School-based Speech-language Pathologists Research Articles

AAC Business as Usual: Clinical Practice of School-Based Speech-Language Pathologists

AAC Business as Usual: Clinical Practice of School-Based Speech-Language Pathologists

Spelling Facilitates Reading: A Tutorial on the Spell-to-Read Approach.

According to the American Speech-Language-Hearing Association (ASHA), prevention, identification, assessment, and intervention of children who are learning to read and write are within the scope of practice for school-based speech-language pathologists (SLPs). Furthermore, for SLPs who work in the school setting, it is not uncommon to have struggling readers and poor spellers on their caseloads. Importantly, for students who have difficulty in spelling, their spelling errors are among the early indicators of dyslexia and can provide a means for identifying readers who may benefit from early intervention. SLPs can both assess spelling skills and implement evidence-based spelling and literacy diagnosis and instruction. Spelling instruction in kindergarten through the high school grades that is heavily grounded in metalinguistic activities can provide access to mental representations of word spellings, pronunciations, and meanings; links between whole-word and phonics approaches to reading instruction; and a foundation for reading fluency and comprehension. Learning to spell is essential for learning to read. Accordingly, this tutorial aims to elucidate how to (a) assess and identify phases of spelling development and (b) teach spelling to facilitate reading through a listening-first approach.

Written Language Practice, Self-Efficacy, and Beliefs: A Survey of Speech-Language Pathologists Working With School-Aged Clients.

This study examined the clinical practice, self-efficacy, and beliefs about assessing and treating written language among speech-language pathologists (SLPs) working with school-aged clients (aged 5-21 years) in school and nonschool settings in the United States. A survey was completed by a nationwide sample of 344 SLPs working with school-aged clients in the United States. Statistical analyses were conducted to determine differences between (a) SLPs' self-efficacy in assessing and treating spoken versus written language and (b) school-based and non-school-based SLPs' clinical practice, self-efficacy, and beliefs about their roles with written language. All respondents reported significantly lower rates of self-efficacy in assessing and treating written language compared to spoken language, and their self-efficacy had a significant, positive relationship with the amount of clinical time devoted to written language. School-based SLPs devoted a significantly lower percentage of clinical time to written language, had significantly lower self-efficacy in addressing written language, and had lower rates of agreement on statements about their roles and responsibilities with written language compared to non-school-based SLPs. These differences were not found with spoken language. The most prevalent written language needs on respondents' workloads were reported as written expression (69.3%) and reading comprehension (66%). School-based and non-school-based SLPs report different levels of clinical time devoted to written language, self-efficacy in addressing written language, and beliefs about their roles in addressing written language. There is a need to investigate the reasons for these differences and the potential impact of preservice and in-service training in ameliorating them. https://doi.org/10.23641/asha.25511047.

Pediatric Feeding Disorder and the School-Based Speech-Language Pathologist: An Evidence-Based Update for Clinical Practice.

This prologue introduces the forum "Pediatric Feeding Disorder and the School-Based SLP: An Evidence-Based Update for Clinical Practice" and informs the reader of the scope of articles presented. The guest prologue author provides a brief history of pediatric feeding and swallowing services in the public-school setting, including previous forums on swallowing and feeding services in the schools (Logemann & O'Toole, 2000; McNeilly & Sheppard, 2008). The concepts that have been learned since the 2008 forum are shared. The contributing authors in the forum are introduced, and a summary is provided for each of the articles. The articles provide evidence-based information on topics that are uniquely of interest to school-based speech-language pathologists managing pediatric feeding and swallowing in their districts. The topics shared in this forum range from relevant information on anatomy, physiology, developmental milestones, and differential diagnosis to therapeutic practice when identifying and treating pediatric feeding and swallowing in the school setting. The forum also includes focused articles on the necessity of collaboration with families during the treatment process, current information on legal parameters dealing with school-based pediatric feeding disorder services, and a framework for assessment and treating pediatric feeding disorder in the school setting.

Comparing Spoken Versus iPad-Administered Versions of a Narrative Retell Assessment Tool in a Practice-Based Research Partnership.

In the current age of greater digital delivery of services, it is important to examine the validity and differences between spoken and digital delivery of materials. The current study is a practice-based research partnership between school-based speech-language pathologists (SLPs) and researchers, evaluating presentation effects and validity of a narrative retell assessment tool created by SLPs. Fifty-one children across kindergarten, Grade 1, and Grade 2 completed the narrative retell task, retelling One Frog Too Many and Frog Goes to Dinner in three in-person story presentation conditions administered 1 week apart: spoken, iPad with audio-recorded natural rate of speech, and iPad with slow rate of speech. This was followed by 10 comprehension questions related to story events. Children also completed the Story Retelling subtests from the Test of Integrated Language and Literacy Skills (TILLS). Children recalled significantly fewer events in the spoken condition compared to audio-recorded iPad conditions. No significant effect of speaking rate was found. Presentation condition and rate did not affect performance on comprehension questions. Correlations among retell measures and corresponding subtests on a standardized language test ranged from weak to strong, providing some evidence of concurrent validity. This practice-based research partnership provided valuable insight into differences in delivery modality as well as the validity of a school-based SLP created narrative retell assessment tool. This study found that rate did not impact recall of events or performance on comprehension questions. Additionally, children performed better on narrative retell measures when stories were told using an iPad. This highlights the potential for iPad delivery as an option in narrative retell tasks. Finally, this study provided an initial examination of the Narrative Evaluation Tool's validity, finding the tool captures ability to recall narrative events; however, future studies are needed to examine the tool's validity as a measure of narrative comprehension. https://doi.org/10.23641/asha.25260910.

Effect of Phonological Awareness-Focused Interventions on Phonological Errors and Phonemic Awareness in Young School-Age Children.

This study aimed to explore the effects of an integrated phonological awareness intervention on phonological errors and phonemic awareness among young school-age children. Three children with at least one phonological error pattern and below-average phonological awareness skills participated in a non-concurrent multiple baseline single-subject design across participants' investigation. The integrated phonological awareness intervention consisted of completing blending and segmenting activities using 20 trained words, with a dose of 70 to 100 productions of the targeted phonological error pattern for 10, 30-minute sessions. All participants showed improvement in the primary dependent variable of percent consonants correct for their targeted error pattern for trained words. Results for percent phonemes correct showed gains for both blending and segmenting for all participants. All the participants transferred targeted skills to untrained words with their error pattern and generalized blending and segmenting to consonant-vowel-consonant words that did not contain their target error pattern in a pretest/posttest. Integrated phonological awareness intervention was an effective method of simultaneously improving speech production and phonemic awareness skills for young school-age children across 5 hours of treatment. The intervention was designed to be replicable by school-based speech-language pathologists seeking to efficiently support students with phonological errors and phonological awareness deficits.

Exploring Speech-Language Pathologists' Perception of and Individualized Education Program Goals for Vocabulary Intervention With School-Age Children With Language Disorders.

Among the varied roles and responsibilities of school-based speech-language pathologists (SLPs) are the planning and delivery of effective vocabulary intervention for students with language disorders. Despite the abundant literature regarding effective vocabulary intervention, practice patterns indicate that the research has not yet translated to practice. The purpose of this study was to examine SLPs' beliefs and expectations regarding vocabulary instruction and the content of Individualized Education Program (IEP) goals to better inform continuing education and research programs to generate lasting effects on SLP practices. We queried a national sample of school-based SLPs via an online survey regarding their perspectives on robust vocabulary instruction, vocabulary intervention practices, and IEP goal development targeting vocabulary skills for school-age children with language disorders. There was consistency across the sample for SLPs' beliefs about the importance and impact of robust vocabulary instruction. However, they reflected varied expectations about the vocabulary intervention they provide. Qualitative analysis of IEP goals for vocabulary reveals the range and frequency of strategies and intervention targets as an artifact of implementation of robust vocabulary instruction. School-based SLPs believe that vocabulary is important and have a strong understanding of the impact robust vocabulary instruction can have on reading and writing outcomes. SLPs in this sample had varying expectations regarding the way their instruction is implemented and generalized. Implications and limitations of these results are discussed. https://doi.org/10.23641/asha.25077992.

What School-Based Speech-Language Pathologists Need to Know About Pediatric Swallowing and Feeding Development and Disorders.

School-based speech-language pathologists are at the frontline for treating children with pediatric feeding disorders (PFDs). Often, speech-language pathologists are the primary allied health professionals who are charged with maximizing safety, supporting nutrition and neurodevelopmental growth. Due to the increasing need for assessment and treatment of PFDs in schools, it is fundamental that PFDs and dysphagia are detected, differentially diagnosed, and addressed to support developing children. This tutorial addresses the anatomy, physiology, and development of functional feeding and swallowing patterns across the spectrum of childhood for both PFDs and dysphagia. A clinical expert review of the anatomy, physiology, and development of functional feeding and swallowing patterns in children across the spectrum of childhood will be completed. The aim of this tutorial is to support school-based speech-language pathologists in their understanding of the anatomy and physiology of feeding and swallowing. School-based speech-language pathologists should complete this tutorial with an increased understanding and breadth of knowledge related to typical anatomy and physiology versus atypical or disordered presentations. This tutorial would support school-based speech-language pathologists in determining whether a child presents with characteristics of oropharyngeal dysphagia and/or a PFD.

Go Team Go! Interprofessional Practice for Pediatric Feeding in the Schools.

The purpose of this clinical focus article is to discuss processes and procedures for building school-based programs to address the feeding and swallowing needs of students in the public-school setting. Interprofessional practice (IPP) team member roles and responsibilities, screening, eligibility, considerations for developing Individualized Education Programs that address the needs of students with pediatric feeding disorder (PFD) and dysphagia, as well as billing documentation requirements, are discussed. Additionally, coordination across the continuum of service delivery for students with PFD and dysphagia is investigated. Guidance on documentation, processes, and procedures that comply with the Individuals with Disabilities Education Act mandates will be provided. This clinical focus article will demonstrate that students with PFD and dysphagia continue to present to public schools and require skilled services and supports in order to meet their individualized needs. School-based speech-language pathologists have a legal requirement to provide these supports when deemed educationally relevant. Schools must employ processes and procedures that result in the timely and effective evaluation and identification of students with PFD and dysphagia. An IPP approach to the management of PFD and dysphagia is critical to ensure optimal outcomes for students found eligible for services.

Overcoming the Research–Practice Gap: Key Considerations for Speech-Language Pathologists Related to Multitiered Systems of Support

Purpose: This tutorial highlights the challenges and opportunities school-based speech-language pathologists (SLPs) face related to engagement with the multitiered systems of support (MTSS) framework in their public school work practices. It positions SLP involvement in MTSS as an area where a gap between research and practice exists and highlights key ways for SLPs to overcome barriers to support student success within this framework. Method: This tutorial provides a general description of the MTSS framework and highlights the immediate applicability of the framework to SLP school practices. Key considerations are offered for SLPs ready to take concrete steps related to implementing the MTSS framework. Hypothetical cases are used to illustrate how school-based SLPs can use these considerations to guide meaningful but realistic changes. Results: Ongoing concerns about the impact of the pandemic on student outcomes and growing awareness of systemic inequities in education are prompting SLPs to move beyond asking if they should be involved in MTSS to focusing on how they should be engaged with this framework. This tutorial provides five key considerations for SLPs to realistically deepen their engagement with MTSS and overcome the research–practice gap in this area. Conclusion: This tutorial provides a resource for SLPs to take concrete and immediate steps to support at-risk students through MTSS given the needs at this unique moment in time when concerns about learning loss and achievement gaps are front and center in public schools.

A Balancing Act: How School-Based Speech-Language Pathologists Navigate Their Efforts Related to Individual Education Plans and Multi-Tiered Systems of Support.

Speech-language pathologists (SLPs) in public schools have a key role in assessment, intervention, program design, compliance, and prevention. They address the needs of students of all ages and disorders, ensure the educational relevance of their services, and provide culturally competent care. Given the scope of their work, SLPs must balance and prioritize their varying responsibilities in school settings. This study investigates how SLPs navigate their involvement with the prevention-oriented framework Multi-Tiered System of Supports (MTSS) while providing direct support to students with disabilities through Individualized Education Programs (IEPs). This study took place in a district with a stated goal for the academic year of deepening their involvement with the MTSS framework. Eight SLPs working in this rural district participated in a series of interviews over the course of the 2022-2023 school year. Qualitative data were collected about SLPs' motivations and evolving views related to MTSS. While participants in this study were motivated to engage in MTSS because they viewed this framework as a useful mechanism to support students outside of special education, they were limited by time constraints and the challenges of forming collaborative relationships. Each participant navigated the process of balancing their efforts related to MTSS and IEPs in a unique way that reflected their specific setting and circumstances. This study directly investigated how SLPs navigate this balancing act in real time and provided a novel perspective on the potential synergies and disconnects between SLPs' efforts related to MTSS and their responsibilities related to providing appropriate speech-language services via IEPs.

Examining Graduate Training in Written Language and the Impact on Speech-Language Pathologists' Practice: Perspectives From Faculty and Clinicians.

This study had two aims. Aim 1 was to query both communication science and disorders (CSD) faculty and school-based speech-language pathologists (SLPs) regarding how written language is/was covered in their graduate programs. Aim 2 was to query school-based SLPs about their written language service provision. CSD faculty (n = 143) and school-based SLPs (n = 610) completed an online survey examining (a) if and how written language was addressed in their graduate program, (b) what content related to written language was covered in graduate school, and (c) provision of written language services in schools (SLPs only). There was a discrepancy in reports of training provision. Faculty reported providing more training than SLPs reported receiving. However, SLPs with fewer years of experience reported slightly higher levels of training compared to those with more years of experience. Additionally, there was variability among SLPs in how often they targeted written language in therapy. Finally, receipt of training in written language was a significant predictor of provision of written language services, as reported by SLPs. SLPs play a key role on literacy teams in schools, but many SLPs did not receive adequate training in written language. In order to ensure SLPs are trained to work with children with reading difficulties, graduate programs should ensure that written language is part of the clinical and academic curricula. https://doi.org/10.23641/asha.24543469.

Differences in Child Language Assessment Practices Between School-Based and Non-School-Based Speech-Language Pathologists: Results From a Nationwide Survey.

The purpose of this study was to compare child language assessment practices of speech-language pathologists (SLPs) working in school and nonschool settings to determine if their place of employment impacts the diagnostic decision-making process. School-based SLPs (e.g., direct service providers employed in preschool and/or K-12 schools; n = 382) and non-school-based SLPs (e.g., direct service providers employed in private practices, university clinics, and/or medical settings; n = 147) completed a web-based questionnaire. The questionnaire examined the types, frequency, and perceived importance of specific assessment tools and potential workplace factors that may impact their diagnostic decision-making process. Both school-based and non-school-based SLPs reported using a combination of assessment tools when evaluating children with potential language disorders. School-based SLPs tended to rank the frequency of use and importance of most assessment tools similarly, while non-school-based SLPs ranked interviews as the most frequently used and most important assessment tool. Statistically significant group differences indicated that school-based SLPs ranked the frequency of use and importance of standardized testing higher compared to their non-school-based counterparts. Also, school-based SLPs rated employment-based factors impacting diagnostic decision making higher compared to non-school-based SLPs. SLPs practicing in school-based settings seem to handle more employment-based factors that impact independent diagnostic decision making than SLPs working in different employment settings when assessing children for potential language disorders. Clinical recommendations are provided, and implications for implementation-based assessment research in child language are discussed.

A Mixed-Methods Analysis of Speech-Language Pathologists' Executive Function Services.

The purpose of this study was to examine school-based speech-language pathologists' (SLPs') implementation of services to address students' executive function (EF) needs, with particular emphasis on the prevalence and characteristics of EF interventions and the factors and barriers that influence service provision for students with EF needs. We applied an explanatory sequential mixed-methods research design, beginning with a quantitative survey followed by a series of qualitative interviews. We analyzed the survey results using descriptive data and binary logistic regressions and used the emergent trends to inform our interview protocol, so that we could explore those trends in greater detail and context. We synthesized our quantitative and qualitative data to evaluate the characteristics of EF interventions and the factors influencing services. Most SLPs reported that they addressed their students' EF needs through some sort of direct or indirect intervention. Direct interventions varied by targeted domain, service delivery setting, and teaching techniques, though most SLPs favored strategy instruction and highly contextualized services. Indirect services included accommodations and consultation. SLPs commonly reported the lack of collaborative support, time, and knowledge as barriers, and most reported that professional development would be helpful to improve their services. Speech-language pathology graduate programs and providers of professional development should be mindful of their role in preparing SLPs to address EF needs, while SLPs may use these results to inform their own practice. Further guidance and research are necessary to elucidate the SLPs' role in mitigating the negative impact of EF challenges on students' education. https://doi.org/10.23641/asha.24101241.

Speech-Language Pathologists' Perceptions of Language and Literacy Instruction for Pre-K Children With Developmental Language Disorder.

Speech-language pathologists (SLPs) have multiple roles and responsibilities related to language and literacy instruction in schools. The purpose of this exploratory, qualitative study was to analyze school-based SLPs' perceptions related to effective language and early literacy instruction for pre-K children with developmental language disorder (DLD). The goal of this study was to inform development of a new language and early literacy professional development program for inclusive pre-K teachers. Eight school-based SLPs participated in a 1-hr virtual focus group conducted via Zoom recording technology. The researchers used a conventional content analysis approach to analyze the focus group data and identify themes from the discussion. The researchers developed two themes: (a) SLPs identified repeated exposure to books, peer interaction, and teaching vocabulary with visual supports and props as key elements of language and literacy instruction that can be integrated into a variety of contexts, and (b) SLPs want more time with parents and teachers to support their book reading and model specific language strategies. SLPs identified several instructional practices inclusive pre-K teachers could be taught to use during professional development programs to support the emergent literacy development of children with DLD. They also discussed the need for ongoing collaboration between SLPs, caregivers, and teachers to maximize children's early language and literacy experiences. Future research should explore the impact of partnerships with caregivers and teachers on children's language and literacy outcomes.

Narrative Retell Assessment Using "Frog" Stories: A Practice-Based Research Speech-Language Pathology Partnership Exploring Story Equivalency.

Narrative abilities are an important part of everyday conversation, playing a key role in academic settings, at home, and in social interactions. As narrative assessments are an effective method for identifying children falling below age expectations, it has been recommended they be included as a routine part of clinical language assessments. It is important that assessments meet the needs of clinicians and their practice. The current study is a practice-based research partnership, where research questions arose from a partnership with school-based speech-language pathologists (SLPs). Working together, SLPs and researchers evaluated a bespoke narrative retell assessment tool. The current study examined recall of events in two wordless picture books, in order to evaluate story equivalency and determine if the tool was appropriate for progress monitoring. These findings were then used to develop local norms. Two hundred sixty-three students were recruited across 12 schools in kindergarten, Grade 1, and Grade 2. Students completed the narrative retell task, retelling either One Frog Too Many or Frog Goes to Dinner, followed by answering 10 comprehension questions related to story events. A significant effect of story was found for both main and supporting events recalled, but not for total events recalled. Total events recalled were found to be predicted by grade only. An examination of percent events recalled revealed four main and four supporting events in each story that were potentially misclassified. Reanalysis following reallocation revealed no significant effect of story for main or supporting events recalled. Normative values for each grade were created using percentile ranks of total events recalled. Through a practice-based research partnership, researchers and clinicians worked collaboratively to evaluate a tool, adapt its use, and improve evidence-based practice in a manner that was appropriate and met the needs for the clinical context.

K–8 Speech-Language Pathologists' Training and Implementation of Research-Based Behavioral Intervention Strategies

Purpose: The purpose of this study was to examine school-based speech-language pathologists' (SLPs') training and implementation of research-based behavioral intervention strategies and to determine if there were differences in the SLPs' training and implementation based on school district size and years of experience. Method: Nonexperimental and quantitative survey research methods, using a researcher-developed survey with 21 response items inquiring about training and implementation of research-based behavioral intervention strategies, were distributed to current members of the American Speech-Language-Hearing Association. Seventy-eight qualified respondents completed the survey. The researchers utilized multiple independent-samples two-tailed t tests for analysis. Results: Results indicated that SLPs in the study had some training in research-based behavioral intervention strategies and that these strategies were implemented sometimes during speech therapy sessions. There was no statistically significant difference in amount of SLP training or implementation based on years of experience or district size. Insight was gained on the types of behaviors that SLPs encountered during speech therapy sessions and how those behaviors negatively impacted their ability to provide services as well as their overall job satisfaction. Conclusions: Although K–8 SLPs have some training and sometimes implement research-based behavioral intervention strategies, regardless of their years of experience or the size of the district in which they worked, SLPs identified several topics of behavior intervention strategies that would be helpful to address in future training. To better prepare SLPs to work with students who exhibit behavioral issues, more training in research-based behavioral intervention strategies in preparation programs and professional development plans should be considered.

“I don’t think you can really understand it until you put it to action”: school-based SLPs’ reflections on graduate and continuing education in AAC

Graduate programs have made strides to improve augmentative and alternative communication (AAC) learning opportunities for pre-service speech-language pathologists (SLPs). In addition, a number of continuing education opportunities are available to practicing SLPs; however, many still report feeling underprepared to serve clients with AAC needs. The purpose of this study was to describe school-based SLPs’ perspectives regarding their graduate training, on-the-job experience, and ongoing professional development needs related to AAC. Semi-structured interviews were completed with 17 school-based SLPs. Interviews were recorded and transcribed verbatim. Using a phenomenological approach, key themes emerged related to AAC knowledge and skills including a need for SLPs to rely on a framework for decision making, the importance of interprofessional training, and difficulties with staying abreast of new technology. The researchers present recommendations of principles and concepts for instructors to include in graduate AAC courses, as well as professional development considerations.

Employment and Work Task Characteristics of 111 Swedish School-Based Speech-Language Pathologists

Purpose: Speech-language pathologists (SLPs) are a new but rapidly growing addition to the Swedish school work force. This study sought to inventory the employment and work task characteristics of school-based SLPs to assess equitable access to SLP services. Method: We collected questionnaires from 111 SLPs currently practicing in Swedish schools. The respondents were asked for details regarding their employment. Results: Roughly equal proportions of respondents reported to work with intervention and consultation to teaching staff. Almost all reported that the preservice training provided insufficient preparation for school-based practices. The work assignments of school-based SLPs were more similar than 10 years ago, likely a consequence of agreements between the parties caring for students with language disorder, and the vast majority of SLPs now being employed within student health teams. However, differences in workload and assigned tasks affect the nature of the work performed, to the point that current best practice cannot always be upheld. Conclusions: The results indicate that the services provided by Swedish school-based SLPs can be expected to vary because of qualitative and quantitative differences in employment and work task characteristics. The results are discussed in light of reviews of language interventions for children and young people.

School-Based Speech-Language Pathologists' Engagement With Evidence-Based Practice: An Update With Implications for Implementation Research.

We replicated a prior survey study (Hoffman et al., 2013) to document current evidence-based practice (EBP) patterns as reported by school-based speech-language pathologists (SLPs) during the 2021-2022 school year. Via an online survey, SLPs reported their training experiences and needs, workplace resources, and frequency of engagement in EBP activities. A total of 889 SLPs in 50 states participated in the survey. Results revealed that 19% of seasoned SLPs (with more than 10 years since last degree) had no formal training in EBP, 22% of SLPs worked in school districts with official EBP procedural guidelines, and 36% had scheduled time in their work week to support EBP activities. Early career (EC) professionals were more likely than seasoned career (SC) professionals to pose and research one or more EBP questions per year and to read journal articles about assessment and treatment. The gap in article use by experience groups was larger than a decade ago. Like prior survey results, the majority of SLPs read zero to four American Speech-Language-Hearing Association (ASHA) journal articles on assessment or intervention per year, with similar results for reading non-ASHA journal articles. Although the past decade has fostered some positive increases in the use of EBP resources and engagement in EBP activities, there continues to be a need for additional training and support for school-based SLPs to fully implement EBP. Training and implementation support should account for differences in training preferences and workplace resources and address differentiation of reported practices by EC versus SC professionals. Further implications for implementation science in schools are provided. https://doi.org/10.23641/asha.23152817.