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Clinical Fellow (and Setting-Switching SLPs) Survival Guide in the Schools

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Related image It’s early August, and that means that the start of a new school year is just around the corner.  It also means that many newly graduated clinical fellows (as well as SLPs switching their settings) will begin their exciting yet slightly terrifying new jobs working for various school systems around the country.  Since I was recently interviewing clinical fellows myself in my setting (an outpatient school located in a psychiatric hospital, run by a university), I decided to write this post in order to assist new graduates, and setting-switching professionals by describing what knowledge and skills are desirable to possess when working in the schools.

LiteracyFirst up, the big one! Assessment and treatment of literacy disorders!  Times are changing. When I graduated over a decade ago, literacy was taught in some programs but not emphasized nearly enough in many of them.  In fact, long after I graduated and worked in the field the emphasis on literacy in schools in my area was practically nonexistent.  Fast forward to 2014, when dyslexia legislation was passed in the state of New Jersey, I started seeing some subtle changes that literacy was beginning to play a much more important role in speech pathology.  Continuing education in dyslexia in the state of New Jersey was mandated.  Speech pathologists were heavily involved in not only the passing of the dyslexia law but also developing that Handbook for Dyslexia in my state.  I myself applied for and received a grant from Seton Hall University so I could develop classroom-based interventions with a focus on improving literacy abilities of children with a psychiatric impairments, which is the primary population in my setting.

Fast forward several years later after that and even on social media things were changing. School-based SLPs were starting to discuss literacy more and more in a variety of SLP based Facebook groups as well as on Twitter.  Several new Facebook groups were formed with the emphasis on literacy for speech-language pathologists.  I also started seeing more acceptance of literacy as part of the SLPs scope of practice.  Sure, there was still significant resistance, which was due in part to limited education many SLPs received in the area of literacy, as well as due to grotesquely overblown therapy caseloads due to which many SLPs were reluctant or simply unable to take on additional duties in the form of assessment and treatment of literacy.

Nevertheless, the fact remains, given appropriate coursework, whether formal or self-taught, SLPs can be incredibly effective in assessing reading writing and spelling abilities of school-age children.  So what can you do? Familiarize yourselves with psychometrically sound assessments of reading, spelling, and writing.  Read up about evidence-based reading intervention practices. Join reputable Facebook groups dedicated to this area.  Subscribe to evidence-based podcasts as well as listservs and blogs run by individuals with specialization in the above areas.  Start developing a library of FREE and paid evidence-based assessment and intervention materials.  Finally, please keep in mind that the most effective therapy practices involve the integration of language and literacy into sessions for optimal outcomes, faster gains, as well as shorter time spent in therapy.

Related imageSocial CommunicationSimilarly, a little less than a decade ago there had been an increase in recognition that pragmatic/social communication abilities are firmly a part of language, and that children who present with Developmental Language Disorder (DLD) also present with subtle or overt social communication difficulties that require assessment and intervention.  More assessment tools were developed to assess social communication abilities of school-age children.  A number of studies also came out evaluating the effectiveness of current pragmatic/social communication/social cognition interventions on the market today.

So what does it all mean for clinical fellows entering the school system? It is important to familiarize yourself with the available literature discussing the connection between DLD and psychiatric impairments such as anxiety and depression.  It is also important to understand that there is significant comorbidity between psychiatric impairments and language disorders.  Consequently, it is hugely important to thoroughly assess the social communication abilities of children presenting with behavioral difficulties as well as children with confirmed/suspected psychiatric impairments. It is also important to investigate the strength of available social communication interventions in order to determine which treatment options are most suitable (and of course evidence-based) for students with social communication impairments.

The Controversy of RTIRTI or Response to Intervention was introduced back in 2004, as a method of effectively identifying students with learning disabilities.  Composed of three tiers, made up of regular, data-driven classroom instruction and interventions (Tier 1), small group, high quality interventions, with intensive the data tracking (Tier 2), and small, intensive, specialized intervention (Tier 3), for students needing the most amount of support, it was expected to be the data-driven solution to effective model of early identification and support of students with learning and behavior needs.

Unfortunately, this well-meaning plan had backfired quite spectacularly according to many critics of the RTI program. The problem was multidimensional.  Numerous entities claimed to have good-quality response to intervention programs, but none of them bore evidence-based scrutiny.  Rather than implementing short intervention periods of 8-15 weeks in length, poorly implemented intervention dragged on for months and months at a time without any benefit. Data was taken poorly or not at all.  The above resulted in numerous claims that the RTI process was denying children Free and Appropriate Education (FAPE) in the form of timely assessment and qualification for special education services. Claims of denial of FAPE ran so rampant that the US Department of Education had to issue an OSEP MEMO, stipulating that RTI cannot be used to deny timely assessment services for students with language and learning needs. So what does it mean for you? Find out if your school system is implementing the RTI process and if so how well is it run? Familiarize yourselves with the OSEP Memo, in order to ensure that if you are asked to implement RTI in your setting, you will not be inadvertently engaging in any FAPE violations.  Review the studies detailing the flaws in the RTI process.  If necessary, compile a list of concerns, as supported by tangible data, to present to your administration, to avoid any ethical violations.

Related imageBest Practices in Bilingual Assessments and InterventionsThis is definitely not a new topic but it is one that has been at the heart of raging debates for decades.  Despite the abundance of good quality literature on the subject of effective assessment and intervention of bilingual children, myths and inappropriate practices continue to predominate in our field.  From the inappropriate use of standardized assessments to the misguided recommendations to speak English only to bilinguals with a variety of language-based disabilities (DLD, ASD, DS, FXS, ID, etc.), this is one hotbed of controversy.

So how can clinical fellows begin to delve into this complex subject? Familiarize yourselves with dynamic assessment practices of bilingual learners.  Read up about evidence-based translanguaging intervention practices. Join reputable Facebook groups dedicated to this area.  Subscribe to evidence-based websites and blogs run by entities dedicated to the spread of evidence-based information on the subject of bilingualism. Take some FREE continuing education coursework offered by the Leader’s Project website  Start developing a library of FREE and paid evidence-based assessment and intervention materials.  Finally, please keep in mind that the most effective therapy practices involve respecting the language and culture of the clients on our caseloads.

Selecting Psychometrically Sound AssessmentsOne of the dirty, little secrets in our field is that graduate school do not spend adequate amount of time on teaching their students how to “read” and analyze technical manuals of speech and language assessments. A rather sad fact is that there are very few SLPs who actually take the time to read the technical manuals of the tests that they purchase.  Even worse, many do not understand what they actually read. As a result, when discussions regarding the purchase of new assessments ensue in a variety of SLP based Facebook groups, the questions tend to be more like this “Which tests do you like?”, vs. like this: “Which tests are the most psychometrically sound to assess __?”

The problem is that there are very few psychometrically sound comprehensive tests on the market today and even those require supplementation with a variety of clinical (formerly known as “informal”) assessments.  Furthermore, depending on which test is available to the SLP, and coupled with the arbitrary eligibility criteria set by their home state, many students with glaring speech, language, and literacy needs will not qualify for intervention services, due to the above limitations.

So what can you do? Well, as trite as it sounds, make sure to read technical manuals, in order to locate information on the sensitivity and the specificity of the test you are about to use or purchase.  Make sure you understand the limitations of available to you, instruments, the information on which is plainly stated or is glaringly omitted from the manual. If you are not sure how to interpret the available information, don’t be afraid to ask your questions in reputable groups. Listen to this podcast discussing the use of tests, as well as review these available assessment resources.   Search for the information on the psychometric properties of tests in the SLPs for Evidence-Based Practice Group on Facebook.

Correct Interpretation of the States’ Educational Codes to Make Appropriate Eligibility DecisionsThis is another very significant issue that demands greater attention.   Nowhere is it more apparent than online in the major SLP FB groups.  At least, several times a week, some SLPs will try to crowdsource to determine whether their tested student qualifies for therapy services.  However, there are a number of problems with such queries.  Namely, different states have different eligibility criteria for qualification for special education services.  As such, after conducting culturally sensitive, psychometrically sound, and clinically balanced assessment, one needs to carefully read the educational code of the state they are located in in order to determine the qualification criteria.

Another problem is that the educational codes get routinely misunderstood and misinterpreted by SLPs. Let’s take the state of New Jersey for example.  New Jersey has a specific state eligibility criteria to qualify for special education.  However, this criterion is misinterpreted so frequently that the department of education actually came out with a clarification memo explaining in great detail regarding how the state’s eligibility criteria should be interpreted.

To illustrate, SLPs believed that they need to administer two standardized tests, one of which should be comprehensive, and that the student needs to receive total scores 1.5 standard deviations below the mean on both tests in order to qualify. However, the clarification stipulated that 2 was actually a minimum number of tests, and that more tests can be administered if needed. It also clarified that total scores were completely unnecessary and that any combination of scores in conjunction with clinical judgment can be used in order to qualify students for services.

The notion of using clinical judgment in order to administer tests was also completely misinterpreted.  So was the fact that standardized tests may NOT be needed to qualify for services, if the clinicians use their clinical judgment to administer clinical assessments which are more sensitive to the students’ deficits then standardized tests, all of which possess significant limitations.

So what can be done about that? First, familiarize selves with your state’s eligibility criteria. Then, make sure to carefully select appropriate testing instruments, whether standardized or clinical, in order to administer balanced and fair assessments to the students referred for testing.  When in doubt, reread your state’s educational code very carefully in order to ensure that you are not misinterpreting the state’s eligibility criteria. Speak to your department of education representative, if possible.  If still uncertain, you can certainly pose this question to your state colleagues whether in school or online asking whether you have interpreted something correctly.

Evidence-Based Practice, Questionable Diagnoses, and Pseudoscientific Treatment Recommendations: In this area, I am happy to say, I have seen some positive changes in our field.  While it is true that social media does a highly effective job of spreading pseudoscience like wildfire online, I have also seen significant pushback on the behalf of numerous professionals on a variety of social media platforms, valiantly combating pseudoscientific practices.  No setting is exempt from them, and schools have plenty of them. From questionable diagnoses lacking stand-alone validity (e.g., APD), to downright pseudoscientific treatments denounced by ASHA (e.g., FC and RPM), there is a lot of misinformation to combat.   From Whole Language/Balanced Literacy to Learning Styles, Interactive Metronome to Behavioral Optometry, many schools are rife with controversial requests, demands, and practices.

This is obviously hugely overwhelming to any SLPs unfamiliar with this phenomenon due to a lack of exposure to it.  Consequently, it may be rather difficult for them to discern facts from myths especially when the information is presented to them in a highly confident and persuasive manner.  So what can be done about it?  For starters, analyze all the information presented to you in a critical manner.  If the claim sounds too good to be true, if a treatment is purported to work on the vast array of disorders, consider how likely that could be from the standpoint of science.  Research the claims and requests for certain programs/systems/therapies, etc., in reputable locations online.  Join reputable listservs, forums, or social media groups, where the information presented to you would be reputable and relatively unbiased.

Free Evidence-Based Assessment and Intervention ResourcesWe are finally down to the last topic of this post, namely, where to find evidence-based FREE evidence-based resources.  Before I tell you, please consider the following, evidence-based approach is a scientifically informed process which involves using science and solid-quality research to inform your clinical practice.  EBP is not a static state, but rather an ever-changing one since new research studies are frequently being published that may result in us reevaluating our practices based on new findings.  As a result, evidence-based clinicians may use a variety of resources and materials and make them evidence-based to suit their clients’ needs.  Consider this.  Children’s picture books are certainly not evidence-based.  They are simply entertaining books replete with some nice vocabulary and great pictures.  However, how clinicians utilize these picture books in their clinical practice to engage in contextual interventions, is when evidence-based practice comes into play. How they read to the kids, how they prompt and cue them, how they ask relevant questions, as well as test their knowledge of the presented material, is what constitutes an evidence-based practice.

Now that I’ve said that, we can proceed to the links to selections of FREE Resources below.

And make sure to click on the multitude of multicolored links throughout this post in order to access the references, links, resources, and more cited in the process of writing this post.

There you have it. I hope you have found this post beneficial to your practice.  For more  FREE EBP information pertaining to assessment and treatment in speech pathology (including instructional videos, books, links, websites, CEUs, etc.), visit SLPs for Evidence-Based Practice group on Facebook.






1 thought on “Clinical Fellow (and Setting-Switching SLPs) Survival Guide in the Schools

  1. This blog post has so much helpful information. This would’ve been so helpful when I started my CF. However, even though I already have my CCCs it is still extremely useful information for working in a school. Thank you!

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