Evaluation and Eligibility for Speech-Language Services in Schools

Evaluation and Eligibility for Speech-Language Services in Schools

The terms used to describe entry and exit criteria for school-based services vary across the country. Some frequently used terms include eligibility, entry, exit, and dismissal. Regardless of what terms are used, it is critically important that speech-language pathologists (SLPs) understand the difference between the federal, state, and local requirements for an educational identification of a speech-language impairment or need for services under the Individuals with Disabilities Education Act (IDEA) and the procedures used for a clinical determination of speech or language impairment.

Overview of Regulations and Guidance

Speech and language services that are provided in schools to students with disabilities are offered as “special education and related services” under IDEA. The Individuals With Disabilities Education Act guarantees all children with disabilities a free and appropriate public education. Each state must follow the IDEA federal regulations, 34 CFR Parts 300 and 301 Assistance To States For The Education Of Children With Disabilities And Preschool Grants For Children With Disabilities Final Rule (U.S. Department of Education, 2006; 34 CFR § 300-301) and develop their own state regulations (34 CFR § 300.149 b.). States may refer to these using a variety of terms including: “State Regulations” (VA), state “Rules” (CO, WI), or “Administrative Code Rules” (OH) “State Rules and Regulations” (AK), “State Board Policy” (MS), “Alabama Administrative Code” (AL), and “Arizona Revised Statutes” (AZ). For the purposes of this article, the term “state regulations” will be used. State regulations must follow IDEA federal regulations, but may also include additional requirements, frequently referred to as eligibility criteria. In some states, eligibility criteria may also be known as “operational definition.” Because any additional requirements added must be followed and are only applicable in that particular state, SLPs must be aware of the specific requirements for their state in order to remain in compliance with federal and state regulations. A local education agency (LEA), sometimes called a school district or school division, may also develop additional policies or procedures that must be followed. The American Speech-Language-Hearing Association's (ASHA's) policy document, Guidelines For The Roles And Responsibilities Of The School-Based Speech-Language Pathologist, highlights assuring compliance with IDEA and state education agency (SEA) regulations in addition to local policies and procedures as a key responsibility of school based SLPs (ASHA, 2010).

In addition to federal and state regulations, guidance documents may assist SLPs in understanding the federal and state regulations and best practice within the profession. Each SEA and LEA may determine if guidance is needed on a particular topic. Additionally, guidance from professional associations, such as ASHA, state speech-language-hearing associations, and related organizations, may inform the work of school SLPs. While regulations establish the framework of what is required, guidance generally provides additional information about how tasks should be done.

When regulations and guidance conflict, it is important to understand who has jurisdiction, the official power to make legal decisions and judgments. For school-based SLPs, federal and state regulations and local policies and procedures must be followed. Guidance from state and local education agencies, ASHA, and other professional associations may assist professionals in clinical decision making and advocacy, but do not supersede official regulations.

Services Under IDEA

Students who meet criteria set forth in federal regulations, and any additional state regulations for one of the 14 disability categories is eligible to receive “special education and related services.” Speech-language impairment (SLI) is one of the 14 categories in IDEA federal regulations. Although most states use the term SLI, some may use another disability category name such as “Language Impaired” (MS) and “Speech Impairment” (ND).

The federal definition of special education requires that in order to be identified as a student with a disability, the student (1) have an impairment, that (2) results in an educational impact, that (3) requires specially designed instruction (34 CFR § 300.8). Federal and state regulations also set forth specific requirements for some disability categories (such as SLD). Students may be identified with up to three disability categories (a primary, secondary, and tertiary identification) according to IDEA. Additionally, under IDEA, students who do not meet state eligibility criteria for speech-language impairment may still receive speech and language services as a related service. In order to receive related services, a child must be eligible under at least one disability category and the child's Individual Education Program (IEP) team must determine that speech and language services are required (§300.304).

Under IDEA and state regulations, all educational decisions are made by the team. No single person may determine if a child is eligible for services or determine the amount or type of services.

Eligibility for SLI Identification

Speech-language impairment is defined in IDEA as “a communication disorder, such as stuttering, impaired articulation, a language impairment, or a voice impairment, that adversely affects a child's educational performance,” (34 CFR §300.8 a 11). Many states, including Louisiana, Ohio, Hawaii, Tennessee, Arizona, South Carolina, and North Dakota, use the federal definitions and/or regulations as written. Additional criteria or clarification, including exclusions, may be added to individual state's education regulations. Examples of states that have added additional requirements include Colorado, Florida, Oregon, and Virginia. States may not limit or reduce federal requirements under IDEA.

Some states may reiterate the federal requirements for eligibility under IDEA, in their state regulations. An example of this is the North Carolina requirement “for a student to be considered for intervention, the student's speech, language, voice, or fluency must be determined to have an adverse effect on educational performance,” (North Carolina Department of Public Instruction, 2010, NC 1500-2.11 b (16)). Another example of a reiteration of federal regulation is Ohio's definition of “a communication disorder, such as stuttering, impaired articulation, a language impairment, or a voice impairment, that adversely affects a child's educational performance,” (Ohio Department of Education, 2014, 3301-51-01 B 10 d xi).

There are many states that have added specific criteria into their state regulations. This additional regulatory language may (1) provide clarification for requirements for special education evaluation or (2) force teams to examine and document possible factors in order to prevent inappropriate identification of students with disabilities. The federal government's State Performance Plan (SPP) IDEA Indicators 9 and 10 require that states collect data on disproportionate representation in special education by race (indicator 9) and disability category (indicator 10)¹. This federally mandated data collection has increased attention to evaluation and eligibility practices in states. Table 1 includes examples of additional criteria found in various state regulations.

When states utilize terms such as “significant discrepancy” and no specific definition is provided, each LEA may further define criteria for services under IDEA by interpreting state and federal regulations. These interpretations may be provided in either local policy or offered as guidance. Individual SLPs do not have the interpretive authority—the right to interpret or clarify regulations—and must adhere to local interpretations and work as part of the team. It is vital that SLPs be aware of and understand state regulations and any applicable guidance to ensure appropriate eligibility decisions in compliance with state and federal regulations.

Related Services

Speech-language therapy is a related service available to students with disabilities when the IEP team determines that it is required for the student to benefit from special education. When speech-language services are added as a related service, the criteria for related services is used, not the federal and state regulations for SLI identification. Although some states may have specific criteria, others may use the definition of related services from IDEA, “services as are required to assist a child with a disability to benefit from special education,” as the criteria for addition of related services. Individual Education Program teams, including school-based SLPs, should have data to document their decision that services are required.

Some children may require specific services to be written into their IEP so they can benefit from their special education program. In order to make decisions about related services, IEP teams should review evaluation data and document their decisions. Related service providers with expertise should have input and may be a part of the IEP team or may contribute information in writing or by consulting with parents or staff. Some states, such as Arizona, Florida, North Carolina, and Virginia, offer guidance for related services to assist IEP teams with evaluation and decision making.

No Longer Eligible: Dismissal or Exit from Services

When it is believed that a student no longer requires services, the IEP team should be gathered to review data and determine next steps. This decision making process is delineated in state and local regulations. The process may vary between states, by locality, or depending on whether the child has an identification of SLI or is receiving speech-language services as a related service.

For a child with an SLI identification under IDEA, the team determines if a child is eligible as or continues to be a child with a disability. When a student no longer meets the required federal and state criteria, then their identification as a child with SLI ends. There is no separate federal criteria to end services, and all requirements for evaluation and documentation apply when considering a child who may no longer be eligible under the category of SLI.

Similarly, students who receive speech-language services as a related service have no separate federal criteria for ending a related service. In the absence of any state or local criteria, IEP teams must review the data and determine if the services continue to be required or are no longer required. Once again, SLPs must utilize state regulations and any applicable guidance to ensure compliance with state and federal regulations when considering whether or not students continue to receive services in schools under IDEA.

Evaluations of Students for Speech and Language Services

Although SLPs are trained clinically to determine if an impairment exists, school-based SLPs must work as part of an interdisciplinary team that uses a variety of assessment tools and strategies to gather developmental, functional, and academic information (U.S. Department of Education, 2006; CFR 300.304). The team's evaluation should consider a student's abilities across tasks and settings to examine a student's communicative functioning in an educational program. Data from teachers, parents, and the student are necessary to examine not only the student's strengths and weaknesses, but the impact on the student's education and their need for specially designed instruction. Speech-language pathologists must ensure that their evaluation practices align with IDEA regulations and any state regulations or local requirements. Additionally, guidance is provided by many states and ASHA to assist SLPs with implementation of assessment practices that are evidence-based.

Regulations on Evaluation

The Individuals with Disabilities Education Act provides explicit regulations on evaluation that pertain to all disability categories, including SLI. Evaluation is a process that begins with a review of existing data. If existing data is not sufficient, then the team determines what additional data is required (34 CFR §300.305 a). It is vital that school-based SLPs view themselves as part of a team that will “draw upon information from a variety of sources, including aptitude and achievement tests, parent input, and teacher recommendations, as well as information about the child's physical condition, social or cultural background, and adaptive behavior” (U.S. Department of Education, 2006, CFR 300.306 c i). This data from multiple sources is critical to decision making since IDEA prohibits the use of “any single measure or assessment as the sole criterion for determining whether a child is a child with a disability and for determining an appropriate educational program” (U.S. Department of Education, 2006. CFR 300.304 b. 2). Additional regulations on evaluation procedures set forth requirements for all evaluations and address issues such as bias, culture, and cultural and linguistic differences. IDEA §300.304 requires the use of technically sound instruments that are selected and administered not to be discriminatory on a racial or cultural basis, and these instruments must be provided in the child's native language or other mode of communication and in the form most likely to yield accurate information.

Beyond IDEA's federal requirements, state regulations and local policies and procedures governing evaluation and eligibility decision making may include additional considerations or processes. Some states have added regulations that address the need for more comprehensive evaluation practices or that list assessment methods or techniques that are evidence-based and deserve recognition even though they may not provide a standardized score. Some examples from various states are included in Table 2.

Guidance on Evaluation

Specific guidance on evaluation, to assist SLPs in understanding how to implement the federal and state regulations, may be available in states. This guidance may be general and describe the evaluation process, highlight research and best practice, or specifically address a topic that state education agency staff have found problematic. In 2012, Spaulding acknowledged that “due to limited guidance offered by both ASHA and the research literature, school-based clinicians may turn to their state education department to identify recommended procedures” (Spaulding, Szulga, & Figueria, 2012, p. 179).

Areas with specific guidance, including diagnostic accuracy, comprehensive assessment, culturally sound assessment, and the impact of poverty, are examined in greater detail below. Ultimately, school-based SLPs should be familiar with state regulations and guidance pertaining to evaluation published by their SEA and/or LEA and ensure that their own evaluation practices align with state and federal requirements.

Diagnostic Accuracy of Assessment Instruments

For more than a decade, researchers have suggested that norm-referenced measures should have at least 80% accuracy in discriminating language abilities (Spaulding, Plante, & Farinella, 2006). Speech-language pathologists should review assessment instruments and consider the diagnostic accuracy, sensitivity, and specificity prior to use in educational evaluations (Spaulding et al., 2006). In a 2013 study, Betz, Eickhoff, and Sullivan (2013) reported “the most discouraging finding […] was the lack of correlation between frequency of test use and test accuracy” (p. 141).

State guidance that addresses overreliance on standardized assessment include “Standardized speech-language tests measure decontextualized communication skills using formalized procedures. Administered outside the normal contexts in which the child communicates, they capture neither the complexities nor the subtle nuances of the communication process,” (Connecticut State Department of Education, 2008, p. 23).

Additionally, SLPs are cautioned against reliance “solely, or even primarily, on norm-referenced assessment instruments to determine a student's communication abilities,” (Virginia Department of Education, 2011, p. 17). Even when tools selected meet criteria for diagnostic accuracy, careful review of test norms with consideration of the individual student is required.

Comprehensive Assessment

A comprehensive assessment by an SLP provides a picture of a child's functional language skills in relation to his/her ability to access the academic, and/or vocational program, and to progress in the educational setting (Virginia Department of Education, 2011). A variety of data sources should be used to gather valuable information about the student's use of his/her communication skills in school. School-based data, including contextualized measures (e.g., statewide assessment) and academic activities (e.g., classwork and classroom observations) should be combined with data gathered by the SLP, including decontextualized tests (e.g., standardized or norm referenced tests) and SLP probe data to provide a comprehensive look at the student's communication abilities (Moore & Montgomery, 2008). Many states recognize the importance of SLP probe data and include in their guidance information on dynamic assessment data, discourse assessment (e.g., language sample analysis and narrative assessment), play-based assessment, speech intelligibility measures, checklists, assessment of metacognitive and metalinguistic skills, and history and interview information from student, teacher, and parents/caregivers (Colorado Department of Education, 2013; North Carolina Department of Public Instruction, 2006; Virginia Department of Education, 2011).

For example, in Florida, a language impairment is documented based on a comprehensive language evaluation, which includes an observation, standard score(s) significantly below the mean, and information gathered from parents and teachers. These pieces of data must align and show evidence of significant language deficits that interfere with the student's performance and/or functioning in the educational environment (Florida Department of Education, 2010, SBE Rule 6A-6.030121, (7)(c), F.A.C.).

Federal regulations require that teams “use a variety of assessment tools and strategies” and that “no single measure or assessment [be] used as the sole criterion” for determining eligibility for services (U. S. Department of Education, 2006; 34 CFR §300.304 b). The integration of additional data, including systematic observations and contextualized assessments, is needed to create a complete picture of a student's communication skills.

Each student presents with unique skills and abilities that are impacted by their life experiences and communication partners. Cultural differences and socioeconomic status have been shown to impact language and academic performance (Roseberry-McKibbin, 2012) and should be considered when developing an individualized approach to student assessment and during analysis and interpretation.

Cultural Considerations in Assessment

A lack of cultural sensitivity may result in inadvertent over-identification of language learning impairments by identifying dialectally and culturally acceptable productions as inadequate relative to Standard American English. Test items that require a high level of knowledge and experience with mainstream culture are considered to have a high “cultural load.” Test items that require a high level of proficiency with English are considered to have a high “language load.” Ortiz reported that students with cultural and linguistic differences may score substantially lower (up to 35 points) than peers due to language and cultural differences (Ortiz, 2005).

Dialects and Non-standard Varieties of English

Although non-standard varieties of English are rule-governed, patterned, and predictable, they still may be viewed as inferior to Standard American English (Charity & Mallinson, 2011). Assessments requiring Standard American English (SAE) may result in an underrepresentation of ability or achievement when assessing students using a dialect such as Southern White English (SWE) or African American English (AAE) or those whose native language is not English. The SLP should be able to identify and distinguish contrastive features (features unique to the dialect) versus non-contrastive features (features shared with SAE) in order to differentiate a language disorder from a language difference (Bland-Stewart, 2005). Educators who are familiar with common dialect features should identify dialectical differences when reviewing language or writing samples.

The Impact of Poverty on Language and Learning

In his 2004 article, Barton highlights the striking relationship between language and socio-economic status when he reveals that “Three-year-old children in professional families had a vocabulary as large as that of the parents [Emphasis added] in the study who were on welfare,” (Barton, 2004, “Home Learning Conditions”). Low socio-economic status (SES) students have been shown to be particularly at risk for difficulties with language and academic skills (Pruitt & Oetting, 2009; Roseberry-McKibbin, 2012). During an assessment, SLPs should examine background knowledge, experience with narratives, exposure to Tier II vocabulary, understanding abstract and decontextualized language, and perseverance and self-efficacy skills carefully to discern lack of exposure (e.g., difference) from disorder.

Evaluation Components

Once a team determines a speech and language evaluation is required and consent is provided, the SLP determines the appropriate components to gather. Consideration of the issues raised by team members, specific areas of concern, and research and best practice information on assessment should guide the selection of tools and techniques that are individualized for each student. Using data sources beyond standardized and norm-referenced tests provides the opportunity to conduct a culturally sensitive assessment that considers individual student differences within the context of their home, community, and school environment (Betz et al., 2013: Horton-Ikard, 2010).

Case History and Interviews

A case history is essential for gathering information on the development of a student's speech-language skills, significant birth and medical history, and academic, social, and emotional functioning. Additionally, it provides information about language models and language use in the community.

Interviews with parents, service providers, teachers, and the student provide valuable information about a student's effectiveness in communication. This information can provide insight into how the student's speaking, listening, writing, and reading skills are impacted by the student's speech and language skills in various environments. Student interviews, when appropriate, can disclose the student's perception of his or her communication skills and his or her motivation to address these skills. Free online modules examining critical questions for interviews are available from the Law and Evidence-based Approaches for Disability Evaluation and ReSources (LEADERSproject; Crowley, 2015).

Review of Student Work

This school-based information is a vital source of data for documenting the educational impact of a communication deficit.

Language Disorders from Infancy Through Adolescence: Assessment and Intervention by Rhea Paul (Paul, 2006) provides detailed information about use of student work in assessment.

Narrative Analysis and Language Sample Analysis (LSA)

Difficulties with narrative comprehension and production have been linked to students' difficulties with reading comprehension, writing, and social achievement (Schachter & Craig, 2013). Narratives are sensitive indicators of language impairment in students; children and adolescents with compromised language skills typically produce shorter, less complete, and less elaborate narratives than their same-age, typical peers. Therefore, assessment of students' narrative abilities is an essential part of a comprehensive speech-language assessment.

“The diagnostic accuracy of distinguishing a language difference from language impairment is substantially increased when LSA is used in conjunction with standardized testing” (Horton-Ikard, 2010, p. 17). Research shows that the diagnostic accuracy of narrative retells is high in addition to being a sensitive indicator of language impairment. This makes LSA a valuable tool in resolving the difference vs. disorder conundrum (Horton-Ikard, 2010; Peña, Gilliam, & Bedore, 2004).

Dynamic Assessment

Dynamic assessment (DA) is a vital source of data for documenting the need for specialized instruction as part of determining eligibility for services under IDEA. In their article Dynamic Assessment of Diverse Children: A Tutorial, Gutierrez-Clellen and Peña (2001) explore graduated prompting, testing limits, and test-teach-retest. Dynamic assessment using the test-teach-retest method allows SLPs to systematically assess a student's ability to improve speech-language performance and determine the intensity of intervention required. This data can be used to distinguish speech-language impairments from speech-language differences (English as a second language/English language learner, nonmainstream dialect, at-risk populations). Dynamic assessment yields data-based recommendations for use in classrooms and intervention plans. Speech-language pathologists can use principles of dynamic assessment for a variety of tasks, including narratives, articulation, and fluency assessments. Peña et al. (2014) report that dynamic assessment consistently demonstrates good classification accuracy when attempting to differentiate children with diverse cultural and linguistic backgrounds from those with true language impairment.

Other Considerations for School Based SLPs

In addition to consideration of regulations and guidance for eligibility decision making, school-based SLPs should be aware of other topics or issues that may impact professional practice.

Educational Identification and Clinical Diagnosis

Prescriptions, diagnosis, or reports from professionals must be considered by the school-based team, but are not sufficient to make an eligibility or related service determination. The Individuals with Disabilities Education Act requires that the group consider information from multiple sources that documents the presence of an impairment, the adverse impact on educational performance, and the need for specially designed instruction. Additionally, teams must adhere to any state or local criteria.

School-based SLPs should be prepared to address the difference between educational identification under IDEA and clinical diagnosis of SLI. One way to highlight the difference is to review the criteria for the specific disability category mandated by IDEA and their own state and local special education regulations. Speech-language pathologists and teams should, and in some states are required to, have data to substantiate the educational impact and need for specially designed instruction that is a direct result of the child's impairment. It is possible for a student to have a clinical diagnosis of SLI but not meet the federal and state criteria for an educational identification as a child with a speech-language impairment under IDEA or require services through an IEP.

Multi-Tiered System of Supports (MTSS) and Response to Intervention (RtI)

Although this article addresses the requirements and best practice for identification of students under IDEA, many SLPs are increasingly being asked to support students in other programs that support students who may be struggling such as MTSS and RtI. To ensure compliance with state and federal requirements, SLPs should learn about state and local requirements for participation in MTSS and RtI initiatives. Some SEAs or LEAs may provide funding for or relief from IDEA work assignments that can be used to create a balanced workload. Although SLPs are qualified to address many areas of concern, it is critical that they understand the differing requirements between IDEA requirement and services and other programs.

Cognitive Referencing

Cognitive referencing is the practice of comparing IQ and language scores for the purpose of eligibility decision making for speech-language intervention. This practice is based on the assumption that language functioning does not surpass cognitive levels. “Research results in recent years have demonstrated that cognitive prerequisites are neither sufficient nor even necessary for language to emerge,” (ASHA, n.d., para. 1) The use of cognitive referencing is not supported by many states. For example, West Virginia guidance states that

Virginia's guidance states that, “students with significant impairments of intellect may respond well to speech-language interventions, therefore improving their ability to succeed academically and in the community,” (Virginia Department of Education, 2011, p. 30).

Furthermore, peer-reviewed articles such as Basing eligibility on discrepancy criteria: A bad idea whose time has passed (Nelson, 2000) and ASHA's Cognitive Referencing resources (ASHA, n.d.) for professionals should be considered with respect to state and local regulations.

Conclusion

Speech-language pathologists must understand the difference between educational identification under IDEA and clinical diagnosis of SLI and the requirements of IDEA and any state and local regulations. As members of the team, SLPs must adhere to their state eligibility criteria and special education regulations when making determinations about eligibility for services.

State education agencies and professional associations provide many resources for school-based SLPs. Table 3 provides examples of state guidance documents that are available to assist SLPs and teams with decision making. The State Education Agencies Communication Disabilities Council (SEACDC) maintains a list of states with guidance documents for SLPs. A resource to assist school-based SLPs in reviewing state and local requirements and increase awareness of specific state requirements and availability of guidance, the Checklist of Requirements for Determination of SLP Services In Schools tool, is available as a free download (State Education Agencies Communication Disabilities Council, 2016).

Utilizing data from multiple sources and avoiding overreliance on standardized norm-referenced tests when presenting information to the team is paramount. The limited diagnostic accuracy of standardized assessments and utility of evidence-based assessment techniques such as language sample analysis and dynamic assessment should be considered. A comprehensive assessment that attends to the student's unique presentation and considers the potential impact of dialect, low socioeconomic status, and cultural differences is vital for decision making.

Teams should be able to clearly differentiate between clinical and educational decision making requirements and be aware of their state's regulations or guidance on topics such as cognitive referencing, the role of the SLP, and supports available to students outside of IDEA (e.g., RtI or MTSS).

When considering if a student meets entry or exit criteria for services, SLPs must follow all state regulations and local policies and procedures and should be aware of non-binding guidance available to assist members of the IEP team in making a determination of need for services.

Use of state-specific criteria is required and consideration of guidance and best practice information is critical. Recall that state eligibility criteria may contain specific language to: (1) mandate use of specific evaluation practices and ensure adequate documentation, (2) document the presence or absence of specific features, or (3) provide exclusions intended to limit mis- or over-identification. Additionally, attention to research and evidence-based practice recommendations for diagnostic accuracy, analysis and interpretation of assessment, considerations for culture and socioeconomic status, and other factors is vital for the decision making process.

Author Note

We would like to acknowledge the members of the State Education Agency Communication Disabilities Council (SEACDC) for sharing specific state regulations and guidance used as examples in this article. Additional information can be found online at http://www.seacdc.org/resources.html. Correspondence concerning this article should be addressed to Marie Ireland [email protected] or Barbara J. Conrad [email protected].

Author Notes