School based SLPs have to assess a LOT of different disorders across a large span of ages. During the course of my career, I have assessed students at the preschool level all the way to high school. Feeling confident with speech assessments in so many speech and language areas is overwhelming. Have you also noticed the increasing demands to add more assessments to your reports, so that they are legally defensible? That makes doing them extra scary. Because, one, I fear that I won’t have enough time. Secondly, I want to make sure I have covered all the areas of concern. Which takes more time. That I don’t always have. Today, I want to share about how SLPs can feel more confident when conducting social language assessments. I know they can feel scary, and time consuming. Knowing how to map out what you need can make doing them less intimidating.
Social Language Assessments May Not Be Your Strength
Let me just clarify this for anyone looking for time hacks and ways to make these assessment go quicker: social language assessments take a lot of time. End of story. The best practices I am going to share today are going to feel like more work. I know you are probably thinking, “Girl, I don’t have time for all this extra stuff.” And guess what, I know you don’t have time. Especially if your workload is out of control.
So, if you are not comfortable with social language assessments, and this info feels like a lot, just take it one step at a time. There are still areas in the field of social language assessment that I would love to feel more confident about, like apraxia assessments for example. I have never really had a student with suspected apraxia, so I would be looking to all you SLPs for help in this area. Even though I have gained an understanding for the framework for social language assessments, it still feels overwhelming at times.
Tips For Defeating Overwhelm When Doing Social Language Assessments
Start planning out and doing your social language assessment early. Do not wait until the week before the IEP to start these assessments. Your stress will skyrocket and you will be scrambling for information that you need. Additionally, the chances that you forget valuable information will increase too.
Pencil in when you are going to do different parts of the assessment in your calendar. If you have a 15 minute chunk of time, pencil in that you are going to observe that student in class. Or review the case history and/or call the parent for concerns they see at home. If it isn’t on your schedule, you will find something else to do.
Ask for help. I rely on my SLP colleagues and the student’s teacher to help guide my assessment tools. When I have completely a large bulk of the assessment, I will consult with other SLPs about eligibility, goals and how to word observations in my report. Along with the assessment results, the student’s teachers and parents help me determine what goals would help impact the student the most in the classroom setting. With social language, there are so many skills to assess and work on. When there are too many to choose from, I struggle with nailing down what is impacting the student the most. That’s why I rely on my team’s expertise to help me feel confident with my assessment conclusions.
Tips For Feeling Confident With Your Assessment Findings
Get familiar with understanding characteristics of social pragmatic deficits and characteristics of students with a diagnosis of Autism. This will help you when describing the specific deficits as well as the skills the student has.
Know what is typical. When you have a “moment,” go into a general education classroom for the different ages and see what is typical for the developmental age group. Hang out at recess and lunch and see what typically developing students do with each other. This will help you know what to look for when assessing. If you don’t have that time, at lunch, sit in the staff room and ask your teachers to share what is typical for their students.
Use your Student Study Team (SST) or gen ed RTI process to streamline these social language assessment referrals. I typically will attend all language-concern SST meetings. At those meetings, I will try to collect as much background information from the teacher and parent as possible. This is when I will have them fill out a background questionnaire, so I have it from day one. If you need more tips about my referral process, check out my blog post HERE.
What To Look For In Interviews With Parents & Teachers
In your background section, you want to include information about the child’s developmental milestones. You also want to include previous assessments conducted as well as any other pertinent information relevant to the child’s background. If you want more tips on what should be included in this section of your assessment, check out this blog post. Here are a few things to ask and look out for during these interviews:
-Reports of language regression after normal language onset. This is unique to Autism and not found among children with other developmental delays (Lord, Shulman, et. al. 2004).
-Listen for report with concerns with the child’s early developmental milestones.
-Listen for the child having strong interests and enjoying to talk about perseverative topics (only want to talk about trains with everyone). Furthermore, other red flags may also be the student exhibiting restricted interests (really likes penguins or only plays with cars).
What other red flags do you look and listen for when collecting parent interviews?
Speech & Language Areas To Cover In Your Assessment
Based on the background section, you will know the main areas of concern. The bulk of your assessments should be focused on the main areas of concern. It is best to document informal and/or formal assessment findings in all areas even if the team doesn’t express concern. For example, if the team has expressed concerns with having conversations with peers and understanding social language, your report should mostly be addressing the areas of concern. However, you still need to document skills observed with articulation, language, fluency, etc.
It is important to include standardized language and social pragmatic assessments in your testing, but equally important to do dynamic assessment. Furthermore, documenting observations of the child in natural settings demonstrates how the student is applying social pragmatic language in real life situations.
Assessing Receptive & Expressive Language Considerations
There are a lot of standardized assessments available to help you gather information about the student’s performance. Typically, I will do a language screener if I do not have concerns with vocabulary and grammar. If receptive and expressive language abilities are a significant concern, then I do a full battery of tests in that area.
Pragmatic Language Assessment Tools
Here are some standardized assessments I have used to formally evaluate social pragmatic language understanding and use:
The Clinical Evaluation of Language Fundamentals – 5th Edition (CELF-5) has a Pragmatic Profile checklist that you can fill out with parents and teachers. It also has a Pragmatic Activities Checklist that provides the clinician with a criterion reference score. I prefer to do the Pragmatic Activities Checklist because you get to see how the student applies his/her language skills in real time social interactions. The Pragmatic Profile checklist has a lot of great descriptive information to help you narrow down the child’s strengths and weaknesses.
The Clinical Assessment of Spoken Language – 2nd Edition (CASL-2) has several subtests that look at figurative language in the areas of Inferences, Pragmatic Language, Meaning From Context, Nonliteral Language, and Double Meaning. These subtests can help you determine if the student struggles with using context clues to figure out the language meaning.
The Test Of Narrative Language – 2nd Edition (TNL -2) assesses how a student can comprehend a story and tell a story. Based on the results from this assessment it can tell me if they can shift perspective and explain the character’s thoughts, motives, and actions. It also allows me to evaluate how well the student can see the big picture of the story or if they lack important details about the story. When the student is missing big chunks of the story, this can also demonstrate how or why the student has weaknesses with following the main idea of a conversation.
Receptive, Expressive & Social Language Assessment – Elementary looks at understanding and expressive use of language in the areas of vocabulary and syntax. It also has a social language component that gives you good information and is relatively quickly to give. The RESCA – E has a social communication observation scale to help determine how the student is performing in naturalistic settings.
Standardized Social Language Assessments
Clinical Assessment of Pragmatics test battery is a video-based assessment tool that elicits responses from the student about real-life social situations. You can obtain information about what the student’s ability to pick up on perspective taking, non-verbal and verbal cues from these video based situations. I learned about this standardized measure at CSHA 2018. This year, I am using it with a few students.
You can download a free assessment report template for how to write up your findings in your report. For your students that may “know” the right answers for social situations, this assessment may be able to elicit the weaknesses with applying social pragmatic language in a real life context.
Social Language Development Test – Elementary measures the language needed to make inferences about how someone is thinking or feeling based on the social context. This assessment also measures how well the student can make multiple interpretations of situation, if they can take on the perspective of others in problem situations and negotiate and support their peers. There is also the Social Language Development Test – Adolescent for older students.
Test of Pragmatic Language – Second Edition is a standardized measure that evaluates social communication in context, telling you how well students listen, choose appropriate content, express feelings, make requests, and handle other aspects of pragmatic language. If you do have to use formal assessments, this one is great because it tests language skills up to the age of 18.
Informal Pragmatic Language Assessment Resources
Social Thinking has an informal assessment framework called the ILAUGH model. It provides a framework for how you can report informal assessments to explain the skills a student is or is not exhibiting. The following is the acronym for ILAUGH: Initiating communication, Listening with the eyes and brain, Abstracting and inferencing, Understanding perspective, Getting the big picture (gestalt), and Humor and human relationship.
One powerful informal assessment is completing the Double Interview that I learned about from the book by Social Thinking – Thinking About YOU, Thinking about ME. Using this method, you conduct an interview with the student and observe how they respond to your questions. Then, you let the student interview you and see what types of questions they ask and what social behaviors they exhibit. One time, I showed a picture of my dad and myself on my wedding day. The student thought he was my husband. The double interview helps with figuring out if students can use background knowledge/cues to make social inferences and so many more skills! You can get a free checklist to use while doing the double interview and sample questions to ask HERE.
To informally evaluate a child’s theory of mind, you can administer the Sally – Anne Test to see if the child can shift perspectives and has a strong theory of mind.
Classroom Observations of the Student
I would recommend that you perform at least two observations of the student during naturally occurring situations. I like to watch the student at recess or lunch. Another good time to watch the student is during a collaborative instruction time. Here are some other times when you can observe the student:
Structured vs. unstructured times
Desired vs. undesired activities
Adult-directed vs. student-directed
Easy vs. difficult activities
Familiar vs. unfamiliar
In small groups, large groups
With family and peers
Here are some things to look for when observing the student
Use of eye contact (be mindful of the student’s cultural background and customs)
Topic maintenance and conversation
Language flexibility (understanding non-literal language)
Gestures and non-verbal language
Stereotyped, perseverative speech and echolalia
Ability to initiate, and close a conversation
If you are short on time and can’t observe the child. I recommend getting feedback of observations that the teacher is seeing in the classroom. Furthermore, I would also rely on the parent’s observations at home. That said, it I highly recommend doing observations of the student in a natural environment. You are the clinician that can determine the child’s social pragmatic understanding and use.
Social Pragmatic Checklists To Help You Identify Presence Of Skills
There is a checklist on the RESCA -E and the CELF – 5. Another comprehensive checklist to look into is the The Social Skills Checklist (Quill 2000).
If you are conducting social language assessments for minimally verbal students, I highly recommend using The Communication Matrix to informally assess the student’s functional communication. What checklists have been helpful for you to determine presence of skills?
What Assessment Tools & Resources Do You Use For Your Social Language Assessments?
I would love to hear about your expertise in conducting social language assessments. Share below resources that you have found helpful! I would love to know how you streamline your social language assessments too.
How many times a year do you progress monitor speech goals? I have to do it 3 times in California and then for the annual IEP. In some states, I have heard of SLPs having to do it 8 times a year! Share in the comments how many times your state/district makes you progress monitor.
Progress reports are like cleaning your bathroom. You know the bathroom needs to be cleaned. Each day you walk past that bathroom thinking about all the germs that have started to build up in that toilet. You want your bathroom to be germ free (who doesn’t!?). But the thought of going in there to clean your bathroom after working all day makes you want to cry. So, you just close the bathroom door and use the guest bathroom for a few days. Then, when you know that you can’t stand the idea of a germy bathroom, you slide on those yellow gloves, get the cleaning supplies out and start scrubbing. While you are cleaning, you think to yourself “if only I cleaned the bathroom last week. I wouldn’t have to be here for 30 minutes deep cleaning everything”.
Who doesn’t want a squeaky clean bathroom all the time!? We just wished someone else would do it for us, right? Progress reports are one of those necessary chores we have to do as speech pathologists. We try to avoid them, but they never go away. As much as I have tried to get better at doing them, I still don’t like them. I know why I have to do them. I see how it can be helpful when communicating with families about their child’s progress. And, it is definitely an important part of tracking the progress my students are making towards their goals. They just take a long time (insert dreadful, complaining face).
Maybe it is my caseload of 55 students that makes it such an unwanted task? Hmmmm….. or maybe it is those students that come to me with goals that I didn’t write, and I am wondering how on earth am I supposed to measure this goal??
Progress Monitor Speech Goals With A Checklist (save your sanity)
To stay organized and make sure I don’t miss a step in the process, I made a progress monitoring checklist. That way if I have a 20 minute opening between therapy groups, I will know exactly where I left off with progress reports. When you are organized with the process, it is easier to navigate. Download the free checklist by clicking the pink button below.
Tips On How To Progress Monitor Speech Goals Efficiently
I have come to accept that progress reports are not going away. In an effort to bring calm to the chaos, I am always in search of strategies to make them feel less overwhelming. I share a lot of my tips on how I progress monitor speech goals efficiently in my blog post HERE.
One of the best strategies I have found to progress monitor speech goals is to write better goals. Taking the time to really think about those areas of need and make sure my goals are S.M.A.R.T. simplifies my therapy planning. It also helps me to take better data in a session. I usually picture my therapy sessions and think about how I am going to take data in a mixed group. When I have more data, I can write up my progress notes a lot easier.
Plan progress monitoring days where you have individual worksheets or activities for everyone in the group. During the session, have each student come work with you, so you can progress monitor any goals that you need.
Resources To Help Progress Monitoring Speech Goals With Ease
Here are some resources I have found to be helpful with progress monitoring :
Read Works has free non-fiction and fictional passages sorted by grade level and even have comprehension questions included for your students working on listening comprehension.
Use rubrics on those therapy days (I like the ones from The Speech Bubble SLP HERE) when trying to manage a group’s behavior–teaching an engaging lesson and writing down data on each student just isn’t going to work.
Here is my FREE Articulation Data Sheet that can help you with progress monitoring students when they are doing tasks that are more conversational or multiple sentences and taking tally data can be cumbersome.
Find resources that have pictures with the skills you need to progress monitor. Put all the tools in a binder for that skill such as pronouns or noun-verb agreement. Then, pull out those tools during progress monitor time to see how your students are doing. I like to administer 5 stimulus items with minimal prompting to see how they work independently. Then, I will add in visual cues/prompts or give answer choices to know exactly where the student is with his/her level of independence.
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 email@example.com or share in the comments below.
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.
Managing your caseload IS overwhelming. Especially, if your caseload is over 65. SLP caseload organization is seriously a process–lol! Some of you SLPs have caseloads that I am sure 4 speech pathologists could be managing. That is crazy to me.
The Struggles I Faced With SLP Caseload Organization
About 6-7 years ago, I was managing two schools, with a very transient population. Kids were coming and going every month. I had, on average, 75-83 students on my caseload at any given time. In addition to this, I served two Mod-Severe Special Day Classrooms with students on the Autism spectrum. I also served a mild-mod Special Day Classroom for grades 3-5. It was too much for me to healthily manage. But at the time, I was stuck managing this caseload until something or someone stepped in to lighten my workload. During those few years, I learned ways to manage my caseload as best I could. It wasn’t always pretty and it definitely wasn’t perfect. You will probably hate me for writing this, but I am going to put it out there.
What I Learned From Managing A High Caseload
I struggled, and continue to struggle, with keeping my schedule organized, staying up to date with medicaid billing, managing incoming referrals, communicating with staff and parents, lesson planning and making sure to log my therapy notes. It is something that I do well with during certain times of the year and something that is a struggle when I have 10 or more IEPs in a month.
Once I had a more manageable caseload of 48-57, I realized how many organizational strategies I had learned and implemented with my large caseload. With my large caseload, I had developed systems to help me do things quicker and more efficiently. I talked with my SLP colleagues to see how they were doing things. I figured out what was going to give me the most organization for the least amount of upkeep.
SLP Caseload Organization Does Get Easier
Organizing my smaller caseload was much less overwhelming because by that time, I had 7 years in the field under my belt. And, I knew what systems worked for me. Let me just say, having a smaller caseload, doesn’t always make the caseload management piece less overwhelming. I was still overwhelmed those first few months back! Especially, whenever I transitioned to a new school assignment. I felt brand new all over again. Within a few months, my brain was no longer on fire from trying to remember everything. You know what I mean…..remembering staff member names, student names, passwords, copier codes, students goals, your schedule, lesson plans, etc.
So if you are new to the schools or just have a rough transition to the start of the year, I wanted to share some systems and forms that may help you with your SLP caseload organization.
What should I expect to do that first week back?
Show up – lol! You will probably go to professional development on the first and second days back at work. The professional development will be a lot of information. If you find your brain wandering, start writing down a list of things you want to go back to when you get time.
Get all the things – check out your computer, get your keys, check out an Ipad, copier codes, etc. If you are new to a site, I introduce myself to staff. I make a point to meet new teachers that I will be working with for the year.
Make sure everything works – check your passwords and print out something you need, like your caseload. If technology isn’t working, this is when you can submit IT ticket support. It is a pain, but better to get it fixed now.
Meet With Your SPED Staff
Start scheduling for the year – Those that are new to a site, find out from your IEP team how you need to schedule IEPs. I recommend getting staff together and scheduling IEPs for the year. Things will change during the year, but it is nice knowing a rough outline. If your team doesn’t schedule out the whole year, I would recommend scheduling all your IEPs that you are the case manager. Typically, I do at least 3 months out, so I can plan “To Do” tasks accordingly each week.
Get comfortable with processes at your site – If you are brand new to your site, I recommend learning about the Student Study Team (SST) or general ed Response To Intervention (RTI) process at your site. This is the time to make yourself a GUIDE for how staff will refer students to you all year. Check out my speech referral process HERE (it has links & tips for making an organizational binder).
Here is a checklist of what SLPs should do the first week back
Having a checklist of responsibilities helps reduce anxiety when trying to manage your caseload. There are a lot of things that need to be set up before you see kids. Make a list or ask an SLP for their list to help you feel less overwhelmed. Here are some things on my checklist:
Organize the therapy/data binder. Review goals and services for your students. I put all of this information on my therapy log forms using SLPtoolkit. You can read my blog post on this caseload management system HERE.
Once school starts, review your caseload on SEIS and verify students attending your schools. Put in requests to remove students from your caseload that are not attending your school. Put in requests to add students that transferred in that are not on your caseload.
For any new students who do not have a working file, contact the SLP from his or her previous school or put in a records request to obtain information.
Review IEPs of students. Document accommodations/modifications, services and goals. Communicate services and accommodations with the classroom teachers.
Make your speech schedule. This may take A LOT of drafts, but it will get made, I promise!
Verify your student’s attendance and make note of his classroom teacher.
Collect all schedules you may need: PE schedule, RSP schedule, OT schedule, Bell Schedule (need lunch and recess times), ELD schedule, Music schedule and Intervention Schedule
Create a draft speech schedule and send out to teachers. Make changes as you get feedback from staff.
More “To Do” Tasks for The Start of the Year
Print and put contact logs for each student in your therapy binder or in their folders. During the year, you will have easy access to the log when contacting parents. I use contact logs from The Speech Bubble SLP.
Organize your IEP calendar by figuring out your annuals and tri’s for the year. You can print your caseload from your IEP database and put them in your calendar or on an IEP monthly tracking form. HERE is a google sheet I created to keep track. You can keep digitally or fill out for your caseload, and print. Then, you can manually check off what you need to do if you are more a paper/pencil SLP. Schedule out IEPs at least 3 months out or for the whole year.
Set up your behavior management system. Prep any forms, sticker charts, rules, etc. for your speech room.
Contact students’ parents. Check in with them and introduce yourself. A letter of introduction is recommended. Review it with your Principal prior to sending home. There is a link to a FREE letter below.
Set up your medicaid billing system with your students, so you can easily bill during the year.
Print parent rights copies for IEP meetings and store in a file folder.
Put any monthly staff meetings or Professional Learning Community meetings on your calendar.
Inventory materials and assessment tools (if you have time).
HERE is a checklist of all these things you need to do those first weeks back.
Facebook LIVE Tips for SLP Caseload Management Those First Weeks Back
Watch my Facebook LIVE replay to see what I do my first weeks back if you are more of an auditory/visual learner.
Helpful SLP Caseload Organization Forms
Need lesson plan templates for sensory bins, push-in language lessons, themed lessons, social skills or weekly lessons? Click the button below to get your FREE lesson plan guides.
There you have it! That is what you need to do to be successful with organizing your caseload. If you take the list of “to dos” and take on one task at a time, you will get through. How do you make setting up your caseload at the beginning of the year work? Your tips may help an SLP feel less frazzled at the start of the year. Share your expertise in the comments!
The speech referral process influences our caseload size and impacts how teachers and parents view the role of SLPs. Working in the school setting, you will get speech referrals from teachers, parents and the RTI general education process. Today, I want to share why I have a speech referral process.
Why I have A Speech Referral Process
Having a speech referral process helps you make better clinical decisions when deciding if you should test a student. Many SLPs work with a large number of students who speak English as a second language. So, although, the student may not be meeting common core standards in the classroom, it may not be related to a language disorder. A student could be struggling because he or she is learning a second language. Furthermore, environmental factors may impact a student’s communication development. For example, a student starting Kindergarten without attending preschool may not be exhibiting language skills equivalent to his or her peers. The student’s language abilities may be due to lack of exposure to the school environment. RTI can help the SST team determine if it is a language disorder or lack of exposure to school.
More Considerations For Why Having A Speech Referral Process Is Important
In a school setting, it is important confirm that general education interventions were performed for any students with language and social pragmatic concerns. This should be done before moving toward a speech assessment. This is in alignment with IDEA whereby we ensure that we are providing a free and appropriate education in the least restrictive environment. When the least restrictive environment isn’t being successful with general education interventions, that is when a discussion about a special education assessment is warranted.
One reason to conduct general education interventions is that we do not want to inaccurately identify a child with a speech and/or language disorder. Additionally, if general education interventions are working for the student, completing an assessment may not be recommended at that time.
It is highly recommended that you discuss your referral guidelines with your administration and speech department. Every state has different education codes for special education and being well-versed on your state’s education laws is paramount.
Here Is What The Speech Referral Process Looks Like In My World
All articulation, speech fluency and voice concerns come directly to me via a google form I created. You can read more about how to electronically gather speech referrals with google forms/docs HERE.
I follow up with the teacher to review concerns and determine if errors are developmental or a dialectal difference. This is when you can ask the teacher questions about speech intelligibility, and frequency/duration of dysfluencies. Then, follow up with how the speech concern is adversely impacting the student (this is key).
Then, you can conduct a classroom observation. If you need parent permission to informally talk to a student, then this would be the time to get a parent permission slip signed. If you notice red flags that this student may possibly need a speech assessment, you can do RTI for 6-8 weeks or initiate an initial assessment. SLPs needing an articulation & language screener for elementary, can use this one that I created HERE.
What To Do If The Student Is Stimuable For Their Sound Or Strategy
If the student is stimuable for the speech sound in some contexts and intelligibility is not significantly impacted, you may address the need through RTI speech improvement class. You typically would need to get parent permission. Discuss with your speech department how RTI speech improvement will look for SLPs. , I do RTI speech improvement for 6-8 weeks for my students that have only 1-2 sounds in error, or not demonstrating a year delay with sounds. If I observe multiple sound errors, decreased speech intelligibility and it is adversely impacting them in the classroom, I typically initiate a speech assessment. Sometimes, I will do RTI intervention and then make a decision to test after that 6-8 week intervention.
This is the process that was approved in my current district. I have worked in other districts that did not want me working with students that did not have an IEP.
How I Handle Language & Social Pragmatic Concerns
Any language and/or social pragmatic concerns I refer the teacher back to the Student Study Team (SST) general education process (your district may call it something else). In my district we have a pre-referral Student Assistant Program (SAP) in which a school team documents and discusses tier I and tier II interventions. I have let my schools and teachers know that if there are concerns with language and/or social pragmatics to include me in those meetings. Looking for information from ASHA regarding RTI? Check out their RTI page and ASHA’s position about Early Intervention.
Why Attending RTI or SST Meetings Is Worth Your Time
I go to any SST meetings that have language and/or social skill concerns for the following reasons:
Staff and parents can see my professional expertise in the areas of speech and language when I am present at the meeting.
SLPs can ask questions to the parents and collect background information on the spot. The background information is documented if a speech and language assessment is recommended or a full team assessment. Then, you don’t have to call the parent again for background information. You can also have parents fill out forms before or after the SST meeting.
This prevents professionals writing in recommendations for speech and language assessments to be completed without getting your professional insights. I know you may be think, “But, I don’t have time for more meetings.” I hear you. None of us have time for more meetings. But, when you think about how much time a full assessment can take to complete, you may re-consider. Testing the child, writing the report, IEP and holding the IEP meeting can take 8-15 hours of work. Attend 1 hour meeting or do a 15 hour assessment? If your team is signing you up for assessments that you know will not meet special education eligibility, you are opening yourself to work that could be spent more effectively. For example, if you aren’t doing that 15 hour assessment, you could be providing RTI intervention. Or you could be providing visual supports for teachers with that time.
Being at the meeting allows me to identify any red flags for a possible speech/language disorder
When a teacher has language and social pragmatic concerns, I may consult with them for strategies to implement in the classroom during the meeting or right after the meeting.
What To Do If You Can’t Attend The SST Meeting
If I can’t attend the meeting, I pre-staff the meeting with the psychologist or head person running the SST. I give examples of red flags that may warrant a language assessment or provide questions to ask the parent and team. Furthermore, if the team is feeling that language is a big concern, I ask them to document “consult with the speech pathologist” under actions. This allows me to see the SST notes, and consult teacher/parent before giving recommendations. If I see that RTI interventions haven’t been done or the student is an ELL learner, I want to make sure those things have been put in place before moving forward.
How To Stay Organized With Your Referral Process
If you are more of a visual learner, you can check out my Facebook LIVE video about how to streamline your speech referral process HERE.
One way that I stay organized with incoming referrals is by making a binder. That way, when you have educators handing you forms, you can shove it all into one place! You can support teachers by having an electronic version of your speech referral process. Send this process through email when a teacher has a question. You can get my referral process HERE and add/change what you need.
Helpful Forms and Resources For Your Speech Referral Binder
You can include helpful developmental milestones, and parent permission slips. Put your screener forms, or cheat sheet guides in your binder too. Here are some links to organizational forms that you can include in your speech binder:
Data Binder Forms that include parent permission slips for RTI intervention from The Speech Bubble SLP (My district has their own template, so if you don’t have a template, I recommend using these).
What forms or important information do you include in your speech referral binder?
Share Your Experience With The Speech Referral Process
All in all, a speech referral process is a guide. The speech referral process is there to help SLPs make more informed clinical decisions. Do you have a speech referral process? Why or why not? What roadblocks have you faced with trying to implement your speech referral process? Did you find any solutions that you can share with other SLPs? I would love to know your thoughts around this topic in the comments!
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