4 suggestions for safe delivery of speech-language therapy
Nearly a year into the COVID-19 pandemic response, concerns persist in schools on how to deliver speech-language therapy remotely and in person.
Districts continue to refine their efforts to deliver speech-language therapy services safely and optimally, says to Tiffany White, school services director at the American Speech-Language-Hearing Association.
She noted key issues that concern school-based speech-language pathologists in remote learning and returning to in-person service delivery. As follows, the issues include student safety, engagement, learning loss, and progress monitoring.
Issue: Speech pathologists returning in person may be concerned about the effects of wearing masks and other personal protective equipment when providing speech-language services.
Students may be unable to read nonverbal cues, or they may have difficulty seeing the clinician’s mouth movements or articulators for producing sounds to remediate sound production errors.
Masks could potentially muffle the clinician’s speech and make it difficult for students with hearing impairments to recognize and understand orally presented information.
Solution: Speech pathologists are working with schools and unions to advocate for equipment and sanitizing measures.
A district may increase its stock of clear “communicator masks,” which allow listeners to see the mouth when speaking. Frequency modulation systems, too, can help address barriers to delivering quality services, said White. Such equipment should be in ready supply.
Issue: For speech pathologists returning to remote interventions this semester, there may be continued concerns about technology access and student engagement in therapy lessons.
While many districts have provided hotspots and technology to students throughout the pandemic, some still struggle to meet the need, according to White. She said districts that can provide access must ensure their providers and students are knowledgeable of the technologies they use.
And as learning resumes, speech pathologists may encounter challenges with scheduling virtual sessions based on conflicts with instructional blocks for academics and parent schedules.
Solution: Increasing student engagement may require that the speech pathologist look differently at her service delivery models such as conducting group sessions, engaging in classroom-based interventions during instructional blocks, offering asynchronous lessons, and collaborating more with teachers and parents.
“Clinicians must find engaging activities and ways of implementing therapy that allows for greater interactions,” said White, noting speech pathologists are increasingly turning to online programs, videos, and interactive sites to keep students interested while they address IEP goals.
Full participation in therapy interventions requires that students and staff members must have access to appropriate and updated computers and tablets, she said. Therapists and students need access to reliable Wi-Fi connections.
White said there has been a learning curve for most clinicians transitioning their therapy sessions from in person to virtual while retaining quality services. But she said resources through the American Speech-Language-Hearing Association and other online programs have helped speech pathologists to acclimate to tele-practice services.
Issue: There are several strategies, depending on a student’s overall prognosis and level of severity, speech-language pathologists can use to help students retrain their current levels of functioning and reduce potential regression during remote learning, according to White.
“The most important strategy is the provision of carryover activities and asynchronous lessons for parents to implement with their child in between therapy sessions to address goals and maintain skills,” she said. “This allows students to continue working on their skills and applying them within a naturalistic environment, where the parent can provide feedback to the school-based clinician in the upcoming therapy session.”
As districts have relied more on parents during the pandemic to monitor and help their children with remote services, collaboration between pathologists and parents has increased. Such collaboration incorporates clear expectations, strategies, and resources for parents.
Solution: White said speech pathologists may consider reexamining service delivery models. Some students may benefit from individual interventions. To reduce distractions, provide moderate to maximum prompting or greater differentiation in the therapy activities. Other students may benefit from group and classroom-based sessions to reinforce what the student is learning in the academic setting and curriculum.
Issue: “From a compliance standpoint, school-based [speech pathologists] should abide by their state and school district’s mandates pertaining to the documentation of services related to the student’s performance, progress, and participation in therapy,” said White.
Solution: White said speech pathologists should document all services, both direct and indirect to maintain accurate records of student engagement and progress toward her IEP goals.
“If there are barriers to the provision of services, it should be recorded in the therapy log note [in case the pathologists] need to refer back to the information at a later date and time,” said White. “Adequate and current documentation should contain information that could support modifications in service delivery or prescription, therapy amount and frequency, if needed. Documentation should include both qualitative and quantitative representations of the student’s performance in therapy sessions and address the goals outlined on the student’s IEP.”
Johnny Jackson covers special education issues for LRP Publications.