Adventures in Advocacy…part two

Creatively known as How many ways can we fail a student?

Alternately known as Let’s describe Educational Impact.

Otherwise known as What do you mean it’s my fault he can’t get a job?

Hmmm. Did that last one get your attention?

One topic of conversation that’s popped up here, on Facebook, on the ASHA forums, etc. has been eligibility requirements for schools based services. Many SLPs have the understanding that children with only one or two speech errors are not eligible for services because they are not “severe” enough. I have been told that some schools do not do ‘articulation’ therapy at all as it’s not educationally impacting. Or the students were dismissed because of “time constraints.” I realize it’s not the SLPs that are doing this, it’s administration…but wow. What a way to fail our students.

A month or so ago, I was contacted by one of the instructors at a nearby university. I was asked if I’d consider taking on an adult client. Apparently this client; whom I’ll call P, had an articulation problem that went untreated until recently. P, an education student, went for the mandatory speech-language screening at the university only to fail the screening. P was informed that without remediation of the problem, P would not graduate with an education degree. Needless to say…P was a bit…desperate.

Now, normally I don’t see adults. I’m not set up for private practice and I’m plenty busy between consulting work, blogging, creating apps, and my own school position. But I was intrigued by the story so I agreed to meet with P.

After talking with P, I was outraged at the system, at the excuses that were offered (yes, I mean excuses), and the way that we failed to protect those who need it most. P grew up in a different state, went to elementary school, and received speech therapy. Apparently P had several ear infections as a child and was extremely hard to understand (sound familiar? I thought it might). P received therapy up until middle school (5th grade I believe). At the middle-school transition, P was dismissed from services. Not because P had mastered all the sounds, but because there was no ‘time’ for therapy. (hmmm…this can’t be good)

For those of you that don’t work in the schools, middle-school is…challenging. Anything that is out of the ‘norm’ is considered fair game for ridicule, bullying, and general disgust. If you forget to wear your hair a certain way…fair game. Wear the wrong kind of shirt…fair game. If you talk just a bit different…definitely fair game. Middle school is dangerous and very much a kill or be killed scenario, figuratively of course (actually in hindsight, I should have paid more attention to this it might have prepared me for the world of academics but that’s an entirely different rant).

Needless to say with P’s speech errors, middle school was a less than ideal place. P started to refuse to speak at school, refused to participate in classes, and refused to have anything to do with peers. In short, P refused to speak outside of family members. Fast forward several years and imagine P’s distress to discover that the articulation error that was not worth treating was actually career hampering.

Now…P’s speech errors are more than just /r/. P says ‘wif’ for ‘with’, ‘de’ for ‘the’ and vowelizes /l/. P is understandable, but the articulation errors definitely stand out. P’s education is definitely impacted as evidenced by the “fix it or don’t graduate in your chosen field” thought process. Needless to say, I couldn’t turn away this challenge. Not only the challenge…but the opportunity to correct the incredible disservice done so many years ago. One or two more years of speech therapy may have had an incredible life-changing impact for this child.

Which brings me to my rant…(you knew there would be one, right?)

I totally understand the situation for many school-based SLPs. High caseloads, not enough time for every student, can only take those who will actually progress, etc. I do… I get that. (Frankly, the fear of high-caseloads is one of the driving reasons I’m still at the school I’m at – well that and awesome admins, even if the weather is less than ideal.)  But, in my opinion (which I’ll readily admit is highly biased today), what happened to P is nothing less than criminal.

We, as a profession, failed P miserably by not advocating for services.

The education system failed P by not ensuring a student was ready to be prepared for the work force or higher education.

P’s family failed P by not advocating for P’s needs in the school. Although to be fair, they may not have been told they could…they may have been under the impression that the professionals knew it all.

Now, as you know by now, my mantra is “be a part of the solution” because if there is a problem you’re either part of the problem or part of the solution…and frankly, being a part of the problem is demoralizing and not very awe-inspiring…even if it is easy.

So…my part of being the solution is two-fold. First, I’m seeing my first adult client. P and I are working on the speech errors and doing what we can. Second, I’m writing this post.

We, as a profession, MUST advocate for ourselves and our clients. We can NOT do effective therapy in groups of 5-10. Truly, I think 2-3 is the limit, although I also have groups of 4 some days. Please know, this is not a slur against any SLP…even superheros have limits.

We can NOT be effective therapists with caseloads as high as 80-120. I’d go out on a limb and say we can’t be truly effective with caseloads over 60. If the children we saw were able to learn in large groups, they wouldn’t be on our caseloads.

We must advocate for what makes a student eligible for services. To hear someone say “it’s only an artic problem – it’s not educationally impacting” makes me furious. The purpose of education is to make a student ready to be a successful, self-supporting adult ready to interact with the world. Having an articulation disorder, even if it’s just one sound, hampers that ability. It impacts how the world interacts with that individual.

If two people who are equal in skills apply for a job – the one without a speech error is the one who will get hired (I’m fairly sure). In P’s situation, I’m fairly certain P would not be hired by any school district because of the errors. For P, it’s not even the job…it’s the basic right to finish a college degree of choice.

Now, articulation errors that would have been challenging to correct as a child, have become extremely challenging as an adult. Thank goodness P is highly motivated.

My final solution to the problem, is to do my level best to make sure NONE of my students is ever in this position.

How will you advocate for your students? Does your school district require “educational impacting?” Can you argue that it will impact their life? Social skills? Something?  More importantly…will you? Or will you be grateful that it’s one less kid on a caseload that is far too large already? If that’s the case (and I’m not judging), will you advocate for lower caseloads? What will YOU do to help the Ps in your community? I can’t wait to hear…drop me a note.

Until then…Adventure on!


12 thoughts on “Adventures in Advocacy…part two

  1. I had a 5th grader (in speech since K) who still had /r/ (Many other sounds mastered over the years) )I was contracting to the school (3years straight) and they finally hired their own SLP and I consulted with her over the past year (it was a big caseload 66)) I found out that my /r/ student was dismissed and many other kids who only had one or two sounds left to master because of the high caseload and they were deemed “functioning in the classroom” She now has the caseload down to under 50, I’m sad to think of those kids who were dismissed to make a more manageable caseload ( I tried to advocate for a part time SLPA to help me out and admins never listened).

  2. I totally agree. I can never understand how even one sound error could not be considered an educational impact. I’m afraid some are looking at it impacting math, reading, spelling or other academic skills. And yes it could but I always view it as impacting the social skills needed to learn. Look how it impacted “P.” As a professional I look at each case and make recommendations based on all the facts that impact that student. Recently I tested a third grader who had no errors for /s/ at the word level and inconsistent errors in conversation. I did not recommend service based on the facts listed plus she was receiving private therapy. I informed her parent to monitor her daughter’s progress and to refer her again if progress did not continue. For this child this was her “least restrictive” alternative. I may have the same recommendation for another child even if they were not receiving private therapy….but I need all the facts first for that child.

    Great post Mary!

    • Absolutely Cindy – I would have recommended the same for that kiddo. On top of getting private therapy, the sounds are emerging – showing it’s coming…if it’s emerging, we probably don’t need to work on it. I think of “P” going through middle-school and essentially selectively mute due to her speech errors…it’s so frustrating…and it makes me wonder how many other “P”s are out there.

  3. I keep thinking about the caseloads for specialists. Not being a specialist, I wonder if the half-hour time slots are the best way of running specialist timetables.

    As you said, we cannot miss any of those kids. Would there be any other structures that might work better? From an administrator perspective, I’d love to see a set of other options to structure school timetables so that none of these kiddos are ever missed. Really. I’m always trying to think outside of the proverbial box.

    • There’s nothing that says half-hour of therapy is the magic number. Some students do very well with 5-10 minutes a day for artic therapy; some are highly motivated and do well with 15 min 2x week. We have to be flexible. I think we (and by we I mean me as well) get “stuck” with keeping things the same in order to have groups or work around teachers schedules. Trying to fit little Tommy in with the group means he gets what the group gets even if that’s not necessarily the best possible scenario.

      • Agreed. I’m looking for possible scenarios we can try that are better.

        I’m thinking we have a combination of 30-minute sessions, 10-15 minute sessions, small group… anything else? To organise this, I’m thinking about putting student’s needs on note-cards and trying to sort the cards based on projected need for time as well as specific articulation problems. Is that correct?

  4. Thank you. Thank you. Thank you. This issue comes up in relation to social skills in autism and it is hard to get people to understand. Just because it doesn’t involve getting a grade doesn’t mean it isn’t academically relevant.

  5. I was just thinking this morning that this generation of children is going to grow up to be a group of adults with lots of articulation errors. I am in speech-language pathologist in private practice but I am also a mom to children in public school. When I volunteer in my childrens’ classrooms, I see several students who have derhoticized “r” and lisps – who are not getting treatment. What’s to become of them? Will it be the norm soon that adults have these types of errors in their speech?

  6. I was “one of those middle school therapists” and I refused to dismiss my kiddos until ALL sounds were remediated and I was confident they would not have a relapse. That is not to say they were 100% perfect because none of us have perfect intelligibility 100% of the time. I loved having teachers and parents tell me how much the student’s articulation improved and how it affected their self esteem and how glad they were to be dismissed finally. However, I also got many many students who were ready to be dismissed before ever getting to middle school but the elementary therapists would not have time either to dismiss them, so the job would fall on me. (that’s another rant)………

    What infuriated me was when those students were absolutely ready to be dismissed, no longer wanted to come to therapy, no longer had a need for therapy and were functioning very well not only academically, but also with their peers, family and others and were able to give presentations in class without any hindrances due to their articulation errors; but families refused to let them be dismissed. Administration would not support me for fear of lawsuits or rocking the boat.

    I tried to see my kiddos before their first period so they wouldn’t miss any school and they were just hanging out in the gym for those students who chose to come see me rather than missing class. Sadly, I was reprimanded and told unconditionally that this was not allowed and I had to rearrange my schedule so that students had to miss class and be in groups of a minimum of 4-6. Needless to say, that was not effective and very much demoralized me. I finally had to realize that I could not be effective with a huge and difficult caseload and my students would not be able to make progress no matter how hard I tried.

    Great post though…..I’m just glad that P is improving and I hope having improved self-esteem!!

    • How frustrating that you couldn’t use time before school to do therapy. That would have been perfect. In all honesty, I wasn’t thinking of middle-school therapists as bad guys…I have no doubt that if caseloads weren’t horrendous and time slots were open, this wouldn’t happen. I lay the vast majority of the blame on rules and regulations. If “P” sounded even half as bad then as now, there is no way a decent SLP would have dismissed willingly. It had to be rules and regulations requiring it…that’s what my rant is about.

      We should be allowed to make the best decisions for our students. We shouldn’t have to see children because their parents are eager to sue, we shouldn’t have to dismiss students because there’s no time to see them. We shouldn’t have to take paperwork home at night and weekends because our districts refuse to hire another SLP. I really wish admins, rule makers, and financial guru’s understood…it’s not a luxury…it truly does make a lifelong difference in the quality of life through adulthood.

  7. Great blog post, it is very sad to see that failure of provision has impacted on P’s psychosocial experiences: on his life. You make a great point about the time spent doing therapy earlier on vs time spent later; maybe cost savings would be more of a priority with a public healthcare system (we began to lose our NHS today and I can imagine this sort of problem becoming more commonplace here too). I’m glad to see you standing up for this via actively offering articulation therapy to P and by discussing it so that other children–>adults aren’t faced with this in future.

    I am shocked that the P is not able to graduate with an education degree without remediation, I have never heard of anything of the sort in the UK – that is complete discrimation and feel it should be reported to higher authority. I guess this would bring into question is an articulation impairment a disability? From a social model, I feel it is, if it is impacting on the way in which people are interacting with P and vice versa, as you say. I hope that the college who are enforcing this are paying for P’s articulation therapy! Thanks for the thoughts 🙂

  8. 1. I love the “5 Minute Kids” approach. I haven’t been able to schedule many kids 4x per week, but I do 1:1 artic therapy for 5-10 minute sessions and LOVE it!
    2. Feeling guilty. I felt the pressure to dismiss a few /r/ kids this year (4th and 6th grade) b/c it doesn’t impact educational performance. That plus the fact that I couldn’t get the kids to generalize these sounds and felt that the kids weren’t going to take ownership and do their part to generalize these sounds. I’d love to hear how others are bridging from that sentence/reading to generalization level. One SLP told me they see kids generalize later. Crossing my fingers! 🙂

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