The Big /r/ Referral Debate – What Should School SLPs do?

If you work as a school based SLP, getting speech therapy referrals for the R sound is pretty common. The /r/ distortions are pretty noticeable by teachers, parents and staff. Have you ever gotten that referral from a preschooler or kindergarten teacher and think, “I should probably get that teacher a developmental norms chart ASAP.”

 

A couple of years ago, our SLP Professional Learning Community discussed how to handle speech therapy referrals for /r/. Guess what happened…..there were a lot of varying answers and viewpoints. It stirred up a hot debate (all friendly discussion). And we left the PLC without a clear direction with how to handle /r/ speech therapy referrals.

What I learned after the Professional Learning Community Discussion

The perspectives of the /r/ referral varied from SLP to SLP. Some felt that you should take them younger  (6-7 years of age) if they are stimuable. Other SLPs felt that the student wouldn’t meet eligibility for an articulation disorder based on educational code, but the student would receive support via Response To Intervention (RTI) with speech improvement. There were some SLPs that didn’t feel comfortable with providing RTI because of potential legal ramifications for seeing gen ed students without an IEP.

I decided to send out a survey on Speech Therapy Referrals

The discussion with other SLPs in the room was helpful in learning about different perspectives regarding an /r/ referral. However, I didn’t leave the discussion with a clearer understanding of what our district was supporting SLPs to do. Everyone had valid points and reasons for how they handled /r/ referrals, but we lacked a cohesive game plan for /r/.

My biggest question to the SLPs in the group was “when do you consider an /r/ error outside normal development?” I also wanted to know when SLPs took students with /r/ distortions on their IEP caseload or if they treated it through RTI.

Again, answers varied from SLPs. This prompted me to wonder what other SLPs thought across the United States. I figured I could get a bigger perspective by surveying a larger group.

Here is the situation I shared with SLPs

You have a 7 year old in second grade with a distorted /r/ in all positions. The teacher shares that at times it is difficult to understand the student. The parent also has concerns about his articulation. The parent signed a screening form for you to do a quick observation of his speech. You noticed that the /r/ is pretty distorted and he is not stimuable for /r/ when given prompts.

These were the results from the survey on how SLPs would handle /r/ referral:

Speech Therapy Referrals – Considerations about /r/

Many SLP’s commented that they would do an RTI model for this student; however, their district does not allow them to see students without an IEP.

Some SLP’s shared that they would not get an assessment plan signed until after age 8 because their district eligibility guidelines would not allow them to take a student for /r/ at age 7. Interestingly, some SLP’s shared that their district would not deem a single sound error of /r/ to meet eligibility for speech services. (There is an argument that /r/ is not a single sound error among some SLPs).

Many SLP’s also shared that because the teacher and SLP are observing reduced intelligibility, this may warrant a full assessment of articulation.

What I learned from being in the school setting & doing this survey

In certain districts where I have worked, I would not be able to get a signed assessment plan until the student turned 8. I was also told that I could not serve students in an RTI model because this would impact legalities with my job.

When looking at an /r/ referral, I have to determine if the articulation disorder is adversely impacting the student’s academic progress. This is where we ask ourselves if the student’s /r/ distortion is adversely impacting the student’s ability to meet the speaking and listening standards. We would also want to determine if the student’s intelligibility is below 80% intelligible. If it isn’t affecting academics or intelligibility, it is highly likely that the student will not meet eligibility for an IEP under an articulation disorder. That being said, if you feel that the /r/ distortion is adversely impacting those two areas, it is very important to make distinct mention of that in your report findings. 

A few SLP’s shared that the classroom teacher must do 6-8 weeks of general education intervention before moving towards an assessment.

Many SLP’s shared that when the student’s /r/ is addressed earlier than 7.5-8 years in a “speech improvement model”, the /r/ improves. Furthermore, many have found when they monitor the student’s growth just by checking in with the gen ed teacher, that most develop the /r/ in third grade without intervention.

We must also consider our professional judgment with dealing with these referrals. We use the developmental norms as a guideline and really need to look at educational impact when looking at a student with articulation errors.

How I handled /r/ referrals in my previous job

Based on some reading that I did on ASHA’s website, federal law may impact an SLP’s ability to take students with /r/ on an IEP. Serving students in an RTI model may also lead use to legal implications. ASHA recommends SLPs not label intervention as RTI, but rather call it a “speech club.”  I call my intervention “speech improvement class.”

Here is a link to RTI information on ASHA. This could be a great discussion piece to have with your districts and speech departments. I also found the Speech Sound Disorders page on the ASHA website helpful. 

At the time of this survey, my speech department was having a lot of discussions about implementing a “speech improvement program” or seeing students on an IEP for /r/. There was not a final discussion. So, I did see a couple of students in  speech improvement class that have noticeable /r/ distortions. The students were in second grade and between 7 or 7 1/2 years of age. Parent permission was obtained and the speech improvement class was for 6-8 weeks.

What are your thoughts about the /r/ referral or single sound error referrals?

How does your SLP department and district handle speech therapy referrals for /r/? What are your thoughts on taking an /r/ student in the school setting? I would love to hear your expertise. Feel free to email me at feliceclark@thedabblingspeechie.com or share in the comments below.

Helpful Blog Posts For Articulation & Treating R

Once your student has the /r/ phoneme established at the word level, you need therapy materials to treat /r/!  Here are 10 resources you can use to treat /r/ in therapy.

Here are my tips for getting high articulation repetitions without losing all the fun!

Do you have students that are at the generalization level with their articulation? I have some articulation carryover therapy resources that will help you plan therapy that also go well with mixed groups!

Need some free visuals to support self awareness and functional practice of your student’s articulation sounds? This blog post has FREE printables and ideas for how to organize your articulation therapy.