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					        Context for Change

   DR. SHANNON HALL-MILLS, PH.D., CCC-SLP
                 FLDOE/BEESS
                    &
      DR. CAROLYN FORD,Ed.D., CCC-SLP
USF / DEPT. COMMUNICATION SCIENCES & DISORDERS
       Background – Context for Change

• A wave of policy changes has been sweeping through the
  states to better align with updated federal (IDEA, ’04)
  and state regulations for students with disabilities,
  and reflect current knowledge, reflect evidence-
  based and current best practices.
• Initiatives such as Response‐to‐Intervention (RtI)
  and the role of scientifically research based
  instruction and evidence based interventions in
  decision‐making have required states to reconsider
  methods for evaluation, eligibility determination, and
  implementation of services for students with disabilities.
      Background – Context for Change

 Changes affect all “program” areas of exceptionality,
  including speech and language impairments.
 Professionals are challenged to embrace
  shifting roles and responsibilities to meet the
  diverse needs of students.
       Background – Context for Change
                                          Parents
                             Teacher
                              s, etc.                 SLPs


                                                                    School
                                                                 Administrators
              Community
                                                                    District
                                                                 Administrators


                           University                  FLASHA
                            Faculty                    / ASHA

                                        Government
                                         Officials


•    Policy changes in Florida have taken place through collaborative efforts across a
    variety of stakeholders throughout the state: parents, teachers, SLPs, school/district
       administrators, community, university faculty, and professional associations.
History of Speech/Language Rule Revision
in Florida

 3 year process
 8 rule development workshops with opportunity for
  public input
 Purpose of revision:
     reflect current knowledge in the field
     update practice in accordance with current best practice
     better align with recently revised related SBE rules
 Proposed rule organization similar to current rule
 Content differs significantly
           Workgroup’s Topics of Discussion

• Included in the discussion:
  – Federal & state regulations

  – Rules of eligibility from other states

  – Rule vs. policy vs. guidance
      •   Implications for implementation
      •   Role of ongoing TA and updated resources
  –   Concurrent SLD and general rule revision
  –   Clarity & flexibility of requirements in rule
  –   Role of clinical/professional judgment
                Workgroup’s Challenges

• Redefining eligibility for Speech Impairment (SI) and
 Language Impairment (LI) without traditional
 limitations such as:
 –   Cognitive referencing
 –   Discrepancy formulas
 –   Strict cut-off scores
• Determining significance and adverse effect of an
 impairment (speech or language)
 –   Relation between significance and adverse educational impact
• Updating definitions
• Outlining minimal evaluation practices
• Addressing eligibility (speech and language)
Key Changes – General Education Intervention
          Procedures & Activities

 Adherence to general education intervention
 procedures and activities
  outlined   in SBE Rule 6A-6.0331, F.A.C., General
   Education Intervention Procedures, Identification,
   Evaluation, Reevaluation and the Initial Provision of
   Exceptional Education Services.
            Key Changes – Evaluation


Scores as snapshots…
• “A profile of scores is no
  more the reality of a
  person than is a portrait
  taken in a photo studio.”
 (p. 30, King, 2000)
             Key Changes - Evaluation

• Office of Special Education Programs (OSEP)
 letter to ASHA (2007)…
 –    “…public agency must use a variety of assessment
     tools and strategies to gather relevant functional,
     developmental, and academic information.”
            Key Changes - Evaluation

• Evaluation components will include:
  – Review of data indicating results of evidence‐based
    interventions for identified areas of concern
    (whether in general or special education setting),
  – Information gathered parent/guardian, teacher(s),
    student re: language concerns
  – Observation(s) of student’s language skills in one or
    more settings
  – One or more standardized norm‐referenced
    instruments designed to measure language
    (alternative instruments as necessary)
               Key Changes – Eligibility

• Removal of cognitive referencing and discrepancy
 formulas from eligibility criteria because:
 •   IQ scores reflect current abilities, not potential for language
     learning (Krassowski & Plante, 1997).
 •   The notion that cognition limits language development so
     that language cannot exceed cognitive performance levels is
     unfounded (Kamhi, 1998; Lahey, 1996).
            Key Changes - Eligibility

 Eligibility for language impairment (LI) will occur
 within an RtI framework (using a problem-solving
 model) already established in Florida policy.

                           Few


                           Some




                           All
               Key Changes - Eligibility



 Relation between LI             Allowance for
 and SLD:                         pragmatic language
    Explicit acknowledgement     impairment
     of similarities between         Additional observation
     academic manifestation of        required
     LI and SLD
    Alignment of LI and SLD
     rules
           Key Changes - Eligibility


 Requirement to document the adverse effect of the
 speech or language impairment on the student’s
 ability to perform and/or function in the typical
 learning environment, thereby demonstrating the
 need for exceptional student education.
        A Note Regarding Adverse Effect
  Office of Special Education
  Programs (OSEP) letter to
        ASHA (2007)…
• “Education performance is
  not limited to academic
  performance.”
• Effects determined on a
  “case‐by‐case basis,
  depending on unique needs
  of a child, not based only
  on discrepancies in age or
  grade performance in
  academic subject areas.”
           Key Changes – In Summary


 Increased reliance on:
   Significance & educational impact of the communication
    impairment
   Collaborative problem‐solving team and data-based decision
    making
   Review of all available data from multiple sources

   Clinical/professional judgment
       Tell me more…

  MORE ABOUT THE RELATION BETWEEN
  LANGUAGE AND COGNITION AND WHY
COGNITIVE REFERENCING FOR ELIGIBILITY
  DECISIONS IS A PAST PRACTICE FOR LI
                 Language and Cognition



The relationship between                Correlational data suggest
language and cognition is               multidirectional
dynamic and complicated                 relationships between
(ASHA, 2002; Casby, 1992; Cole, 1996;   language and cognition
Notari, Cole, & Mills, 1992).
                                        (Casby, 1992; Kamhi, 1998).
               Language and Cognition



 The notion that cognition limits language
 development so that language cannot exceed
 cognitive performance levels is unfounded (Kamhi,
 1998; Lahey, 1996).


 Scores on IQ tests can fluctuate across & within tests
 over time, so discrepancies can be unstable.
               Language and Cognition


 Some comparisons of cognitive and language scores
 may yield discrepancies when others do not (Aram,
 Morris, & Hall, 1992; Cole, Mills, & Kelley, 1994; Nelson, 2000).
 Some comparisons vary across different points in
 development over time (Cole, Dale, & Mills, 1992; Cole,
 Schwartz, Notari, Dale, & Mills, 1995).
                       Cognitive Referencing


•Evidence of children with commensurate language and
cognitive abilities benefiting from language intervention at
least as much as children with the discrepancy between
language and cognition (Cole, Dale, & Mills, 1990; Dale & Cole, 1991; Notari, Cole,
& Mills, 1992) and in some cases, more so (Cole, Coggins, & Vanderstoep, 1999; Fey, Long, &
Cleave, 1994).


•IQ scores reflect current abilities, not potential for language
learning (Krassowski & Plante, 1997).
           The Discrepancy Approach

• Shaywitz, Escobar, Shaywitz, Fletcher, and
 Makuch (1992) defined “reading disability” as a
 discrepancy between “the level of reading ability
 predicted on the basis of intelligence (ability) and
 the actual level of reading achievement” (p. 146).

• Also used in defining mental retardation, but
 challenged in the courts and in the research on
 the language/dialect factor in IQ tests. IQ tests
 are never strictly nonverbal.
Faulty Logic of the Discrepancy Approach


 It depends on a poor showing on one test... but a
  bad day on any test is not a good basis for a
  diagnosis.
 No one ever proposed judging over-achievement
  as a discrepancy between low IQ scores, say, and
  high language proficiency... and it would not make
  sense to do so because IQ scores, for the most
  part, are language proficiency scores...
               Measurement Concerns

Comparisons are made based on norm-referenced language
  tests, which:
• focus on narrow aspects of language (receptive
  vocabulary) rather than broader aspects (discourse,
  pragmatics) (ASHA, 1989; 2000);
• do not include valid, technically adequate, age-
  appropriate tools to assess all aspects of language for all
  language levels (ASHA, 2000);
• often lack adequate validity and reliability (ASHA, 1989);
• are more likely reflecting factors of cognition,
  achievement, ethnicity, and motivation (ASHA, 1999, 2000).
            Other Measurement Concerns


•   Psychometrically incorrect to compare scores across
    tests having varied standardization populations and
    theoretical bases (ASHA, 1989; Whitmire, 2000).
•   “No pure measures of either verbal or nonverbal
    abilities; children with language difficulties exhibit
    problems with nonverbal tasks that could affect their IQ
    scores (Sattler, 1988), thereby leading to a convergence of
    test scores.” (ASHA, 1989; 2000)
•   Cognitive tests likely reflect language difficulties (Francis,
    Fletcher, Shaywitz, Shaywitz, & Rourke, 1996; Nelson, 2000).
Evidence Based Practice

INFLUENCE OF EBP IN EVALUATION &
     ELIGIBILITY PRACTICES
                Evidence Based Practice

 The goal of EBP is the integration of:
  (a) clinical expertise,
  (b) best current evidence, and
  (c) client values to provide high-quality services reflecting the
     interests, values, needs, and choices of the individuals we serve.
 Conceptually, the trilateral principles forming the bases
  for EBP can be represented through a simple figure:
                    Relevance of EBP

Consider the definition of EBP:
    “The American Speech-Language-Hearing Association
     (ASHA) defines evidence-based practice (EBP) as a
     clinical decision-making process that fosters the
     integration of high-quality research evidence with
     clinician expertise and client preferences” (p. 2, Hall-Mills &
     Apel, 2007).
    EBP is accomplished via an integration of best available
     evidence for diagnostic and treatment methods with
     sound clinical expertise and judgment (Hegde & Maul, 2006).
   Workgroup considered EBP in light of…

 Evaluation components for all evaluations of speech
  and language
 Assessment considerations for children from
  culturally & linguistically diverse backgrounds (CLD
  populations)
 Determination of eligibility
 Application of scientifically-based research
 Evaluation & Determination of Eligibility;
           Basis in EBP (cont’d)

 Identification of language impairment by using an
  arbitrary low cutoff score is “frequently unsupported
  by the evidence that is available to clinicians in test
  manuals” (Spaulding, et al 2006).
 “It is inappropriate to use severity cut-off scores (e.g.,
  1.0, or 1.5 SD below the normative group mean) applied to
  standardized tests as the sole determinant of
  eligibility.” (ASHA, 2000).
 “…severity is not the sole determinant of whether a
  condition adversely affects educational performance.”
    (ASHA, 2000).
Evaluation & Determination of Eligibility
         Based on EBP (cont’d)

   Assessment considerations for children from culturally &
    linguistically diverse (CLD) populations:
       Consider cultural and linguistic biases inherent in many
        standardized assessment tools (Hedge & Maul, 2006; Roseberry-
        McKibbin, 2002).
       Consider advantages of dynamic assessment (ASHA, 2000) and
        child-specific procedures such as observations and language
        sampling (Hegde & Maul, 2006).
Evaluation & Determination of Eligibility
         Based on EBP (cont’d)

Evaluate data regarding the application of
 eligibility criteria:
  use of multiple sources of evidence in determining
   eligibility,
  “mismatches” between eligibility/dismissal criteria &
   service delivery model may reflect questionable clinical
   practice (Apel & Schulman, 2001),
  Strong body of evidence across three decades,
   challenging the use of cognitive referencing in
   determining eligibility for services.
                Scientifically based research …

 In IDEA [reference to the definition in section 9101(37) of the ESEA]
Scientifically based research -
(a) Means research that involves the application of rigorous, systematic, and objective procedures
    to obtain reliable and valid knowledge relevant to education activities and programs; and
(b) Includes research that –
    (1) Employs systematic, empirical methods that draw on observation or experiment;
    (2) Involves rigorous data analyses that are adequate to test the stated hypotheses and justify
    the general conclusions drawn;
    (3) Relies on measurements or observational methods that provide reliable and valid data
    across evaluators and observers, across multiple measurements and observations, and across
    studies by the same or different investigators;
    (4) Is evaluated using experimental or quasi-experimental designs in which individuals,
    entities, programs, or activities are assigned to different conditions and with appropriate
    controls to evaluate the effects of the condition of interest, with a preference for random-
    assignment experiments, or other designs to the extent that those designs contain within-
    condition or across-condition methods;
    (5) Ensures that experimental studies are presented in sufficient detail and clarity to allow for
    replication or, at a minimum, offer the opportunity to build systematically on their findings;
    and
    (6) Has been accepted by a peer-reviewed journal or approved by a panel of independent
    experts through a comparably rigorous, objective, and scientific review.
               Scientifically based research …

   In Florida, SBE Rule 6A-6.03411(1)(ff), F.A.C., Definitions, ESE Policies and Procedures,
    and ESE Administrators.
(ff) Scientifically based research. Scientifically based research means research that involves
    the application of rigorous, systematic, and objective procedures to obtain reliable and
    valid knowledge relevant to education activities and programs, and includes research
    that:
1. Employs systematic, empirical methods that draw on observation or experiment;
2. Involves rigorous data analyses that are adequate to test the stated hypotheses and justify
    the general conclusions drawn;
3. Relies on measurements or observational methods that provide reliable and valid data
    across evaluators and observers, across multiple measurements and observations, and
    across studies by the same or different investigators;
4. Is evaluated using experimental or quasi-experimental designs;
5. Ensures that experimental studies are presented in sufficient detail and clarity to allow for
    replication; and
6. Has been accepted by a peer-reviewed journal or approved by a panel of independent
    experts through a comparably rigorous, objective, and scientific review.
                                  References

 Aram, D. M., Morris, R., & Hall, N. E. (1992). The validity of discrepancy criteria for
          identifying children with developmental language disorders. Journal of
          Learning Disabilities, 25, 549-554.
   American Speech-Language-Hearing Association. Committee on Language Learning
          Disorders. (1989, March). Issues in determining eligibility for language
          intervention. Asha, 31, 113–118.
   American Speech-Language-Hearing Association. (1999). IDEA and your caseload:
          A template for eligibility and dismissal criteria for students 3–21. Rockville,
          MD: Author.
   American Speech-Language-Hearing Association. (2000). Special Interest Division
          1: Language Learning and Education Newsletter, 7(1), 3–29.
   American Speech-Language-Hearing Association. (2004). Admission/Discharge
          Criteria in Speech-Language Pathology [Guidelines]. Available from
          www.asha.org/policy.
   Casby, M. W. (1992). The cognitive hypothesis and its influence on speech-language
          services in schools. Language, Speech, and Hearing Services in Schools, 23,
          198–202.
   Casby, M. W. (1996, April). Cognition and language: Basis, policy, practice, and
          recommendations. In P. A. Prelock (Ed.), Special interest divisions, language
          learning and education (Vol. 3, Issue 1, p. 5).
                                 References

 Cole, K. (1996, April). What is the evidence from research with young
          children with language disorders? In P. A. Prelock (Ed.), Special
          interest divisions, language learning and education (Vol. 3, Issue
          1, pp. 6–7).
   Cole, K.N., Coggins, T.E., & Vanderstoep, C. (1999). The influence of
          language/cognitive profile on discourse intervention outcome.
          Language, Speech, and Hearing Services in Schools, 30, 61-67.
   Cole, K. N., Dale, P. S., & Mills, P. E. (1990). Defining language delay in
          young children by cognitive referencing: Are we saying more than
          we know? Applied Psycholinguistics, 11, 291–302.
   Cole, K. N., Dale, P. S., & Mills, P. E. (1992). Stability of the intelligence
          quotient-language quotient relation: Is discrepancy modeling
          based on myth? American Journal of Mental Retardation, 97(2),
          131–145.
   Cole, K. N., & Fey, M. E. (1996). Cognitive referencing in language
          assessment. In K. N. Cole, P. S. Dale, & D. J. Thal (Eds.),
          Assessment of communication and language (pp. 143–159).
          Baltimore: Brookes.
                                          References

   Cole, K.N., Mills, P.E., & Kelley, D. (1994). Agreement of assessment profiles used in cognitive
             referencing. Language, Speech, and Hearing Services in Schools, 25, 25-31.
   Cole, K., Schwartz, I., Notari, A., Dale, P., & Mills, P. (1995). Examination of the stability of two
             methods of defining specific language impairment. Applied Psycholinguistics, 16, 103–123.
   Dale, P.S., & Cole, K.N. (1991). What’s normal? Specific language impairment in an individual
             differences perspective. Language, Speech, and Hearing Services in Schools, 22, 80-83.
   Fey, M. E., Long, S. H., & Cleave, P. L. (1994). Reconsideration of IQ criteria in the definition of
             specific language impairment. In R. V. Watkins & M. L. Rice (Eds.), Specific language
             impairments in children (pp. 161–178). Baltimore, MD: Paul Brookes.
   Fletcher, J. M., Francis, D. J., Rourke, B. P., Shaywitz, S. E., & Shaywitz, B. A. (1992). The validity of
             discrepancy-based definitions of reading disabilities. Journal of Learning Disabilities, 25,
             555–561.
   Francis, D.J., Fletcher, J.M., Shaywitz, B.A., Shaywitz, S.E., & Rourke, B.P. (1996). Defining learning
             and language disabilities: Conceptual and psychometric issues with the use of IQ tests.
             Language, Speech, and Hearing Services in Schools, 27, 132-143.
                                      References

 Hall-Mills, S., & Apel, K. (2007). A hybrid model for teaching and practicing evidence
        based practice. Perspectives on Language Learning and Education, 14, 1, 20-22.
 Hegde, M. N., & Maul, C. A. (2006). Language disorders in children: An evidence-based
        approach to assessment and treatment. Boston: Allyn & Bacon.
   Justice, L. (2006). Evidence-based practice, response-to-intervention, and the prevention of
            reading difficulties. Language, Speech, and Hearing Services in Schools, 37, 284-297.
   Kamhi, A.G. (1998). Trying to make sense of developmental language disorders. Language,
            Speech, and Hearing Services in Schools, 29, 35-44.
   Krassowski, E., & Plante, E. (1997). IQ variability of children with SLI: Implications for use of
            cognitive referencing in determining SLI. Journal of Communication Disorders, 30, 1–
            9.
   Lahey, M. (1996, April). Who shall be called language disordered? An update. In P. A. Prelock
            (Ed.), Special interest divisions, language learning and education (Vol. 3, Issue 1, pp.
            5–6).
   Lahey, P. (1990). Who shall be called language impaired? Some reflections and one perspective.
            Journal of Speech and Hearing Disorders, 55, 612–620.
   Nelson, N. W. (1996, April). Discrepancy models and the discrepancy between policy and
            evidence. Opening remarks: Are we asking the wrong questions? In P. A. Prelock (Ed.),
            Special interest divisions, language learning and education (Vol. 3, Issue 1, pp. 3–5).
                                    References

   Nelson, N. W. (2000, July). Basing eligibility on discrepancy criteria: A bad idea whose
            time has passed. Perspectives on Language Learning and Education, 8-12.
   Notari, A. R., Cole, K. N., & Mills, P. W. (1992). Cognitive referencing: The (non)
            relationship between theory and application. Topics in Early Childhood Special
            Education, 11(4), 22–38.
   Sattler, J.M. (1988). Assessment of Children (3rd edition). San Diego: Jerome M. Sattler.
   Shaywitz, S., Escobar, M., Shaywitz, B., Fletcher, J., & Makuch, R. (1992). Evidence that
            dyslexia may represent the lower tail of a normal distribution of reading ability.
            The New England Journal of Medicine, 326(3), 145–150.
   Smith, M. W., & DickinsonSpaulding, T.J., Plante, E., & Farinella, K.A. (2006). Eligibility
            criteria for language impairment: Is the low end of normal always appropriate?
            Language, Speech, and Hearing Services in Schools, 37, 61-72.
   Whitmire, K. A. (2000, July). Cognitive referencing and discrepancy formulae:
            Comments from ASHA resources. Perspectives on Language Learning and
            Education, 13-16.
                   Resources

 State Rulemaking Handbook:
  http://www.flrules.org/rmhb.pdf
 ASHA EBP general link (ASHA members):
  http://www.asha.org/members/ebp/
 EBP in Schools:
  http://www.asha.org/slp/schools/prof-
  consult/EvdncBsdSchls.htm

				
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