictive environment for students and  in turn, reduce any potential harmful effects that are discussed during IEP development.   

Change can be difficult but I believe that the SLPs at EES are excited about trying new service delivery models. They are innovative thinkers that are always honing their skills. It will be exciting to see the positive impact a more inclusive model can have on student learning. 

Gena Swanagan Frazer,  M. A., CCC/SLP
SLP Department Head

As Communication Disorders go, stuttering has to be the most complex. With no clear etiology and no set pattern of errors, it is difficult to understand, even for a speech language pathologist (SLP). As a general definition, stuttering is a communication disorder that interferes with a person’s ability to speak fluently. It involves the repetition, prolongation, or blockage of sounds, syllables, or words. Stuttering typically occurs at the beginning of a sentence or clause. A student academic, social, and/or functional performance in the classroom may be negatively impacted as they may be less likely to answer questions during whole class discussions, read aloud, or even socialize with peers.  

While the SLP’s primary clinical focus is developing compensatory strategies that promote fluent speech, part of their role is debunking the myths that the stuttering might believe about their own disorder. In exploring the misconception of the impacted speaker, The Stuttering Foundation outlines the following myths for the stutterer:

1. the idea that they will outgrow the stuttering. While there are periods of normal disfluency or stuttering  around age two as language expands, that period usually revolves in six months.  Those that continue to stutter over a period of three years, will most likely stutter throughout adulthood.  
2. the idea that they are alone when stuttering is prevalent in approximately 1% of the Earth’s population; impacting three million people in the United States and 70 million people worldwide. The feeling of isolation or loneliness stems more from the fact that individuals that stutter may not openingly discuss it with their family and friends. Through transparent discussion, an individual can effectively diminish their feelings of isolation by allowing others a better understanding of their personal experience.
3. the idea that one stutters because they are nervous.  While stuttering occurs when one is nervous, nervousness is not the cause of their stuttering; however, it might increase the frequency or intensity of stuttering. The frustrating fact is that just when one wants to stutter less, they stutter more.  Learning to manage the fear of stuttering will decrease overall nervousness and result in more fluent speech.
4.  the idea that stuttering is the fault of the speaker.  While the cause of the stuttering is unknown, it is considered to be a biological and neurological disorder and is not contracted from poor parenting, a stressful childhood, or traumatic event. The variance of the disorder lends itself to just as many therapeutic approaches and strategies to manage it.  What might work one day, will not work the next; it is the nature of the disorder not the result of one’s ability or effort. 
5.  the idea that stuttering should be hidden. Everyone feels like hiding once in a while.  Staying home from a gathering when you are not in the mood or spotting an acquaintance in the  grocery store and heading to another aisle; avoidance is a strategy known to all.  Those who stutter, have more of these episodes with simpler daily interactions such as, answering the phone or responding to a question. Feeling stuck on a word may result in answering the question using different words that may not reflect your true feelings or thoughts. This reaction is commonplace to the stutterer but ultimately results in a feeling of shame and loss of self-respect. In the end, it is far more important to say what you mean and run the risk of stuttering than the shame of stuttering.  

As the stutterer works to understand their communication disorder, the impact of the educator can make a significant difference in their ability to function within the educational setting. The Stuttering Foundation together with Dr. Lisa Scott of The Florida State University, provides educators with the following tips:

1. Don’t tell the student to “slow down” or “just relax.”  Comments like these will lead to an increase in anxiety.
2. Don’t complete words for the student or talk for them.
3. Help all members of the class learn to talk to turns and listen.  Creating a classroom culture of respect benefits all students.
4. Expect the same quality and quantity of work from the student that stutters as the students that do not. 
5. Speak with the student in an unhurried manner, pausing frequently.  As your rate of speech increases, the students will attempt to mirror that rate which will increase the likelihood of disfluent speech.
6.  Convey that you are listening to the content of the message, not thow it is said.
7. Have a one-on-one conversation with the student who stutters about needed accommodations in the classroom. Respect the student’s needs, but do not be enabling.
8. Don’t make stuttering something to be ashamed of. Talk about stuttering just like any other matter.

Through transparent and open communication, the educator will build a trusting relationship that will better serve the student communication and learning. If you are interested in learning more about stuttering, checkout  the free resources on the The Stuttering Foundation. If you have concerns about a student in your classroom who stutters, please speak to your building’s speech language pathologist. 

Gena Swanagan Frazer,  M. A., CCC/SLP
SLP Department Head

Have you ever heard someone say, “Every Child Deserves a Voice?” If you work in special education, chances are you have.  Its existence is heartbreaking but the truth of the matter is that some of our severely impaired students have been historically viewed as having No Mode of Communication. However in recent years, one diligent team has “No Mode” heading toward extinction. The Special Education teams in Greenwood Community School Corporation have been focusing on teaching students Core Vocabulary, or the words that comprise 70-90% of daily word use, for the purpose of Augmentative/Alternative Communication implementation. This approach focuses on the teaching core and fringe vocabulary words that are frequently used and relevant to the individual learner rather than context specific nouns. Once learned, these core words can be strung together to form meaningful two and three- words phrases. 

Each week, the team introduces a “W.O.W” or Word of the Week during whole or small group instruction where the students learn the associated ASL sign and locate the word within the 7 by 10 foot display of the home page of the ProLoQuo2Go application.  After the introductory learning, the students are saturated with the use of the word throughout the learning environment through daily instruction over the course of the week.  The teams also utilize flexible learning opportunities by labeling the areas of the room where the word could be used and featuring a bulletin board with related coloring activities, interactive vocabulary book, recommended app use, and activity sheets that highlight word use during transitions and gross motor activities.  After receiving a grant, the team added adapted books that coincide with the W.O.W to the learning target.  The use of these books provides a learning opportunity that is tied to a classroom curriculum and reflects skills targeted in general education such as answering WH-questions related to a story’s characters, setting, and plot. As the student’s functional communication has grown, teams have expanded the learning activities by sharing the weather report during morning announcements, and practicing language skills and device use on field trips to settings such as, a grocery store, restaurant, and nursing home. Through great efforts of the speech language pathology team, Core Word boards have been recently added to the playgrounds which allows student opportunities to communicate with their peers in a natural context.   

The teams’ efforts have resulted in tremendous student growth. Becky Pina, the Speech Language Pathologist at Southwest Elementary shared that one student, “went from touching fringe vocabulary words repeatedly "Elvis, Shrek, Shrek, unicorn, ghost, ghost" to producing 3-4 word sentences like "I want tablet please," and "this is me."  Core words provided him a way to communicate and he has even become more verbal in repeating the voice output of the Proloquo2Go app on his device.  Teaching him Core Words has made a huge difference.”  The Westwood Speech Language Pathologist, Cara Pyle, reported that every single student’s skills expand either verbally or through the use of the augmentative communication app. Through the use of sentence strips, students were taught sentence structure and fluidity of locating icons on their augmentative devices. This instruction provided them with functional statements that could be used all day such as, I need help.  The teaching of the W.O.W / Core Vocabulary has also had a positive impact on student behavior. Decreased communication skills often results in intense frustration and maladaptive behavior. By teaching students to locate highly motivating items on their devices, the team was able to decrease frustration and prevent emotionally charged breakdowns.

With the advances in technology, students that were previously viewed as have No Mode of Communication, now have a voice.  The success of the building Core Word vocabulary through the use of W.O.W instruction is an example of what educators can accomplish when they collaboratively plan, prepare, and implement a learning approach that provides multiple learning opportunities for students that rely on augmentative/alternative communication for social, functional, and academic engagement.  

Gena Swanagan Frazer, M.A., CCC/SLP

SLP Department Head

Speech Language Pathology is a bit of a mystery to the general population.  The profession has existed for a little over 100 years, with its beginnings based in speech correction.  The idea of speech correction is what lingers in most people’s minds today.  But what do SLP’s really do?

SLPs work with people of all ages, from infants to adults.  Their profession focuses on the prevention, assessment, diagnosis, and treatment of speech, language, social communication, cognitive-communication, and swallowing.  Within each of the above areas, there are more specific conditions that a SLP addresses under the speech umbrella such as, vocal quality, speech fluency or stuttering, accent reduction, apraxia, and dysarthria while aphasia is housed in the area of language. And if that weren’t enough, the SLP works in the ever-changing world of augmentative & alternative communication to establish effective communication for individuals that do not have reliable oral expression.  

Because of the diverse nature of their practice, the SLP can be found working in multiple settings including, clients’ homes, hospitals, rehabilitation centers, long-term and residential care facilities, private clinics, colleges/universities and the site with which we are most familiar, schools.  In fact, more than half of the speech language pathologist work force is located in the school setting.    

In the past fifteen years, there has been a shift in the practice of SLPs in the school setting from one of speech sound correction to the promotion of skills that allows students to improve their access to their academic, social, and social/emotional functioning.  More than ever, SLPs are functioning in a team-based approach to ensure optimal access to general education curriculum and state standards.            

Over the next several months we will be delving into the use of evidence-based practice used by speech-language therapist when providing support in the areas of articulation and phonology (speech sounds), dysfluency (stuttering), voice, receptive and expressive language, and pragmatic (social) language and feature some of the therapists that have implemented practices in their schools with great results.  I hope you are looking forward to this learning journey. 

Gena Swanagan Frazer,  M. A., CCC/SLP
SLP Department Head