Current Issues in School-Based Speech-Language Pathology Introduce myself. Housekeeping. Status of me and Outreach, other units SLPs are dealing with many of the same issues as general ed or vice versa Thoughts on the Day: -nature of learning vs adult learning -use of literacy strategies in sharing the day’s content -structured but self-driven during the pm Shelly Wier, MS, CCC-SLP Easter Seals Outreach Program swier@ar.easterseals.com 501-221-8415

Current Issues Evidence-Based Practice Responsiveness To Intervention SLPs’ Role in the School Literacy Program Status of the SEAS Goal Project Show and Tell: New products, programs, ideas, and collaborative successes EBP OK – [click] Prior knowledge check. Using the handout in your packet called “Rate Your Prior Knowledge by Learning Domain” as a guide, I want you to rate your prior knowledge of EBP. I’m going to give you a brief introduction to EBP, then let you read about and discuss this issue with a partner using a Pairs Read format, which I’ll explain when we get there. I think this will be more effective use of the little time we have to devote to this topic. RTI Again – We’ll do another prior knowledge check when we get there. It is not my expectation from today’s brief foray into these topics that you to feel prepared to put these concepts into practice, but that you understand enough about them to have at least formed an opinion, to be able to discuss them, to feel ready to prepare if necessary, to, at most, already have an inkling of a plan in mind. After our EBP activities, we’ll break (maybe) and I’ll start back with RTI, do a quick little bit on that, give you all a chance to just listen, show you how the “Tiered” concept in RTI compares to what’s going on with the Reading First/SIG Initiative, which will leads us, hopefully, into a discussion and sharing time RE: SLPs Role in Literacy How’s that going? How are you involved? Team? In classroom? Supporting teachers? Supporting without teacher? Do you feel that your expertise is recognized? Acknowledged? Appropriately utilized? If not, what are you doing to change this? Right before we break for lunch (or maybe after if we run long), I’ll share with you the status of the SEAS Goals Project. After lunch, we’ll break into small groups to rotate through the Show and Tell stations. [Inventory and organize afternoon time now based on contributions and group size. Briefly describe options/activities provided by me. Integrate all into stations for rotation.] How many of you brought something to share? Everyone who did will have to, at the very least, introduce themselves and give a brief description of what they brought and why. How many of you have prepared more than that?

EBP: What Is It? “. . . the integration of best research evidence with clinical expertise and patient values.” - Sackett et al., 2000 “. . . the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual students by integrating individual clinical expertise with the best available external evidence from systematic research.” - adapted from ASHA 2004 There is an abundance of definitions of EBP and fortunately, most of them say essentially the same thing. [click] The most well-known was put forth by David Sackett and his colleagues in their text, Evidence-Based Medicine: How To Practice and Teach EBM. [click] In 2004, ASHA’s Executive Board committee on EBP, which was charged with assessing the issue of EBP relative to planning needs and development opportunities for ASHA, used a variation of this definition. Then, I think, the ASHA Schools folks “adapted” and adopted the lower one you see here. Now – instead of “What Is It?” you may be asking . . . [click]

EBP: Why Should I Care? You don’t want to say “Huh?” when a parent asks you why you are using a particular technique. Your principal asked you how you were complying with the NCLB requirement to use scientifically-based practices. You don’t want to go to a due process hearing without a rationale for what you are doing. You are a conscientious professional and want to make sound decisions about intervention. You know the students you serve don’t have time to waste with practices that may be ineffective. I’m here, with a little help from the studio audience, to give you ASHA’s Top Ten Reasons for caring about EBP. [Call out . . .] #10 - #6 [click]

Family/Student Values Goal of EBP Current Best Evidence The goal of EBP is the integration of : [click] clinical expertise best current evidence, and client (I’ve changed it to Family/Student) values . . . to provide high-quality services reflecting the interests, values, needs, and choices of the individuals we serve. A simple triangle represents the basic principles. Because EBP is client/patient/family centered, a clinician’s task is to interpret best current evidence from systematic research in relation to an individual, including their preferences, environment, culture, and values regarding health and well-being. Ultimately, the goal is to provide optimal individual clinical service. [click] EBP is a dynamic process for integrating our ever-evolving clinical expertise and external evidence into day-to-day practice. All of this is from ASHA. Now - rather than me p r e s e n t I n g to you the rest of this information, regardless of how fancy I make the platter, I would like for us to practice a literacy strategy (Next Step, 9-12, Comprehension) called ‘Pairs Read’ that will give you a comprehension of and interaction with the information such that you are on your way to being able to define EBP and form an opinion much more quickly than if I just told you about it. So - [SET UP FOR PAIRS READ (Whole Group). Group according to preference (or lack thereof) for ‘touchy-feely’ group activities. Separate those who hate them into their own group. They can choose to pair off and be miserable together OR to join another pair and be the one who just listens, OR to read silently on your own. (However, this latter choice will also require that you verbally provide a definition and opinion at the end of the day. No, I’m just kidding. In writing will be fine.) Need: copies of article “EBP: Myths and Realities” task organizers, pairs and group EBP Clinical Expertise Family/Student Values

then PAIRS READ ACTIVITY Read Paragraphs 1-11 Stop at Paragraph 12 Summarize: Go back and quickly write one concise sentence for each paragraph. [Ask for a volunteer and model Pairs Read strategy. Use C. Dollaghan’s first two introductory paragraphs. Participants start reading at “Myths and Definitions.”]

In reality EBP is neither . . . In reality, EBP is neither the panacea = cure-all, magic potion, solution . . .

nor . . . . . . nor the bugaboo = cause for concern that its mythology has suggested.

Rather . . . Rather . . . EBP offers us a framework and a set of tools by which we can systematically improve in our efforts to be better clinicians, colleagues, advocates, and investigators – not by ignoring clinical experience and [student] preferences but rather by considering these against a background of the highest quality scientific evidence than can be found. Now there’s your introduction to EBP. One activity choice this afternoon is to further review ASHA’s available literature on this topic, summarize it, and share a condensed version with the whole group. Any comments? Questions? Opinions????

Responsiveness To Intervention Prior Knowledge Check A problem-solving framework that may be used to detect academic and behavioral difficulties and guide the use of research-based interventions to provide intensive instruction. [Click “A Process” to hyperlink to Prior Knowledge Check.] The student’s response to general education and intensive specialized instruction are measured periodically and compared to age, grade, or classmate performance. This data on the RTI may be used to inform instruction, and as part of a comprehensive evaluation for identification of learning disabilities and determination of eligibility for special education and related services. In other words . . . a true, measurable “prereferral” process. However, if I’m not mistaken, “prereferral” was a special education idea. Something we were asking general education to do. RTI, again if I’m not mistaken, is a general education idea, stemming from NCLB. Kinda makes ya go “Hmmm.”

Current Approach IDENTIFICATION COMES TOO LATE TOO MANY STUDENTS What’s the problem with the current approach to identifying disabilities? [WAIT – click] “WAIT TO FAIL” PROCESS MINORITY REPRESENTATIONS WRONG STUDENTS COST OF ASSESSMENT AND SERVICES

Prevention Model New and improved pre-referral intervention (validated interventions and valid progress monitoring) that precedes a comprehensive evaluation. Some view RTI as a prevention model.

Prevention AND Identification Children who remain unresponsive to increasingly intensive interventions are “eligible” for special education. No comprehensive evaluation is necessary. Some view RTI as a prevention and identification model.

Why SLPs Should Know About It? You should be informed about what’s going on in the general education arena It may be the alternative to regression analysis that your district chooses to implement It has the potential to change the way SLPs are involved with learning problems, especially in literacy It may impact your workload It may begin to change the way we think about students with language impairments

Three-Tier Model Tier 1: High quality instructional and behavioral supports are provided for all students in general education. Tier 2: Students whose performance or rate of progress falls behind their peers receive specialized instruction or remediation in the general education classroom. Tier 3: Comprehensive evaluation is conducted by a multidisciplinary team to determine eligibility for special education and related services. Although there is no universally accepted model, many RTI approaches use a variation or modification of a three-tier model: Tier 1 [click] Universal Instruction (80-85% of students) EBP and frequent progress monitoring is implemented by the classroom teacher. Adaptations (meaning accommodations and limited modifications) are made through consultation with a team. Tier 2 [click] Targeted Interventions (5-10% of students) Interventions are designed to address specific needs identified through progress monitoring. These interventions will supplement universal instruction rather than replace it. Usually delivered in small groups with continued progress monitoring. Tier 3 [click] Specialized Treatments (up to 7% of students) Treatment is designed to address limited progress in areas of targeted intervention. Delivered in small groups or individually through special education (eligibility process is followed). Continued progress monitoring. The goal of this approach is to provide differentiated instruction and remedial opportunities in general education, with special education provided only for those students who require more specialized services beyond what is (should be) provided in the classroom.

The SLP and Tier I Help identify appropriate, scientifically-based curriculum, assessment, and instruction in language and literacy Explain the language base of literacy Help identify signs of struggle with language within school-wide progress monitoring systems Consult about appropriate adaptations for struggling students

The SLP and Tier II Consult with and model for the team delivering targeted interventions to help make instruction most beneficial for students with language-learning difficulties.

The SLP and Tier III Provide curriculum-relevant language therapy for students who have not benefited from Tiers I and II Engage other educators in a partnership to provide therapeutic intervention Consult with other special educators to help make their intervention language-sensitive Provide assistance to general educators in making appropriate accommodations

Issues Number of Tiers Movement across Tiers Distinguishing Tier II and Tier III interventions Length of time in Tier II prior to receiving “specialized instruction” in Tier III Eligibility and identification Reconfiguration of existing resources Older students

Advantages of RTI ASSISTANCE IS PROVIDED IN A TIMELY MANNER ASSESSMENT AND INTERVENTION ARE CLOSELY LINKED What are the advantages to implementing and RTI approach? [WAIT – click] DATA INFORMS & IMPROVES INSTRUCTION ENSURES THAT POOR PERFORMANCE IS NOT DUE TO POOR INSTRUCTION NON-RESPONDERS ARE NOT GIVEN A LABEL

RTI and SLI If SLPs are more involved in Tiers I and II, some language impairments may be prevented. RTI is primarily an approach for addressing LD students. How might this approach benefit language impaired students, as well as SLPs.

RTI and SLI Use of RTI can circumvent problems we encounter with identification using standardized norm-referenced tests.

RTI and SLI Providing tiers of instruction may help us identify a smaller group of students for intensive therapeutic services.

RTI and SLI Providing tiers of instruction may help us to become involved with a broader population as part of our workload.

What Will It Require? Greater understanding and recognition of the role of language in curriculum and instruction on the part of educators SLPs becoming more of a “front and center” resource to schools Mechanisms that involve SLPs in all tiers while maintaining a reasonable workload Transition from a “caseload” to a “workload” orientation

Let’s Chat Role in literacy SEAS Goals Project Show and Tell

Show & Tell Stations Video: Arkansas SLPs EBP: ASHA’s 4-Step Process RTI: Reading Interventions Review Self-Study Materials Review New Tests & Materials Bloom & Hicks