Transcript Communication and speech/language services at Metro

COMMUNICATION AND
SPEECH/LANGUAGE
SERVICES AT METRO SCHOOL
9/16/14
Stephanie Dorton, SLP
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.
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Comparison of Guidelines for Students
with Multiple/Severe Needs
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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 speechlanguage 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
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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 DisabilitiesASHA.org; available: http://asha.org/docs/html/GL1992-00201.html)
Clarification?
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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?
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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?
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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?
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Modes of Communication
Communication Interaction
Functions of Communication
Expressive Language abilities
Receptive Language abilities
How this impacts students in the classroomfunctionally and academically
Questions to Ask During Assessment
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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
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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
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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
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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
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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
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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)
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To the high-tech:
A
dynamic display device, often referred to as a
Speech Generating Device (SGD)
Examples of Light-Tech Devices
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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
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Cautions When Using AAC
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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
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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
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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.
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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 listeninglooks like they aren’t paying attention.
CVI, contd.
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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?
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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
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VERY in-depth look at AAC from Boulder, CO school
district:
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http://www.swaaac.com/Files/AssessandImp/AACBasicsand
ImplementationBook.pdf
Teaching Learners With Special Needs:
http://teachinglearnerswithmultipleneeds.blogspot.com
 http://teachinglearnerswithmultipleneeds.blogspot.com/200
8/02/free-boardmaker-boards-and-activities.html (last
updated March 2013)
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Pre-made picture symbols:
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http://picturesymbols.cmswiki.wikispaces.net/
Questions / Comments?
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Contact Information:
Stephanie Hoyle Dorton, M.S., CCC-SLP
Metro School- a CMS School
[email protected]
(980) 343-5450