The State of Dyslexia: Recent Legislation and Guidelines for Serving School-Age Children and Adolescents With Dyslexia.

Purpose: The purpose of this article is to provide an overview of recent dyslexia legislation and guidelines pertaining to services for students with dyslexia in public school settings and to describe possible implications for speech-language pathologists (SLPs). Method: In recent years, there has been increased attention focused on effectively meeting the needs of students with dyslexia nationwide. The Decoding Dyslexia organization has chapters in all 50 states in the nation, and they have been instrumental in promoting public awareness of the importance of improving services for students with dyslexia. As a result, new legislation, policies and guidelines have been introduced and developed in many states. California is an example of 1 state that has recently passed legislation in this area and released guidelines that serve as recommendations related to this law. This article provides a broad overview of recent dyslexia legislation, with more specific information pertaining to recent legislation and guidelines in the state of California. Clinical implications for SLPs who serve this population in school settings are also discussed. Conclusion: The information discussed in this article may serve as a useful model for states that are in the process of developing or revising their own policies or guidelines for meeting the needs of students with dyslexia.

Variability in Interpreting "Educational Performance" for Children With Speech Sound Disorders.

Purpose: Speech sound disorders (SSDs) can have a negative impact on literacy development, social-emotional well-being, and participation across the life span. Despite this, many public schools do not provide appropriate or timely services to this population of children. In large part, this is a result of variation in how state and local agencies interpret "educational performance" as outlined within the Individuals With Disabilities Education Act. The purpose of this study was to explore which educational performance factors speech-language pathologists (SLPs) consider when determining eligibility for children with SSDs. Method: This study surveyed public school SLPs to investigate how educational performance is interpreted for children with SSDs. Data from 575 SLPs across the United States are included. Results: Results supported variability in interpretation of educational performance within a nationwide sample of SLPs. Specifically, SLPs appear to consider educational performance as multidimensional. We also found within-state and between-states variability, indicating ambiguity in interpreting federal mandates. Finally, caseload size and number of years of experience were significantly related to which educational performance factors SLPs chose. Conclusion: There is significant variability across the United States with respect to factors considered part of educational performance for children with SSD. This variability reflects the general quality and specificity of guidelines and/or special education code published by individual states. Clinical and legislative recommendations are included.

Getting comfortable with "comfort feeding": An exploration of legal and ethical aspects of the Australian speech-language pathologist's role in palliative dysphagia care.

PURPOSE: With an ageing population, speech-language pathologists (SLPs) can expect to encounter legal and ethical challenges associated with palliative and end-of-life care more frequently. An awareness of the medico-legal and ethical framework for palliative dysphagia management will better equip SLPs to work effectively in this area. METHOD: This narrative review examines a range of legislation, legal, ethical and SLP literature that is currently available to orient SLPs to legal and ethical palliative dysphagia management in the Australian context. RESULT: Relevant legal and ethical considerations in palliative and end-of-life care are described. CONCLUSION: SLPs have a role in palliative dysphagia management, however, this can involve unique legal and ethical challenges. The legal position on provision and cessation of nutrition and hydration differs between Australian States and Territories. Decisions by the courts have established a body of relevant case law. This article introduces SLPs to some of the important considerations for legal and ethical palliative care, but is not intended to be directive. SLPs are encouraged to explore their local options for ethical and medico-legal guidance. It is hoped that increasing SLPs awareness of many of the concepts discussed in this article enhances the provision of high-quality patient-centred care.

Communication Capacity Research in the Majority World: Supporting the human right to communication specialist services.

Receipt of accessible and appropriate specialist services and resources by all people with communication and/or swallowing disability is a human right; however, it is a right rarely achieved in either Minority or Majority World contexts. This paper considers communication specialists' efforts to provide sustainable services for people with communication difficulties living in Majority World countries. The commentary draws on human rights literature, particularly Article 19 of the Universal Declaration of Human Rights and the Communication Capacity Research program that includes: (1) gathering knowledge from policy and literature; (2) gathering knowledge from the community; (3) understanding speech, language and literacy use and proficiency; and (4) developing culturally and linguistically appropriate resources and assessments. To inform the development of resources and assessments that could be used by speech-language pathologists as well as other communication specialists in Fiji, the Communication Capacity Research program involved collection and analysis of data from multiple sources including 144 community members, 75 school students and their families, and 25 teachers. The Communication Capacity Research program may be applicable for achieving the development of evidence-based, culturally and linguistically sustainable SLP services in similar contexts.

Elizabeth Usher Memorial Lecture: Language is literacy is language - Positioning speech-language pathology in education policy, practice, paradigms and polemics.

This paper is concerned with the fundamental and intrinsic links between early receptive and expressive oral language competence on the one hand and the transition to literacy in the early school years and achievement of academic (and life) success on the other. Consequently, it also concerns the professional knowledge base of two key disciplines whose work is central to children's early language and literacy success: teachers and speech-language pathologists (SLPs). Oral language competence underpins the transition to literacy, which in turn underpins academic achievement. Academic achievement is significant in its own right, conferring opportunities for further education and training post-secondary school, contributing to psychological health and mitigating some of the mental health risks and adversities that can be associated with adolescence and early adulthood. The central thesis is that the linguistic basis of the transition to literacy makes early reading success core business for SLPs. Further, SLPs need a firm grasp of the political and ideological factors that have exerted historical and continuing influence on reading instruction in western nations such as Australia, the US and the UK. This will facilitate the establishment of meaningful working relationships with teaching colleagues, to achieve optimal education outcomes for all children.

A qualitative study of legal and social justice needs for people with aphasia.

This paper presents an exploratory investigation of situations in which people with aphasia may be vulnerable to legal and access to justice issues. The study used a qualitative descriptive approach to analyse 167 de-identified transcriptions of previously collected interviews, with 50 participants with mild-to-severe aphasia following stroke, 48 family members, and their treating speech-language pathologists. Situations experienced by people with aphasia and their family members were coded using key-word searches based on the previously published framework developed by Ellison and colleagues to describe situations of vulnerability to legal and access to justice needs for older people. Health and financial and consumer situations were most frequently identified in the data. Additionally, there were a number of situations found specifically relating to people with aphasia involving their signatures and credit card use. Instances of discrimination and abuse were also identified, and, although infrequent, these issues point to the profound impact of aphasia on the ability to complain and, hence, to ensure rights to care are upheld. The findings of this study are consistent with previous research in suggesting that legal and access to justice needs are an important issue for people with aphasia and their families.

Competence-based curricula for the education of speech-language pathologists and audiologists in Brazil.

OBJECTIVE: The aim of this paper is to present the academic requirements for the education of speech-language pathologists (SLPs) and to discuss some of the challenges in providing quality supervised practice and the solutions proposed by some programs in Brazil. METHODS: Brazilian proposals regarding the training of SLPs are reviewed, with guidelines provided by the International Association of Logopedics and Phoniatrics (IALP) and the Comité Permanent de Liaison des Orthophonistes-Logopèdes de l'UE (CPLOL), and descriptions of the specific experience of the oldest Brazilian program are provided. RESULTS: The bachelor's degree is the minimum level required for the independent practice of speech-language pathology and audiology in Brazil, where there are 75 undergraduate programs. In several programs, students are encouraged to enjoy the diversity at their university, enrolling in courses of different areas to broaden their experience. The basic areas of the undergraduate program are mandatory as per recommendation of the Ministry of Education and include competences related to the health system, decision making, communication, leadership and continued education. Since practice training is part of the undergraduate programs, it is incorporated into the pedagogical concept and has a major role in it. CONCLUSION: The structure of the programs allows the dissociation of theory from practice to be attenuated; both educational strategies are used together as part of the pedagogical concept.

Disfunción ejecutiva en el Trastorno Específico del Lenguaje / Executive dysfunction in Specific Language Impairment

Existe un acuerdo creciente entre la comunidad científica en la necesidad de considerar el rendimiento neuropsicológico como elemento coadyuvante en la caracterización sintomática del Trastorno Específico del Lenguaje (TEL). La estrecha relación entre la adquisición y el uso del lenguaje con funciones de otros dominios cognitivos fundamenta dicha necesidad. En este contexto, se presenta un estudio en el que se ha evaluado el rendimiento neuropsicológico en funciones ejecutivas de una muestra de 31 niños diagnosticados de TEL y 19 niños control. El protocolo de evaluación incluía pruebas destinadas a evaluar: memoria de trabajo verbal y visoespacial; planificación; fluidez verbal y de diseño; inhibición y alternancias. Los resultados encontrados evidenciaron que el grupo TEL presenta un rendimiento inferior en todas las variables. Concretamente, los déficits se objetivan en todas las funciones ejecutivas evaluadas excepto en planificación. Tomados de forma conjunta, consideramos que nuestros resultados ponen en valor la necesidad de contemplar el rendimiento ejecutivo en el diagnóstico de los niños con TEL y sus implicaciones en la elaboración de intervenciones terapéuticas eficaces (AU)

Legal decision-making by people with aphasia: critical incidents for speech pathologists.

BACKGROUND: The assessment and management of a person with aphasia for whom decision-making capacity is queried represents a highly complex clinical issue. In addition, there are few published guidelines and even fewer published accounts of empirical research to assist. AIMS: The research presented in this paper aimed to identify the main issues for speech pathologists when decision-making capacity for legal and related matters arose for their clients with aphasia, and to describe qualitatively the nature of these issues and the practices of the speech pathologists in these situations. METHODS AND PROCEDURES: The methodology was informed by the qualitative research paradigm and made use of the semi-structured interview methods developed for the Critical Incident Technique. Nine speech pathologists, with a range of clinical experience between three and 27 years, were interviewed by telephone, with verbatim notes being taken on-line by the interviewer. The speech pathologists described a total of 21 clients (15 male, six female) with acquired neurological communication disorders (including cerebral vascular accident, traumatic brain injury, and tumour) whose care had raised critical incidents for the speech pathologist in relation to legal and related matters. These verbatim notes were qualitatively analysed using NVivo qualitative analysis software. OUTCOMES AND RESULTS: The main incidents related to legal decisions (for example, power of attorney, will-making), as well as decisions involving consent for medical treatment, discharge, accommodation, and business/financial decisions. In all but one of the incidents recounted, the issues centred on a situation of conflict between the person with aphasia and their family, friends or with the multidisciplinary team. The roles taken by the speech pathologists ranged from those expected within a speech pathology scope of practice, such as that of assessor and consultant, to those which arguably present dilemmas and conflict of interest, for example, interpreter, advocate. The assessment practices involved some standardized testing, but this was stressed by all participants to be of lesser importance than informal observations of function. Speech pathologists emphasized the importance of multiple observations, and multimodal means of communication. CONCLUSIONS AND IMPLICATIONS: The findings indicate that speech pathologists are currently playing an active role when questions arise regarding capacity for legal and related decision-making by people with aphasia. At the same time, the findings support the need for further research to develop guidelines for practice and to build educational experiences for students and novice clinicians to assist them when they engage with the complex case management issues in this area.

An issue hiding in plain sight: when are speech-language pathologists special educators rather than related services providers?

PURPOSE: Under the Individuals With Disabilities Education Act (IDEA; as amended, 2004), speech-language pathology services may be either special education or a related service. Given the absence of guidance documents or research on this issue, the purposes of this clinical exchange are to (a) present and analyze the IDEA definitions related to speech-language pathologists (SLPs) and their roles, (b) offer a rationale for the importance of and distinction between their roles, (c) propose an initial conceptualization (i.e., flow chart) to distinguish between when an SLP should function as a related services provider versus a special educator, and (d) suggest actions to develop and disseminate a clearer shared understanding of this issue. METHOD: Federal definitions of special education and related services as related to SLPs are discussed in terms of determining special education eligibility, meeting student needs, ensuring SLPs are following their code of ethics and scope of practice, and facilitating appropriate personnel utilization and service delivery planning. CONCLUSION: Clarifying the distinction between special education and related services should lead to increased likelihood of appropriate services for students with disabilities, improved working conditions for SLPs, and enhanced collaboration among team members. This clinical exchange is meant to promote dialogue and research about this underexamined issue.

Accountability for services for young children with disabilities and the assessment of meaningful outcomes: the role of the speech-language pathologist.

PURPOSE: This article describes the federal accountability requirements related to young children with disabilities and the contribution of the speech-language pathologist (SLP) to provide these data through the use of authentic, functional assessments. METHOD: The article summarizes recent state and federal developments related to assessment for accountability and draws on the recommendations of national organizations, including the American Speech-Language-Hearing Association, to underscore the importance of high-quality assessment for guiding practice and for documenting child outcomes for accountability. CLINICAL IMPLICATIONS/CONCLUSION: The widespread use of recommended practices for assessment will provide children, families, and practitioners, including SLPs, with the highest quality assessment information, at the same time providing states and the federal government with much-needed valid data on child outcomes for accountability purposes.

Legal and financial issues associated with providing services in schools to children with swallowing and feeding disorders.

PURPOSE: This review of federal statutes and regulations, state and federal administrative and case law, and policy documents is designed to provide information regarding the treatment of children with swallowing and feeding disorders in the law for the purpose of identifying best practice procedures for school personnel serving children with swallowing and feeding disorders. METHOD: A narrative review of federal statutes and regulations, state and federal administrative and case law, and policy documents was conducted. The review identified prevailing and emerging policies related to serving children with swallowing and feeding issues in schools. In addition, federal standards regarding funding were reviewed for relevance to serving children with dysphagia. IMPLICATIONS: Statutes, regulations, and case law establish the rights of students with health impairments, including swallowing and feeding disorders, to receive such related services as are necessary to attend school safely. Recent administrative hearings have addressed dysphagia, identifying the importance of ensuring the child's feeding safety through diet and services. School districts can receive reimbursement for services that are provided to children with dysphagia through Medicaid when said services are provided in accordance with each state's Medicaid requirements.

Mental capacity and professional advice in a patient with dysphagia.

This article considers the implications of a dispute between a speech therapist and other health professionals over whether a patient suffering from dysphagia should be allowed to take liquids by mouth. The right of the patient to act contrary to professional advice is discussed. The patient cannot insist that a health professional acts contrary to his or her professional judgment. The article also considers the law if the patient were to lack mental capacity.

Clinical services and the regulatory environment: an overview.

Most clinicians have difficulty participating in the political process. Patients/clients come first, and there is often little time to pursue information about the political and regulatory processes affecting clinical practice. Yet, such activity is imperative if speech-language pathologists and other practitioners want to achieve individual and collective professional goals and ensure sufficient funding for services to consumers. This article is an overview of politics, health-care policy, and regulation. Definitions are presented, and concepts regarding how politics become policy are cast in the familiar structure-process-outcome triad. Four types of regulation are discussed, and current regulatory initiatives are explained from the perspective of policy-makers. The discussion concludes by applying these concepts to issues and behaviors of specific interest to speech-language pathologists and sets the stage for the other articles in this publication.

HIPAA privacy regulations.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) impacts all health-care professionals, including speech-language pathologists (SLPs). The administration simplification section of HIPAA includes specific regulations designed to protect the privacy of an individual's health records. These privacy regulations are not designed to impede upon essential health-care practices, but do require that covered providers take reasonable steps to limit the use and disclosure of protected health information. Important aspects of the privacy regulations include the development of facility- or practice-specific privacy policies, the development of a privacy manual, staff training on privacy policies and procedures, and the drafting and posting of a notice of privacy practices. In addition, authorization forms are mandated for instances of use and disclosure of public health information not related to treatment, payment, or health-care operations.

The regulatory context for public education.

The provision of special education and related services in public schools involves the intertwining of federal, state, and local laws, regulations, other levels of policy, and practices. Such a multilayered system can obviously lead to misunderstanding and misinformation regarding school-based services, creating challenges in terms of implementation and advocacy. However, by determining the source of the requirements and the intent of the laws, it is possible not only to remain in compliance with mandates but also to influence implementation decisions and improvements that will ultimately be in the best interest of students. Educators must identify and analyze the source and intentions of requirements, understand the responsibilities of states and localities, and when necessary, identify vehicles for advocating for change. This article provides information regarding major federal mandates that affect public education, with comments specific to speech-language services in the schools.

Challenges for professional practice in the next decade.

This article is presented in a question and answer format and shares the thoughts of the 2006 President of the American Speech-Language-Hearing Association (ASHA), Alex Johnson, and current Executive Director of ASHA, Arlene Pietranton, regarding several regulatory issues that the professions of audiology and/or speech-language pathology are likely to have to address over the next decade. Specific topics mentioned include: trends affecting our professions; anticipated service delivery changes; public (i.e., Medicaid and Medicare) and private (i.e., health plans, consumer-driven plans) reimbursement; competing for funding dollars; pay-for-performance; the Individuals with Disabilities Education Act; No Child Left Behind; and ASHA's work with various national organizations and federal agencies in the regulatory arena. Several ASHA resources for further information are listed.

Treating voice disorders in the school-based setting: working within the framework of IDEA.

The role of the speech-language pathologist (SLP) has developed considerably over the last 10 years given the medical and technological advances in lifesustaining procedures. Over time, children born with congenital, surgical, or "medically fragile" conditions hav become mainstreamed into regular school-based settings, thus extending the traditional role of the SLP and multidisciplinary team. Understanding the impact of these voice disorders on the child's educational performance has been a struggle for many clinicians because the eligibility decisions for students in school-based settings must be made within the framework of federal legislation and regulations governing the provision of services for students with disabilities. This article discusses how to identify children with voice disorders under the Individuals With Disabilities Education Act (IDEA) definition, the role of the SLP in assigning priority in various voice management scenarios, and how models of therapy can be incorporated in the school-based setting.

Clinical and professional ethics in the management of motor speech disorders.

The field of biomedical ethics is increasingly discussed in speech-language pathology graduate school curricula as well as in continuing education forums. The application of the principles of medical ethics can be extremely helpful to the difficult decisions sometimes facing speech-language pathologists with respect to doing good for their patients while respecting both patients' autonomy and federal and state law. Professions have increasing attempted to codify professional issues relating to moral issues through codes of ethics and codes of conduct. This article focuses on applying selected principles of medical ethics and professional codes of conduct to the practice of speech pathology specific to motor speech disorders. Case examples are provided to illustrate ethical decision making through consideration of the American Speech-Language-Hearing Association (ASHA) Code of Ethics as well as a number of principles of medical ethics.