Read Microsoft PowerPoint - TSHA 2008 E ticket service delivery.ppt [Read-Only] text version

EBP Definition

E-Ticket Service Delivery: Effective, Efficient, Economical and Evidence-Based

Barbara J. Moore, Ed.D. Director, Special Youth Services Anaheim Union High School District [email protected] [email protected]

· "the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients... [by] integrating clinical expertise with the best available external clinical evidence from systematic research (Sackett et al, 1996)."

(Dollaghan, ASHA Leader, April 13, 2004)

E-Ticket Outline

· I. EBP Service Delivery and School Funding: What's the Connection? · II. EBP: A Brief Overview · III. School Finance: What's money got to do with it? · IV. Old Money and New Money · V. The E-Ticket Ride: EP+BP Service Delivery Saves time and Money · VI. Questions "Evidence-based approaches to clinical services involve the conscious use of current theory and research to frame the services provided (Gambrill, 1999)."

In Apel, K. Developing Evidence-Based Practices and Research Collaborations in school settings. LSHSS, July 2001, p. 196

What Is EBP and why all the fuss???

· Current trend in clinical and educational decision making · Derives from evidence base medicine, and has been the standard in the medical field for over 10 years · Requirements in No Child Left Behind (2001) and Individuals with Disabilities Education Act (2004) for use of scientific or evidence based practice

Scientifically Based Research

"research that involves the application of rigorous, systematic, and objective procedures to obtain reliable and valid knowledge relevant to education activities and programs" (NCLB SS 9101[37])


Current Trends in School Funding

· The Funding Pyramid

What Is Evidence Based Practice?

Mark Fey, Ph.D.

Working Group on EBP in Child Language Austin, TX, May 2004

· A new paradigm for clinical decision-making in which valid, reliable evidence is given more credence than that of intuition, anecdote, and expert authority (Dollaghan, 2002) · By definition, EBP requires the application of evidence in combination with the clinician's experience, or clinical craft, and understanding of the child's and family's unique demographic characteristics and socio-cultural perspectives.

Current Trends in School Funding


­ Full funding for IDEA still not within reach

· Discretionary not mandatory in IDEA 2004 · Roll backs the past two years in federal contribution

Assumptions of Evidence Based Practice

Mark Fey, Ph.D.

Working Group on EBP in Child Language Austin, TX, May 2004


­ Bifurcated COLA on special education funds in California this past year


­ District funds are strapped ­ Special education "encroachment" ­ an "e" word we don't like!

· Expert opinion and clinical experience are useful, but are subject to bias and are often wrong. · Clinical decisions based on knowledge of underlying physical mechanisms and strong theories of normal/abnormal function do not always translate readily into effective treatments.

­ Even theoretically-driven treatments need to undergo a process of development and rigorous testing to be optimally clinically useful.

II. Evidence Based Practice: A Brief Overview

Why EBP?

Mark Fey, Ph.D.

Working Group on EBP in Child Language Austin, TX, May 2004

· The press for EBP in SLP is occurring on several fronts, due to links with:

­ Allied health/medicine/nursing ­ Social and behavioral sciences ­ Education sciences

· At a more global level, many institutions are receiving intense scrutiny

­ Can we do more for less? ­ Can we do our jobs more effectively and efficiently? ­ Can we standardize treatments and minimize various outcome variations?


ASHA Position Statement Evidence Based Practice in Communication Disorders

Joint Coordinating Committee on Evidence-Based Practice

ASHA Position Statement Evidence Based Practice in Communication Disorders

Joint Coordinating Committee on Evidence-Based Practice



"It is the position of the American SpeechLanguage-Hearing Association that audiologists and speech-language pathologists incorporate the principles of evidence based practice in clinical decision making to provide high quality clinical care. The term evidence-based practice refers to an approach in which current, highquality research evidence is integrated with practitioner expertise and client preferences and values into the process of making clinical decisions. ....

"In making clinical practice evidence-based, audiologists and speech-language pathologists --­ evaluate prevention, screening, and diagnostic procedures, protocols, and measures to identify maximally informative and cost-effective diagnostic and screening tools, using recognized appraisal criteria described in the evidence-based practice literature;

ASHA Position Statement Evidence Based Practice in Communication Disorders

Joint Coordinating Committee on Evidence-Based Practice

ASHA Position Statement Evidence Based Practice in Communication Disorders

Joint Coordinating Committee on Evidence-Based Practice



"In making clinical practice evidence-based, audiologists and speech-language pathologists --­ recognize the needs, abilities, values, preferences, and interest of individuals and families to whom they provide clinical services, and integrate those factors along with best current research evidence and their clinical expertise in making clinical decisions,

"In making clinical practice evidence-based, audiologists and speech-language pathologists --­ evaluate the efficacy, effectiveness, and efficiency of clinical protocols for prevention, treatment, and enhancing protocols for prevention, treatment, and enhancement using criteria recognized in the evidencebased practice literature;

ASHA Position Statement Evidence Based Practice in Communication Disorders

Joint Coordinating Committee on Evidence-Based Practice

ASHA Position Statement Evidence Based Practice in Communication Disorders

Joint Coordinating Committee on Evidence-Based Practice



"In making clinical practice evidence-based, audiologists and speech-language pathologists --­ acquire and maintain the knowledge and skills that are necessary to provide high quality professional services, including knowledge and skills related to evidence-based practices;

"In making clinical practice evidence-based, audiologists and speech-language pathologists --­ evaluate the quality of evidence appearing in any source or format, including journal articles, textbooks, continuing education offerings, newsletters, advertising, and Webbased products, prior to incorporating such evidence into clinical decision making; and


ASHA Position Statement Evidence Based Practice in Communication Disorders

Joint Coordinating Committee on Evidence-Based Practice


"In making clinical practice evidence-based, audiologists and speech-language pathologists --­ monitor and incorporate new and high quality research evidence having implications for clinical practice.

"Evidence-based practice occurs when questions arising from clinical practice are addressed by carefully controlled treatment efficacy studies, often referred to as "clinical trials." Treatment efficacy studies, then, are followed by treatment effectiveness research to determine the benefit of a particular approach under conditions of routine clinical practice." (Gierut, 2001, LSHSS)

Evidence-Based Practice: EvidenceTreatment Considerations

· Treatment effectiveness -­ established whether or not a treatment works · Treatment effects -­ the behavioral changes that occur following treatment · Treatment efficiency ­ whether one treatment method is better than another ­ the most important clinically of the three (Gierut, 2001, LSHSS)

Evidence-Based Practice

· Practitioners have a real role in identifying areas of clinical practice that need data. · Practitioners are in a unique position to assist in the collection of treatment effectiveness data. · Causes us to look carefully at the treatment methods and practices we employ.

"Evidence-based practice has been described as the conscientious, explicit, and unbiased use of current best research results in making decisions about the care of individual clients/ patients. It suggests that treatment decisions should be administered in practice only when there is a justified (evidence-based) expectation of benefit. Evidence based practice and its components of treatment efficiency and treatment effectiveness are receiving growing emphasis " (Gierut 2001 LSHSS)

System Impact

· Educational Trends and Hot Topics


Thinking About Teaching and Learning

· To know what we should be doing for students, we need to look at where the educational system is · This includes belief systems about teaching and learning as well as legislation, policy, research and practice · Special education and general education are tied ­ not separate: what is going on in one impacting the other · · · · · · ·

Focus of Practice to Support ALL Learners: The Hot Topics in the Classroom

Literacy: still hot; but not new Closing the achievement gap Evidence-based/Scientifically-based practice Data driven decision making Differentiated instruction Learning/thinking/curriculum mapping Communities of learners (professional staff)

Old Model: Beliefs & Actions

(Moore & Montgomery, 2008)

Old Model Beliefs Students are somehow different internally and instructionally Old Model Actions Assessment should search for within learner deficits

Current Concepts in Student Support

· Look to instructional supports, not within child problems · Response to Intervention · Universal design · Differentiated Instruction · Professional Learning Communities

Tasks in intervention worked on processes rather than content.

Students with disabilities are not capable of learning higher level concepts.

Provide students with watered-down curriculum that does not include challenging content.

Do not expect students to succeed academically, socially or vocationally, so there is no need to provide those opportunities. (Low expectations)

Programs for students with disabilities should be separate from general education.

Separate funding systems.

Separate service delivery (e.g. pull out; separate classes)

New Model of Belief and Action

(Moore & Montgomery, 2008)

New Model Beliefs All students need good solid core instruction. Students who are struggling need more. New Model Actions Assessment guides how the environment should be changed to support the learner (i.e. materials, delivery of service, instructional supports, intensity of instruction).

Looking Around The Education World: What are the Curriculum and Reading People Saying?

All students should master standards and grade level curriculum. High expectations for all learners, including students with disabilities, English learners and those from minority and low socio-economic backgrounds.

Tasks in intervention work on learning the material of the classroom. Special education services should be designed to support students within the general education classroom ­ that's where the core instruction occurs.

Funding should be blended to support student needs; up to 15% of IDEA funds can/should be spent on pre-referral activities.


CURRICULUM: The Work of School

· "Focus on Learners --- All Learners"

· Association of Supervision and Curriculum Development (ASCD) president, Dick Hanzelka, June 2006


· Thinking Maps

­ An instructional methodology which utilized visual tools to assist students in creating complex cognitive networks (Hyerle, 2004)

· ASCD Hot Topics:

­ Academic Language ­ Differentiated Instruction ­ Curriculum Mapping

· Curriculum Mapping

­ The practice of charting in detail what topics should be taught by each teacher during the course of the year

Academic Language

· Increased focus on the need to specifically utilize academic language in our teaching and intervention · Direct vocabulary instruction on words related to content leads to improved academic achievement (Marzano & Pickering, 2006) · Systematic instruction in academic terms critical for students who do not come from an academic background. (Marzano & Pickering, 2006)

International Reading Association (IRA): What's Hot, What's Not for 2007 (Reading Today, Vol. 24(4); February 2006/March 2007)

· · · · · · · · · · EXTEMELY HOT: Adolescent Literacy VERY HOT Direct/explicit instruction English as a second language/English-language learners Fluency High-stakes assessment Informational Text Literacy coaches/reading coaches Scientific evidence-based reading research and instruction

Differentiated Instruction

· An instructional design model that focuses on creating multiple methods for students to experience and demonstrate their learning · Four Ways to Differentiate:

­ ­ ­ ­ Content/Topic Process/Activities Product Manipulating the Environment or Accommodating Individual Learning Styles ­

Focus of Practice to Support ALL Learners: The Hot Topics in Support Services

· Assessment ­

­ ­ ­ ­ Response-to-Intervention Performance based Curriculum driven Consideration of demands of statewide and classroom assessments ­ Limited and limiting the use of standardized measures

· Intervention ­

­ Focus on assisting students master curriculum ­ the work of school ­ Focus on outcomes; student achievement ­ Blended service delivery models ­ Networks


EBP, Instructional Practice and Caseload Management

Finding the Evidence

· Systematic Review

­ Cochrane Collaboration ­ Campbell Collaboration ­ What Works Clearinghouse ­ Psychological Database for Brain Impairment Tx Efficacy

Specificity of Learning

· Individual Studies

­ Medline ­ CINHAL (European)

4 steps in EBP (

· · · · 1. Framing the Question 2. Finding the Evidence 3. Assessing the Evidence 4. Making the Decision

· · · · · ·


Levels of Evidence

Ia. Well designed meta-analysis of > 1 randomized clinical trial Ib. Well designed randomized clinical study IIa. Well designed study without randomization IIb. Well designed quasi-experimental study III. Well designed non-experimental (e.g. correlation and case study) IV. Expert committee report, consensus conference, clinical experience of respected authorities

Adapted from the Scottish Intercollegiate Guidelines Network. (new window)

Framing the Clinical Question: PICO

· Population - kindergartners with articulation


Making Decisions

· What is the relevance of guidelines to your clinical question? · Are the guidelines EB? · Who wrote or published the guidelines?

· Intervention - individual pull-out treatment · Comparison - group therapy treatment · Outcome - ability to produce /s/


7 Step Approach to EBP

· · · · · · · · Nye, Schwartz, Turner (CSHA Magazine, 2005; p. 6) 1. Ask an EBP Question 2. Identify the Source for Best Evidence 3. Evaluate the Quality of the Evidence 4. Analyze the Evidence 5. Check for Chance Meaning of the Evidence 6. Average the Meaning of the Evidence 7. Interpret the Meaning of the Evidence 8. Move from Best Evidence to Best Practice

Evaluating the Clinical Importance of an Outcome

· Is the change the result of treatment rather than outside variables? (internal validity) · Is the change a real one as opposed to a random occurrence? (statistical significance) · Is the change an important one rather than a trivial one? (practical significance)

(Meline & Paradiso, LSHSS, 2003)

Questions to Ask??

· Are the expected outcomes clearly stated? · Is there documented evidence that this is valid for use with this client/patient? · Is there peer-reviewed research that supports or contradicts the stated outcomes? · Does this approach or practice compare favorably in time, performance, and cost with similar approaches or practices? · Do I have enough information to make a sound recommendation regarding this practice?

Effect Size

· Effect size describes how well the average student who received the intervention performed · The larger the effect size, the more powerful the intervention is · Effect sizes larger than .33 are considered to have practical significance; that is, the effect is large enough to make a worthwhile difference in the outcome · Cohen's (1988) guidelines: · .20 ­ small effect (small practicability) · .50 ­ medium effect · .80 ­ large effect

Significance: Clinical v. Clinical

· Statistical Significance:

­ .05 & .01 ­ level of confidence

An Example of Using Effect Size to Help Consider Effective Practice

· Strategies That Impact Student Achievement

­ Classroom Instruction that Works ­ Marzano, Pickering & Pollock (ASCD, 2001)

· But is it practical?

­ Clinical significance: "the practical or applied value or importance of the effect of the intervention ­ that is, whether the intervention makes ay real (e.g. genuine, palpable, practical, noticeable) difference in everyday life to the clients or to others with whom the client interacts (Kazdin, 1999) For EBP, practical significance and clinical significance are more relevant than statistical significance. (Meline & Paradiso, LSHSS, 2003)


Strategies That Impact Student Achievement Classroom Instruction that Works Marzano, Pickering & Pollock (ASCD, 2001)

· Comparing, Contrasting, Classifying, Analogies and Metaphors (ES = 1.61; N = 31) · Summarizing and Note Taking (ES = 1.00; N = 179) · Reinforcing Effort and Giving Praise (ES = .80; N = 21) · Homework and Practice (ES = .77; N = 134) · Nonlinguistic Representation (ES = .75; N = 40) · Cooperative Learning (ES = .73; N = 122) · Setting Objectives and Providing Feedback (ES = .61; N = 408) · Generating and Testing Hypotheses (ES = .61; N = 62) · Questions, Cues and Advance Organizers (ES = .59; N = 1251)

EBP Applied to School Based SLPs LSHSS October 2005 Issue

Prologue: "Scientific evidence has shifted our profession of speech-language pathology to a position where it is no longer acceptable to claim successful treatment of children with speechlanguage impairment if the outcome is improvement in only spoken genres. Rather, treatment outcomes for children's written language development must also be considered."

Meta-Studies that are Familiar

· National Reading Panel Report/Put Reading First (2001) · Preventing Reading Difficulties in Young Children (Snow, et al, 2001)

EBP Applied to School Based SLPs LSHSS October 2005 Issue

Epilogue: "Change is needed to our current practices and resourcing levels because longitudinal studies have typically presented negative academic outcomes or have documented persistent weaknesses in areas critical to reading and spelling (e.g. phonological awareness) for children with speech-language impairment."

EBP Applied to School Based SLPs LSHSS October 2005 Issue

· Clinical Forum on Phonological Awareness · Prologue & Epilogue written by Gail Gillon, Ph.D., U. of Canterbury, New Zealand

How EBP is Impacting School Services

Moore-Brown, CSHA, 2005

· Reasons to Utilize EBP in Schools:

­ 1) Accountability means therapy which can assist students in meeting standards and functional goals ­ 2) Due Process ­ 3) Student/Clinician Time ­ 4) Challenges from the outside ­ 5) Parent/Teacher/Student Satisfaction ­ 6) Enhanced Professionalism


III. School Finance: What's money got to do with it?

Dollars are packaged differently these days

Specific Bucks for Specific Projects


Once you've maxed your dollars for IDEA....

.....Go looking in other places......

Steps to Find the Money

1. Understand Your State Education Funding Formulas

General Education Special Education Other Categoricals

Places to Look...

· · · · · · Combine with other categoricals Other available funds State and Local Grants Association Grants Other agencies Joint Projects

2. Understand the Distribution of Funds in Your District/Region 3. Know where else to look


System View v. Educator's View

· · · · · · · · · System concerns.... Compliance Funding Cost Efficiency Efficacy Legality Change management Student achievement · Educator's View

­ Professionalism ­ Responsibilities

· to job/employer · to children & their families · to family · to self · to colleges · to the profession

It Might Require

A Slight Shift in Thinking

· Collegiality · System's concerns

System View

· As Classrooms Change, We Do too!

Wrap Your Plans Around

School Improvement Service Delivery Student Performance

Think Abouts: Service Delivery Connection between Service Delivery and School Finance

· # of FTEs goes to cost of the program · that's why practices are important · changes in funding models and legal requirements means changes in how we do business


IV. Old Money and New Money

· Old Money: Searching for the Bucks

­ IDEA: The failed Federal Promise ­ Medicare: Love it or Hate it

Early Intervening Services

· Code of Federal Regulations (CFR) 300.226 (b)

­ Professional development (which may be provided by entities other than LEAs) for teachers and other school staff to enable them to deliver scientifically based academic instruction and behavioral interventions, including scientifically based literacy instruction and, when appropriate, instruction on the use of adaptive and instructional software; and ­ Providing educational and behavioral evaluations, services, and supports, including scientifically based literacy instruction.

· NEW Money: Dollars tied to Service Delivery

­ 15% and Early Intervening Services ­ RtI and Reducing Numbers ­ Grants and Other fun Places to Look

Early Intervening Services

· Commentary by the U.S. Department of Education (ED) to the CFR

Early Intervening Services Funding Implications

The Individuals with Disabilities Education Improvement Act (IDEA 2004) includes a new provision for the use of up to 15% of Part B funds for Early Intervening Services.

­ Not to delay an evaluation of a student suspected of having a disability ­ Recipients do not have the rights and protections of special education ­ Intended for students in grades K ­ 12 ­ Emphasis on K ­ 3 ­ Cannot be used for preschool ­ May be used to purchase instructional materials to support these efforts ­ May include related services personnel in the development and delivery of educational and behavioral evaluations, services, and supports

Early Intervening Services

· IDEA 2004 allows services to nonidentified students who are struggling academically and/or behaviorally, and who could benefit from the resources normally reserved for students in special education. · Clear Congressional intent for special education to be engaged in activities which will prevent students from ultimately needing special education identification

Why Use Special Education Funds for Prevention?

"The authority to use some Part B funds for early intervening services has the potential to benefit special education, as well as the education of other children, by reducing academic and behavioral problems in the regular education environment and reducing the number of referrals to special education interventions. Therefore, we believe the use of Part B funds for early intervening services should be encouraged, rather than restricted." (CFR, Commentary by the Education Department, pp. 46626 ­ 46627)


Why Use Special Education Funds for Prevention?

"Nothing in this Act or regulations prevents States and LEAs from including related services personnel in the development and delivery of educational and behavioral evaluations, services, and supports for teachers and other school staff to enable them to deliver coordinated early intervening services."

(CFR Commentary, pp. 46627-46628)

Early Intervening Services: Practice Implications for SLPs

· Once we begin working with non-identified students, caseload counts should decrease · HOWEVER, should not mean elimination of positions, as need staff to do the work of prevention · Need to examine current models of referral and supports to students

Early Intervening Services and Speech-Language Pathologists

· resources of special education, including personnel time, can and should be spent in part on attempting to prevent struggling students from needing special education identification. · provides SLPs with a unique opportunity to engage in prevention activities, including collaboration and consultation, professional development to teachers, and direct and indirect services through RtI programs to struggling students.

Where do I go to find the money for Early Intervening Services?

· Not a new pot of money ­ is 15% of Part B funds · Accessing and tracking these funds is important

Early Intervening Services: Practice Implications for SLPs

· The clear intent of the Congress is to utilize the expertise of special education professionals, including speech-language pathologists, to begin to work with students who are struggling academically, in order to prevent the need for such students from becoming IDEA eligible

Where do I go to find the money for Early Intervening Services?

· Through early intervening services speech-language pathologists can positively affect student performance for all students, but also begin to implement workload management efforts. · Speech-language pathologists in schools are encouraged to be a part of local planning and implementation.


V. The E-Ticket Ride: EBP Service Delivery Saves Time and Money · Having the best of both worlds: Serving students and saving money · Models that enhance efficiency and effectiveness · Tying the principles of EBP and cost containment

Instructional Support Teams

· Not just a reconstituted Student Study Team · Focus on instructional supports for the learner · Instructional support experts

Think Abouts: Identification Processes · If using a process where teachers refer directly to SLPs, and do not use the SST process:

­ no guarantee of using modifications ahead of time ­ leads to a higher incidence of identification ­ leads to a higher number of assessments of students who DNQ ­ teachers don't have the opportunity to work/learn from SLPs in prevention mode

Supporting General Education as an Alternative to Separate Services

(Instructional Consultation Teams: Collaboration for Change Rosenfield & Gravois, 1996)

Two critical assumptions are embedded here.

First, how learning problems are understood is important; they may be defined as internal deficits within children or as a mismatch between how student abilities and the school's attempts to meet the student needs. Each of these assumptions reflects different attitudes and beliefs. As long as individual student disability is perceived as the dominant cause of school failure, public education will be able to avoid undertaking the kind of reforms needed for all students to succeed (Skrtic, 1991; p. 4)

Think Abouts: Identification Processes · Implementation of RtI · Need to use eligibility and dismissal criteria · Consider educational impact when selecting students for service

Supporting General Education as an Alternative to Separate Services

(Instructional Consultation Teams: Collaboration for Change Rosenfield & Gravois, 1996)

The second underlying issue is that of administrative support for education all students. .... Administrators and policy makers must demonstrate a commitment to funding appropriate, restructured services. Also required are guarantees to maintain special education and pupil personnel services (albeit in a restructured form), adequate studentteacher ratios, and evaluation of outcomes. ..... Ultimately, change will be impossible unless there is a basic trust that resources will not be withdrawn as the number of labeled handicapped (sic) students decreased and administration will not place students with special needs into classroom setting without adequate support to the classroom teacher.

(p. 4-5)


Think Abouts: Service Delivery Models · Using a variety of service delivery models allows for greater flexibility in serving students · Emphasis on standards · Need to utilize the service delivery model that will closely facilitate the student's work in the classroom

Speech and Language Services in the Era of Accountability

· WHY & WHEN; WHAT & WHERE: · General education students in the general education classroom --- if SLP is co-teaching or part of the literacy team, may be assisting with core instruction or delivery of vocabulary or introduction of concepts · Pre-referral students involved in a tiered intervention --may be part of early intervening services in an RtI model; hopefully will prevent students from requiring special education · IDEA identified students ­ reduced numbers of students who need intensive assistance through an IEP

Practice Issues: Intervention & Service

The question of screening..

See "To Screen or Not to Screen" (Moore-Brown & Nishida, 2002); screen_or_not_to_screen.htm

Speech and Language Services in the Era of Accountability

· WHO: · General education students in the general education classroom · Pre-referral students involved in a tiered intervention · IDEA identified students

SLP's Service: Adaptations to the Demands of NCLB and IDEA


Legal Mandates Revisited

· NCLB mandates growth in the disability subgroup · IDEA 2004 mandates access to the core curriculum in the general education classroom · IEPs must document present levels of academic achievement under IDEA 2004 · IEPs must document how the student's disability impacts their ability to progress in the general education curriculum and what you are going to do about it!

"All social, political, and professional influences shaping the practice of speech-language pathology in schools have emphasized the consideration of the array of service delivery options when designing an intervention plan that will best meet the individual needs of a child. These options may be combined and should be seen as flexible, depending on changing student needs (ASHA, 1996; NJCLD, 1991). ... Regardless of the service delivery model(s) deemed appropriate for any given student, the focus of the interventions should be functional and content-based, integrating intervention with the meaningful activities of the child's educational experience." Whitmire, CDQ, Winter 2002, p. 73

Focus of Practice to Support ALL Learners: The Hot Topics in Speech and Language · Educationally Relevant Therapy

­ Need to Know: The Curriculum ­ Need to Know: Standards ­ Need to Know: Instructional Design ­ Need to Know: The difference between the curriculum and the standards ­ Need to Know: Measures of student progress in the classroom

Goals of Therapy: Literacy and Functional Communication

What is it about the student's learning/language disability that is preventing the student from performing the function needed to achieve standards? The purpose of the intervention is to assist the student in achieving the goals of school.

Service Delivery: Issues for Consideration

· · · · · Size


Nine Types of Adaptations

Descheness, Sprague & Ebeling (1994)


Adapt the number of items that the learner is expected to learn


­ Adapt how the student can respond to instruction Adapt the extent to which a learner is actively involved in the task Adapt the goals or outcome expectations while using the same materials Provide different instruction and materials to meet w a student's individual goals

· · · ·

Writing Goals to Standards Entry/Exit Literacy Appropriate identification processes, including schoolwide processes · Appropriate service delivery models and methods · Other????


­ Adapt the time allotted and allowed for learning, task completion, or testing

· ·



Level of Support

­ Increase the amount of personal assistance a specific learner Adapt the way instruction id delivered to the learner Adapt the skill level, problem type, or the rules on how the learner may approach the work

Alternate Goals





Substitute Curriculum





ASHA Position Statement

It is the position of the American SpeechLanguage-Hearing Association (ASHA) that speech-language pathologists (SLPs) play a critical and direct role in the development of literacy for children and adolescents with communication disorders, including those with severe or multiple disabilities. SLPs also make contributions to the literacy efforts of a school district or community on behalf of other children and adolescents. These roles are implemented in collaboration with others who have expertise in the development of written language and vary

with settings and experience of those involved.

(ASHA, 2001, p. 1)

Condition of Education

(National Center on Education Statistics, 2003)

· The difference in children's reading skills and knowledge, often observed in later grades, appear to be present when children enter kindergarten and persist or increase throughout the first 2 years of school. (p. iii) · The resources that children possess when they began kindergarten, such as their early literacy skills and the richness of their home literacy environment, were related to their reading skills and knowledge upon entering kindergarten and their gains in reading achievement by the end of kindergarten and 1st grade. (p. iii)

Digest of Education Statistics: 2006 ( · Enrollment in public elementary and secondary schools rose 24 percent between 1985 and 2006. · The NCES forecasts record levels of total elementary and secondary enrollment through at least 2015, as the school-age population continues to rise. Record enrollments are expected each year through 2015.

How to Help Students who Struggle with Learning???

· Historically, struggling students could receive help through Title I or Special Ed and that was it! · There are many reasons why students struggle

· · · · · · homeless high mobility absenteeism illness inadequate instruction just didn't get it!

Condition of Education

(National Center on Education Statistics, 2003) · Public elementary and secondary enrollment is projected to reach 47.9 million in 2005, decrease to 47.6 million in 2010, and then increase to 47.7 million in 2012. The West will experience the largest increase in enrollments of all regions in the country (p. iv) · The number of 5- to 24-year-olds who spoke a language other than English at home more than doubled between 1979 and 1999. In 1999, among these young people who spoke a language other than English at home, onethird spoke English with difficulty (i.e. less than "very well"). Spanish was the language most frequently spoken among those who spoke a language other than English at home. (p. v)

Why a New Movement to Assist Student who are Struggling?

· Students with reading difficulties make up the majority of students identified as having specific learning disabilities (SLD) ­ 50% of the students in special education are identified as SLD; 80% of those students have reading problems; 20% of the students in special education are identified as SLI; they, too, are at-risk for reading failure · "Wait Until You Fail" doesn't work for struggling readers; they don't catch up


Background: Research

· Research of Dr. G. Reid Lyon of the National Institutes of Child Health and Human Development of the National Institutes of Health (Lyon, 1998; Lyon, 2001) · National Reading Panel Report/Put Reading First (2001) · Preventing Reading Difficulties in Young Children (Snow, et al, 2001)

Literacy Facts

· More than 1/3 of American children do not exhibit basic levels of reading proficiency (National Center on Education Statistics, 2005) · Children with clinically depressed language skills are the most at risk for reading failure (Catts, Fey, Tomblin & Zhang, 2002)

Other things we know now about reading and reading problems

Facts on Early Literacy

(ASHA, 2007)

· Connecticut Longitudinal Study Shaywitzes · Matthew Effect - Stanovich

· One out of every 5 of our nation's school-age children suffer from reading failures. (Lyon, 2001) · A majority of all poor readers have an early history of spoken-language deficits. A recent study reported that 73% of 2nd grade poor readers had phonemic awareness or spoken language problems in kindergarten. (Catts, Fey, Zhang & Tomblin, 1999)

Some Statistics About Reading

(Thank you to Tina Eichstadt & Larry Hanken, AGS/Pearson Assessments)

Facts on Early Literacy

(ASHA, 2007) · A child who is not a fluent reader by 4th grade is likely to struggle with reading into adulthood. Today, 41% of fourth grade boys and 35% of fourth grade girls read below the basic level, and in low-income urban schools this figure approaches 70%. (National Center for Education Statistics, 1998) · Poor reading and writing skills have a devastating lifelong impact ­ 75% of school dropouts report reading problems, and at least half of adolescents and young adults with criminal records have reading difficulties. (Lyon, 2001) Fortunately, this scenario can be changed with proper identification and intervention. (Fletcher & Lyon, 1998)

· 10+ million children in the United States are poor readers. (8 million in the 4th ­ 12th grades; Ehren, B., 2007) · 80-85% of children with LD are primarily impaired in the area of reading. · 90% of these children have problems with the development of decoding skills. · 70% of poor readers in the 3rd grade remain poor readers in the 9th grade. · 83% of reading delayed students showed signs of language difficulties at ages 3 & 4. · Reading problems occur with equal frequency in boys and girls. · Schools identify four times more boys than girls.

· Foorman, Fleture, Francis (CARS), Learning Disabilities Online


Facts on Adolescent Literacy

· Approximately eight million young people between fourth and twelfth grade struggle to read at grade level. Some 70 percent of older readers require some form of remediation. Very few of these older readers need help to read the words on a page; their most common problem is that they are not able to comprehend what they read. (Biancarosa & Snow, 2004; p. 3)

Implications for SLPs: We need to understand the research about reading and effective instructional practices, as well as the research in our field related to reading and written language disabilities

English Learners

· Language-minority students who cannot read and write proficiently in English cannot participate fully in American schools, workplaces, or society. They face limited job opportunities and earning power. Nor are the consequences of low literacy attainment in English limited to individual impoverishment. U.S. economic competitiveness depends on workforce quality. Inadequate reading and writing proficiency in English relegates rapidly increasing language-minority populations to the sidelines, limiting the nation's potential for economic competitiveness, innovation, productivity growth, and quality of life. (pp. 1-2)

· National Literacy Panel, 2006

What is Response to Intervention (RTI)?

· Programs designed to provide intense instructional opportunity, for a specified period of time, to students who may be suspected of having a learning/language disability · May use a problem solving approach or a intense intervention · Designed to provide students instructional opportunities they may have missed

English Learners

· Nearly 14 million English Learners (ELs) attend school in the United States · Estimate that by 2020, nearly 40% of all students will come to school with a primary language other than English · Spanish represents the language spoken by 80% of the students whose primary language is other than English

RtI: The Big IDEAS

· Before we identify a learning disability we must rule out missed educational opportunity · Struggling students can and should be helped early, using strategic approaches · Use of scientifically based, or evidence based intervention · Progress monitoring is a big key · Resources from both general and special education need to be used · It's about ALL students


Hypotheses of RTI

· IF the student responds to an intense diet of instruction, then they likely are not disabled learners.

What are the new IDEAs?

· Early Intervening Services allow use of up to 15% of special education funds to be used for pre-referral activities · Allows for use of a Response to Intervention model in determining LD

Why we think RtI is HOT !!

· · RtI is a system change designed to assist struggling learners RtI is a way to integrate the knowledge and skills of SLPs into the whole school RtI utilizes EBP RtI allows flexibility for scheduling and service RtI provides a mechanism to deal with some of the fundamental concerns about our system

SLPs & Other Special Educators: Inside and outside special education

· Inside: With students identified with disabilities · Outside: With responsiveness to intervention (RtI); intensive, systematic interventions in gen ed

(Montgomery, 2006)

· · ·

Multi-tier Model

SLPs & Other Special Educators will be working "inside" and "outside" of special education

· · · · · Encouraged by NCLB Allowed by IDEA 2004 Needed by students Requested by families Tied to academic standards

(Montgomery, 2006)


Roles for SLPs in RTI

Trioa, 2005, TLD · Tier I - Professional Development

­ esp. in literacy, alphabetic principle, strategies for decoding and spelling, how to deliver instruction; ­ later vocabulary development, roots & prefixes; how to select scientifically validated materials; ­ consult on how to deliver effective universal instruction, setting up screening and progress monitoring; ­ monitoring and assisting school teams

Using RtI to Address Disproportionality

· English Learners and Other Overrepresented Groups · Models for Success

Roles for SLPs in RTI

Trioa, 2005, TLD · Tier II - Consultant for teams delivering targeted instruction/interventions · direct role: may provide directed instruction for diagnostic/therapeutic instructional purposes

­ SLP may make recommendations for interventions that prevent long term problems OR if student doesn't respond, then comprehensive assessment may be indicated

RtI is making our world flat!

What we do in one place affects what happens in another place.....often quite far away..... (We know Friedman meant to include us in his book.... )

Roles for SLPs in RTI

Trioa, 2005, TLD

RtI is making our world flat!

· Our job duties are overlapping and synergistic · Collaboration & consultation & networking are critical · The SLP's "value added" role is supporting students in the curriculum ­ it's a must! · Shift toward increasing time in prevention (e.g. pre-referral) · Continue to increase service delivery in regular classrooms with identified students

· Tier III - two types of responsibilities

· (a) providing specialized treatments for poor readers with language deficits who have not responded to universal instruction and targeted interventions · (b) consulting with special educators to help them make their services maximally beneficial · may want to use cyclical approach to increase availability of service to students (3 x 60 min. for grading period)


RtI is making our world flat!

· Will be changing how and what we do with assessment ­ · ESPECIALLY the referral process! · Assessment needs to reflect an academic focus · Assessment will be more dynamic · Assessment needs to reflect students performance on standards

Disproportionality ­ Congressional Concerns, IDEA 2004

· .... in 1994, African-American students were 2.2 times more likely than other students to be identified as having MR; in 2002, they were 3.04 times more likely to be so identified, an increase of 38 percent from 1994. The increase of risk for African-American students in the area of ED in 2002 from 1994 was even greater (41 percent). Even with the heightened awareness of this issue, the risk ratio for African-American students to be identified as MR and ED increase in 2002 from the previous year (Gamm, 2007, p. 2).

Disproportionality in Special Education

· Congress expressed concerns about the rate of increase in the number of racial and ethnic minority students in special education in 1997 and again in 2004 · 1980 ­ 1990 identification of Hispanic students in special education grew 53%, as compared to 6% for white students · In 2004, reports of Black children being overidentified in the categories of mental retardation and emotional disturbance · Also found that in schools with predominantly white children and teachers, minority students were disproportionately placed in special education · (Moore & Montgomery, 2008)


· Overidentification occurs in the "judgmental" categories, not hearing, vision, orthopedic (obvious categories), but SLD, ED, intellectual disabilities · (Gamm, 2007)

Introduction to a New Era

(President's Commission on Excellence in Special Education (2002))

Early Intervening Services to Combat Disproportionality

School districts with significant disproportionality of students in special education based on race and ethnicity will be required to utilize 15 percent of their Part B funds for early intervening services to serve children in the LEA particularly, but not exclusively, children in those groups that were significantly overidentified. (Moore & Montgomery, 2008, p. 77)

Children of minority status are overrepresented in some categories to be labeled mentally retarded and placed in special education. AfricanAmerican children are twice as likely to be labeled and placed as emotionally disturbed. (pp. 1-2)


Emerging Roles for SLPs

· Leadership role - in developing the RtI program at your site, district, region · Leadership role ­ by consulting & collaborating with RtI team members, teachers or a member of the RtI team · Leadership role ­ in shifting practice toward this model (i.e. Be Brave!) and then serving as a model for others

Speech/Language Service Delivery: Intervention Approaches

· Need to be appropriate for the specific needs of the students · Should be provided within a range of service delivery models, resulting in a continuum of services within the program · Must be educationally relevant, and directed toward assisting students meet standards

Speech/Language Service Delivery

· Service delivery is a dynamic concept and changes as the needs of the students change. · No one service delivery model is to be used exclusively during intervention. · For all service delivery models, it is essential that time be made available in the weekly schedule for collaboration with parents, general educators, special educators and other service providers (ASHA, Roles & Responsibilities, 2000; p. 37)

Speech/Language Service Delivery: Intervention Approaches

· Flexible service delivery give the SLP greater management and control · Participation in prevention activities at the school site, collaborating with teachers and administrators, participating in system problem solving and effective utilization of paraprofessionals are all keys to effective caseload management. (Moore-Brown, 2001)

Speech/Language Service Delivery

· ASHA document on roles and responsibilities of the school-based SLP · ASHA documents on literacy: roles and responsibilities and skills and knowledge · ASHA document on keys to successful caseload management · ASHA Implementation Guide: A Workload Analysis Approach


· What do you want your student's teacher(s) to do?



Speech/Language Service Delivery: What to Write on IEPs

· Be cautious about restricting yourself to "2x week for 30 minutes" · Write in adjustments in frequency and duration · Adjust when students improve · In-class services · Ranges are not acceptable · Statements regarding limitations are acceptable (i.e. "Services will not be provided on school holidays, student free days or during testing periods.") · Need to write in service delivery model (i.e. small group, individual, in-class, consultation, etc.)

Service Delivery Models in Educational Settings

(Roth & Worthington, 2001)

· Traditional/Pull-Out

­ child leaves classroom and receives therapy in individual or group sessions

· Consultative

­ Clinician acts as a resource for professionals who work directly with a child and parents to help solve problems related to the child's communicative deficit. Agent of intervention is someone other than SLP.

Related Influences and Considerations

· Professional responsibilities

­ continuing professional development

Service Delivery Models in Educational Settings

(Roth & Worthington, 2001)

· Collaborative

­ The clinician and the classroom teacher share the responsibility for developing speechlanguage goals for a child and integrating them into the academic curriculum. The goals are implemented primarily by the classroom teacher, although the SLP may occasionally work directly with the child

· Professional Association resources

­ code of ethics ­ preferred practice patterns

· Advocacy

­ personal ­ school site ­ district ­ professional/legislative

Multiple Perspectives for Determining the Roles of SLPs in Inclusionary Classrooms

· ...single-discipline perspectives cannot drive service delivery decisions. Providers must view students with disabilities in the context of a larger social system, using multiple perspectives guided by shared, mutually agreedon focus.

Prelock, LSHSS, July 2000 · Therapeutic · Child and Family Centered · Guided Inquiry · Social Interaction · Scaffolding · Research-to-Practice Partnership

Service Delivery Models in Educational Settings

(Roth & Worthington, 2001)

· Team Teaching

­ The clinician and the teacher share the responsibility for classroom instruction on a regular basis. In this model, a comprehensive program with strong language and academic components can be provided within the context of the classroom.


Service Delivery Models in Educational Settings

(Roth & Worthington, 2001)

Speech-Language Service Delivery SpeechModels - Frequency & Duration

· Cycles approach · Block schedule programming (MS/HS) · Declining intensity · Collaborative service · On IEPs, consider:

­ writing monthly minutes ­ 15 minutes/4x wk ­ intense during introduction of concepts ­ document when no service ­ document indiv/group

· Self-contained:

­ The clinician alone served as the classroom teacher and is responsible for developing and implementing all aspects of the curriculum. Classroom activities in all topic areas are specifically designed to promote the development of language skills.

(pp. 26 - 27)

Maintaining a Therapeutic Focus and Sharing Responsibility for Student Success: Keys to In-Classroom Speech-Language InSpeechServices

Dr. Barbara Ehren LSHSS, July 2000

More Service Delivery Models.... ASHA Workload Implementation Guide

· · · · · · · Supportive Teaching Complementary Teaching Consultation Team Teaching Resource Room Speech Club Teaming for Reading Instruction

Speech-Language Service Delivery Models

· Intense Instruction · Collaborative Services · Joint service with RS, SDC, counseling, psychologist, OT · In-class (general ed or special ed classroom) · Consultative · Co-teaching · Para-professional support · Prevention activities · Literacy lab · Articulation lab

Who Gets Service And Why: Practice Issues

· · · · Cognitive Referencing as a determiner Caseload size Intensity for select populations Competition for services: private, other lesser trained individuals (ABA, Ed Therapists, Auditory-Verbal Therapists) · Entry-Exit · Pre-referral Prevention-Intervention


How to Practice Ideas....

· Using a workload approach to scheduling · varying intensity by week, by month, · scheduling multiple schools on consecutive days, rather than MW/TTH · Working in the ELA block, so as to move from classroom to classroom.... Sometimes teachers are homogeneously grouping · Prereferral activities should reduce numbers

A Model for Service

· Prevention Activities · General Education Interventions (e.g. effective student study teams; Tiered Model) · Identification procedures · When a student qualifies · Service delivery models · Exit and follow-up support · Total school activities

How to Practice Ideas....

· Creatively grouping... arrange by grade level rather than disability · Working in class for defined periods of time · Scheduling graduated change in service · Utilize minutes per month rather than per week


· It is predominantly the SLP who decides who is served in the program · There may be some challenges to this, but for the most part... it's us! · We are the ones who put the kids in and say when they are done!

· Involve administrators and teachers in the discussion about your service delivery


· COMES FROM MEDICAL MODEL... We have a different purpose....sometimes we do therapeutic activities, but our purpose is to support educational needs

· · · · · · · · For Kids? Not individual Not integrated Need to fit into a group even if it doesn't match For Clinicians? Limits what clinician can do Doesn't allow flexibility Only x number of 30 minutes in a week!

In All That You Do....

Remember the Kids Focus on:






Microsoft PowerPoint - TSHA 2008 E ticket service delivery.ppt [Read-Only]

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