Transcript ASHA Ad Hoc Committee on the Role of the Speech‐Language

Diane Paul, PhD, CCC-SLP
Director, Clinical Issues In Speech-Language Pathology
American Speech-Language-Hearing Association
[email protected]
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Family of documents (technical report, position statement,
guidelines, and knowledge and skills) related to the role of the
speech-language pathologist in the assessment and treatment
of communication and swallowing disorders in the infant and
toddler population.
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Address issues related to specific cultural and linguistic needs
of infants and toddlers and the need for culturally-appropriate
practice.
Position Statement
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Technical Report
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Knowledge and Skills
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Guidelines
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About 17% of children in the United States have had a developmental
disability (Centers for Disease Control and Prevention, 2007)
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Many children with developmental disabilities have communication and
feeding/swallowing problems needing SLP services.
 limited interest in social interactions
 failure to respond to speech or name
 reduced or atypical babbling
 restricted prelinguistic communication acts (sharing attention or engaging in
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reciprocal “baby” games)
limited use of communication gestures such as pointing
delayed acquisition of first words
slow growth or regression in vocabulary or utterance length
poor speech intelligibility for developmental level
limited or poor feeding and swallowing skills
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Speech-language pathologists have a central role in
providing services and supports for families and their infants
or toddlers with disabilities as members of the early
intervention team.
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Families with infants and toddlers (birth-36 months) who are
at risk for or have disabilities should receive developmentally
supportive care that addresses a broad spectrum of priorities
and concerns.
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Four guiding principles should be considered
in the design and delivery of services to
infants and toddlers with disabilities.
Reflect current consensus about optimal
practices for infants and toddlers (birth - 3
yrs)
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Early intervention services are family-centered and
culturally and linguistically responsive
 Align services with each family’s unique situation, culture,
language/s, preferences, resources and priorities
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Early intervention services are developmentally
supportive and promote children’s participation in
their natural environments
 Appropriate for child's age, cognitive level, strengths,
family concerns and preferences
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Early intervention services are comprehensive,
coordinated, and team-based
 Effectively integrated to meet all of the needs of the child
and family
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Early intervention services are based on the highest
quality evidence available
 Merger of highest quality and most recent research with professional
expertise and family preferences
 Mix of internal and external evidence
▪ Internal Evidence (experience , policies, informed clinical opinion)
▪ External evidence (scientific literature and assessment of quality of study)
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Challenges
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Be able to sort out internal and external evidence
Understand how to evaluate the strength of evidence
Know how to proceed when there is minimal evidence
Know how to monitor progress in different settings
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Prevention
Screening
Evaluation
Assessment (to determine intervention programming)
Intervention planning, implementation, and
monitoring
Consultation
Service coordination
Transition planning
Advocacy
Awareness and advancement of the
knowledge base
Service Delivery Models
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Location
 Natural environments—home and community settings
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Type
 traditional, one-to-one, direct clinical model (pull-out)
 more indirect collaborative approaches
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Team-based
 Multidisciplinary
 Interdisciplinary
 Transdisciplinary
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Characteristics
 Involves multiple professionals
 Complete separate assessments and provide independent services
 May meet to discuss child
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Drawbacks
 Not cohesive
 Limited number of opportunities for professional to interact with one
another and the family
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Characteristics
 Professionals work together
 Consistently coordinate information and resources
 Collaborate with the families and other to achieve priority
outcomes
 Tools may be a single integrated assessment, discipline-specific
tools, or some combination.
 Communicate findings and recommendations
 Share responsibility for providing services
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Characteristics
 Team members work together for assessment and intervention
 Some type of “role release” occurs
 Professionals may serve as consultants to team lead
 Sometimes referred to as a primary service provider (PSP) model
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Possible benefits
 Learn new skills across domains simultaneously and synchronously rather than in
isolation.
 Team’s message is unified by lead member working closely with the family.
 Less fragmentation
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Concerns
 Role release without training
 Lack of involvement of SLP when needed
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How is the team lead selected?
 Based on the needs of the child, relationships developed with the
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family, and special expertise
In consultation with the family
PSP should be SLP when feeding/swallowing and communication are
primary concerns
May be other discipline such as special education, nursing, or
occupational therapy, and the SLP will play a support role
Should not be established by prior program policy or based on
logistics such as travel or caseload
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Early Intervention is a field with many disciplines.
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It is not appropriate for SLPs to train others to
perform professional level services unique to SLPs or
for SLPs to perform services outside of their scope of
practice.
Help family enhance child's communication
development through consultation and education
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Provide information
 cognitive, social, and communication development
 developmental course and characteristics of a
disability
 intervention approaches and strategies
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Promote parent and caregiver abilities to
implement communication-enhancing
strategies during everyday routines
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Seamless transition process for families
moving between programs
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Timely access to appropriate services
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Need for transition plan
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Families play an active role
Knowledge of
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continuum of service delivery models to meet the needs of
the individual child and family (e.g., direct service,
collaborative consultation, playgroup-based).
Skills in
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facilitating collaborative problem solving with families,
caregivers, and other team members to deliver and monitor
interventions.
Knowledge of
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community resources, how to access them, and strategies to
empower families' and caregivers' accessibility.
Skills in
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collecting information about family priorities, resources, and
concerns.