Services Frequently Asked Questions
To submit a question, email Pat Jones, VP for School
Services at firstname.lastname@example.org
Can speech/language therapy services be provided outside
of special education? Is parent permission required? What are the
paperwork requirements? Can an implementer provide these services?
Speech therapy can be provided either as special education
or as regular education. However, if a disability is suspected,
then IDEA requirements kick in and must be followed, so it becomes
a special education issue unless the child is found ineligible.
There is no requirement for signed parent permission since it is
a regular education service; however, most schools feel more comfortable
obtaining a signed permission. There are no set paperwork requirements.
For many schools the signed parent permission is the only required
paperwork. Best practice would dictate, of course, that the SLP
keep data as s/he does with every student and that a system of informing
parents of progress be established, but this is up to the school
An implementer is practicing under a Special Education model, the
implementer model. Implementers cannot provide services that are
not special education.
Can speech/language therapy services which are part of
regular education be provided in the “speech” room?
Regular education speech services can be provided anywhere
other regular education services are provided. Since speech can
be either regular or special education, DESE does not view the “speech”
room as a special education room. So, students receiving speech
therapy as a regular education service can be seen by the SLP in
the “speech” room. They can be seen individually, with
other regular education students, or with students who have IEPs.
They cannot be seen in a Special Education room because in this
setting no regular education services are provided.
Does a child have to demonstrate reduced grades or achievement
test scores in order to qualify as Sound System Disordered in Missouri
Public Schools in order to meet the "adverse educational impact"
The U.S. Department of Education has provided clear interpretation
of the phrase "adversely affects educational performance"
as it applies to children with speech-language impairments. This
interpretation clearly states that a child who has a disability
cannot be denied services because she or he does not demonstrate
concurrent academic problems (ASHA, 2005). Following is a quote
from a letter from Edwin Martin, Acting Assistant Secretary of Special
Education and Rehabilitation of the U.S. Department of Health, Education,
and Welfare (Office of Education in Washington, D.C.):
"The meaning of educational performance" cannot be
limited to showing of discrepancies in age/grade performance in
academic subject-matter areas. The extent of a child's mastery of
the basic skill of effective oral communication is clearly includable
within the standard of "'educational performance' set by the
regulations. Therefore, a speech/language impairment necessarily
adversely affects educational performance when the communication
disorder is judged sufficiently severe to require the provision
of speech pathology services to the child." "It is clear
that, in establishing the existence of a speech/language impairment
that is 'handicapping' in Part B (IDEA), a professional judgment
is required. The basis for that judgment is the child's performance
on formal and/or informal measures of linguistic competence and
performance, rather than heavy reliance on the results of academic
achievement testing. The impact of the child's communicative status
on academic performance is not deemed the sole or even the primary
determinant of the child's need for special education services.
It is the communicative status - and professional judgments made
in regard to assessments of communicative abilities - which has
In the event that the speech-language pathologist establishes through
appropriate appraisal procedures the existence of a speech/language
impairment, the determination of the child's status as a 'handicapped
child' cannot be conditioned on a requirement that there must be
a concurrent deficiency in academic performance."
Although the current Missouri Compliance Plan does not define the
term "educational performance," an excellent explanation
was included in previous state plans as follows: Educational performance
shall be interpreted as not only classroom applications of academic
skills and concepts, but also as generalization of skills and behaviors
such as social interaction, functional communication, and prevocational
and vocational skills and behaviors in other environments.
Is it necessary to obtain written permission in order to
do speech/language screening?
The key question is, “Why is the child being screened?”
Each district must have a child find system in place so routine
screening done when no disability is suspected does not require
permission. Once a disability is suspected, then IDEA is triggered
and written notice and consent is required. If you are screening
to get information for regular education services such as RtI, EIS,
tutoring, etc. permission is not required. If you screen all transfer-in
students then no permission would be required. If a child is on
a “watch” list, probably do not need permission. As
soon as a disability is suspected, then you need to proceed to a
Review of Existing Data and, if evaluation is required, obtain written
Can professional judgment be used in making a determination
of eligibility for Sound System Disorder?
Because of the nature of communication disorders, it is
not possible to remove the element of professional judgment from
eligibility decisions. The old phrase “tests don’t diagnose,
people diagnose” is absolutely true and we should probably
say that “test SCORES don’t diagnose”. Although
critical in our work, very seldom are formal test results a true
and complete picture of an area as complex as communication. Nearly
every eligibility criteria includes a requirement for information
which either supports or does not support test scores. The information
gathered during the Review of Existing Data, screening, observations,
interviews, work samples, etc. should be used in conjunction with
standardized test results to make the best eligibility decisions
Is it okay for a Special Education teacher to provide the
services to a student with a language disorder,
instead of the SLP?
It depends on what the IEP team determines is needed for
the child. If the IEP says that the child needs speech/language
therapy, then the only acceptable models in MO to provide this therapy
are from an SLP or through the approved implementer model. If the
IEP has goals and objectives addressing language skills and the
team determines that those needs can be addressed in the regular
education program or through specialized instruction, then the IEP
would not indicate speech/language therapy and those identified
needs could be addressed by someone other than the SLP. In this
case, the IEP team would determine who would implement that portion
of the IEP.
I would like some different views on the roles and responsibilities
for SLP's and dysphagia in the school setting. Is the school responsible
for the nutrition of the student or is it a medical issue? Who pays
for the swallowing evaluation? Are there any official guidelines
Often tongue-thrust and swallowing issues are viewed as
medical issues and typically are not considered applicable to educational
outcomes. However, if an IEP team determines that the child needs
speech therapy designed to address either of these issues in order
to receive FAPE, the district would be required to provide the therapy
or to see that it is provided. Eligibility in the category of Speech
Impairment based on either of these conditions alone would likely
not meet the definition in the Missouri State Plan for Special Education.
If the child demonstrates other communication difficulties as outlined
in the State Plan and has accompanying tongue thrust or swallowing
problems, the team should consider how these conditions impact the
child’s overall communication skills and if intervention is
necessary to provide FAPE. A good resource is the ASHA guidelines
for SLPs providing swallowing and feeling services in schools at
If it is determined that swallowing needs to be addressed,
would the school district be required to pay for a modified barium
swallow at a hospital or would informal assessment of swallowing
be sufficient to diagnose
Part of the decision-making process would be a review of
existing information available to the team from the medical doctor’s
assessment of the child. It is doubtful that a school-based team
would be the first to determine that the problem exists. However,
a school team may have to respond to the condition and the need
for services as they write the IEP. Some children have disabilities
that impact swallowing and interventions for this may be included
in the IEP when the team determines they are necessary for the child
to receive FAPE. An example may be a child with excessive drooling
stemming from cerebral palsy and a determination that oral-motor
interventions would reduce or eliminate the problem and improve
communication. In those cases the team may decide that the therapy
is necessary and the need directly related to the long term goals
for the child in communication. If a team determines that an assessment
of the child’s swallowing function is necessary in order to
appropriately program for the child, then yes, the district could
pay for the testing or access other funding sources.
Can SLPs use Substitute Teachers?
The only individual that can substitute for an SLP is another appropriately
credentialed SLP. DESE has never approved the use of nonqualified
substitutes which includes all but a few rare individuals from the
regular substitute teacher list. In the past DESE instructed districts
that any missed therapy sessions were to be made up. On 3/8/07,
the federal Office of Special Education Programs (OSEP) responded
to a request by ASHA for interpretation of the need for substitutes
for SLPs based on the IDEA Amendments of 2004.
ASHA’s question was about the need to use substitutes and
to schedule make up sessions when speech/language sessions are missed
as a result of the child’s absences, the SLP’s absences,
or other causes such as school activities. OSEP replied that these
issues are not addressed in the federal law or the federal regulations
and it is up to each state to ensure a Free Appropriate Public Education
(FAPE). Therefore, each school entity needs to consider the effect
of absences (child’s or SLP’s) or other causes of missed
sessions on the child’s progress toward IEP goals. If the
goals are not likely to be met, missed sessions may be a denial
of FAPE. In that case a qualified substitute may be located or compensatory
therapy could be provided. How that will be done is the decision
of the school district.
Where can I find the SLP caseload formula? Can I make my
director of special education use the formula instead of 40-60 students?
Can SLPs use the special education teacher formula?
Information about caseloads can be found in the State Plan for Special
Education on pages 113-120 at http://www.dese.mo.gov/divspeced/stateplan/documents/Regulation_VII_2010.pdf. When the Foundation Formula
was changed and Exceptional Pupil Aid eliminated, mandatory caseloads
for all special education including Speech/Language were also eliminated.
You will note that the Plan indicates a number of factors to be
considered when caseload is determined. These include ages and grade
levels of the students served, severity of the disabilities of the
students served, the unique needs of the students as identified
in their IEPs, the number of IEPs case managed, assessment/evaluation
responsibilities, and other duties assigned to the teacher. The
caseload formula page is still included and can be used, but even
then suggested guidelines for caseloads are only recommendations.
You will note the Plan gives numbers which are “maximum”
and “desirable”. Using a simple head count, the “maximum”
numbers are those which are considered to be what the provider could
serve. However, when the above factors (and possibly others) are
taken into consideration, the “maximum” may need to
be lowered for that caseload. For example, an SLP who is providing
some therapy in a regular education setting or providing some resource
services for language impaired students could obviously not handle
the “maximum” caseload. The “desirable”
number is what is considered, before the above conditions are factored
in, to be the best estimate of the most students for that caseload.
It is up to the director to approve the caseload, hopefully with
the input of the SLP, since the SLP will know specifics about other
duties and student needs.
Can a speech implementer register and provide services
as an SLP assistant?
Yes -- if they meet the SLP assistant requirements including training
and supervision, an implementer can register as an SLP assistant.
However, the education and supervision requirements for an SLP assistant
are substantially different from those for a speech implementer.
The SLP assistant must have a bachelor’s degree in communication
disorders and one of every three therapy sessions provided by the
assistant must be directly supervised by a licensed SLP. The speech
implementer may hold a bachelors degree in communication disorders
or hold a teaching certificate “preferably” in special
education or elementary education. Direct supervision may be provided
by either a licensed or DESE certificated SLP and the supervision
is “periodic” at the school’s discretion. It is
advisable for an implementer to check with their school district
to see if the level of supervision necessary for an SLP assistant
can or will be available. For the requirements to be registered
as a Speech-Language Pathology Assistant go to Missouri Licensure
Rules and Statutes.
When will schools know if speech implementers must be registered
and meet the requirements for SLP assistants or another registration?
The Missouri Board of Healing Arts, Speech-Language Pathology and
Audiology (SLP/A) Commission has been reviewing information in an
attempt to determine if speech implementers should be registered
and meet the requirements for SLP assistants. As of January 2007,
the Board and Commission asked the Attorney General’s office
for an official opinion on the matter. Until that opinion is available,
the issue remains unresolved.
Is there a problem with speech implementers becoming a
fully licensed SLP?
Some speech implementers with bachelor’s degrees in communication
disorders have a desire to become fully licensed SLPs. If it is
determined that implementers are practicing in violation of state
licensure law, it may be difficult for individuals who served as
implementers to obtain their SLP licensure. Until a decision is
made by the Attorney General, the Advisory Commission for SLPs has
decided that implementers will not be penalized for violating state