2 _Fall 1983_ - Texas Speech-Language Hearing Association by yaofenjin


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Tee as                                                                 An official Publication of the Texas
                                                                       Speech-Language-Hearing Association
Texas Journal of Audiology                                             (TSHA)
and Speech Pathology                                               Volume IX, No. 2,                                                               Fall 1983

           OOMYL MUS
Speech Reading Ability WaSUrcd bv Daily Performance Rebecca Slatee .....................................                                                                                                                  2
Guidelines for Reporting a Phonological Process Assessment Lindcr Khan                  Bird .......................                                                                                                      6
Patrons                                                                                .....................................................................................                                              9
Articulation Development of English Consonants in Jiexica n-American Children
     Earlene Palwtei- ./ackie hemoiedy    frunie Green ............................................... 10
Focus: The Parish School. Houston, Texas                                                                                                              ...........................................................   14
,Management of Stuttm-is' Guilt and Shane Gctrdner Gatelel . ............................................                                                                                                           18

Surv°ev of the Nonspeaking Population Ginger Salzman ................................................ 20
Business Procedures in Texas for Speech-Language Pathology Services
    Paula Graham       Linda 041)ala     Elizabeth Holrues    Randolpi) Deal .............................. 24
The Last Word    Predictions - fear 2000 Tina Bangs               ................................................ 36

Executive Board
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Robbin Parish
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Nlarv L. Wood                                                   Authors plcadC consult Aol. IV No.                  pg. 19
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Richard W. Stream
Division of Communication Disorders
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Graphic Design                                                  P.o. Box 638-
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Karlyn P. Greenberg                                             (512) 852-8252
               V A1L ERFORMAHCE
                                          Rebecca H. Slater, MS, CCC-A
                                          Department of Speech, Language and Audiology
                                          Children's Hospital
                                          \evy Orleans, Louisiana

    A review of current literature         It was demonstrated that by utilizing

                                                                                     progress from drills on the most

 revealed that present speech reading      this type of speech reading program       visual sounds in the first session to
 training methods are conducted in        fluctuations in performance relative       drills on the least visual sounds by
 such a manner that daily progress         to motivation as well as other            the final session (whether these are
 cannot be measured and therefore         factors could be measured as they

                                                                                     examined on the phoneme, syllable,
 the ability to reliably measure           occurred on a session to session          word or sentence level). Using these

 effectiveness of speech reading           basis. It was further concluded that      methods, one cannot measure

 training is severely limited. The         speech reading performance should

                                                                                     fluctuations in performance from

purpose of this study was to               be measured on a daily basis so           session to session, and therapy
 determine if speech reading training      that the person may serve as his own      progress cannot, therefore, be

 in which therapy progress was             control and his improvement be            measured on a day to day basis. The
 measured on a daily basis, would         judged solely on his own daily             only alternative to measurement of

 improve ability to speech read as        performance.                               speech reading progress for these
 measured from first to last sessions.                                               methods is pre- and post-testing using

 One set of 78 year old twin subjects,
 with no previous speech reading
 therapy, were administered six
                                          A lpiner (1978) examined present
                                            speech reading methods in his
                                                                                     a test such as the Utley Test of Speech
                                                                                     Reading Ability. However, the validity
                                           book Handbook of Adult Rehabil-           of this test has been questioned by
 individual speech reading therapy         itative Audiology in which he             many (Jeffers and Barley, 1971).

 sessions of approximately 45              reported that although many authors          The technique utilized in this paper
 minutes in length over a three day        have recently published new or            is analogous to the multi-phonemic
period. Both subjects had mild to          remodeled speech reading training         approach in articulation therapy, in
 moderate sensorineural hearing           techniques, none have provided             which the stimuli (sound classifi-
 losses. Each session consisted of        information as to the reliability or       cations) remain constant per session.
 speech reading drills of words,          effectiveness of these methods. Berger     Each therapy session for this study

phrases, and sentences which were         (1972) also commented about this           consisted of drills of all of the visual
 balanced according to number of          situation and indicated the need for

                                                                                     sounds (whether most visible or least
 visual phonemes. Percent of correct      a new speech reading training              visible) on the word, phrase, and
 responses for each of the above tasks    technique which involves more than         sentence levels. Because the stimuli
 were computed and the results from       a reconstruction of the old model          remained constant, comparisons

first and sixth sessions were             from the 1940's.                           could be made of performance on
 compared. Subject I for the                 It is the opinion of this author that

                                                                                     the word level tasks (for example) in
 investigation showed a significant       one reason for the lack of validity or     the first session to performance on

 improvement in ability to speech         reliability testing of these techniques    the same task in other sessions.
 read. Subject 2 did not improve          is the lack of a reliable measure of          The purpose of this study was to
 in speech reading ability. This          speech reading ability. Also, as           determine if speech reading training,
 difference in the subjects' responses    indicated by Berger (1972), present        in which therapy progress was

 was believed to be a factor of their     speech reading training methods are        measured on a daily basis, would

 individual motivation for the tasks      conducted in such a manner that            improve ability to speech read as
 as well as their ability to use speech   daily progress cannot be measured.         measured from first to last session.

 reading versus lipreading techniques.    These methods require that therapy
METHOD                                                                                                            lists may be revised to meet the needs                                                                                                  obtain a "read one time" score. The
  Subjects. Onc set of -8 Vcar                                                                                    of the population treated. For                                                                                                          speaker then prepared a list of the

                                                                                                                  example, for familiarity one may                                                                                                        same words for the subjects to read

old twins \yith no previous speech ,,;

reading therapy, served as subjects in                                                                            choose to compile a list of sentences                                                                                                   following each stimulus presentations.

this investigation on a volunteer basis.                                                                          describing a local city's attractions.                                                                                                  This provided it "list available" score.
                                                                                                                  The Visual sounds for these sentences                                                                                                   Phrase lists consisted of 15 phrases

The subjects hearing losses Were of

                                                                                                                  could then he transcribed and the                                                                                                       with each phrase being two to three


bilateral sensorineurtl type and of



                                                                                                                  number of each Visual sound could                                                                                                       words in length. The phrase lists

mild to moderate degree. The subjects
                                                                                                                  be calculated. These totals Would

were judged to he of average intelli-                                                                                                                                                                                                                     were presented in the same manner

                                                                                                                  then be compared with the totals                                                                                                        as the word lists.

gence on the basis of their hehaVior

                                                                                                                  listed in Appendix A under sentences                                                                                                       A hierarchy of tasks was established


prior to their selection. Both subjects
                                                                                                                  to insure that a ± t agreement existed                                                                                                  based on familiarity with the lists,


had college degrees.

       Equipment. Prior to thcrapV, the                                                                           for each visual sound.                                                                                                                  Nyith "no reading" considered as the

                                                                                                                     Adjustments Would need to be                                                                                                         most difficult, "read one time" as the

subjects were administered pure tone,

               r-4 .r.".

air and bone conduction audiometric                                                                               made for any sound category haying                                                                                                      second most difficult, and "list
                                                                                                                  a variation greater than ± 1. An                                                                                                        available" as the least difficult task.

tests in a quiet environment using a


                                                                                                                  example of this would be if the list of                                                                                                 When the subjects reached a 90
Beltone 100 audiometer (re: ANSI
1969). TDH39 earphones set in                                                                                     sentences contained fifteen / S /                                                                                                       percent criterion of correctness for

MY4l AR cushions were used. A B7OA                                                                                sounds          should he 11 ± 1                                                                                                        the more difficult tasks, the remaining
                                                                                                                  according to Appendix A). In order to                                                                                                   tasks were omitted for that list.

oscillator was used for bone conduc-


tion testing.                                                                                                     reduce the number of visual sounds.                                                                                                        Sentences were presented in a
                                                                                                                  Words with / # / sounds could be                                                                                                        similar manner: however, "no topic",

      Treatment Program. Research                                                                                 substituted for words containing no

                                                                                                                                                                                                                                                          "general topic", and "topic per

of the literature failed to show any                                                                              visual sounds such as substituting the                                                                                                  sentence" scores were obtained.
speech reading training program                                                                                   word the for cr.                                                                                                                        Eleven sentences pertaining to a

which could measure speech reading                                                                                   Substitutions of single sentences,                                                                                                   similar topic were presented each

ahility on a daily basis. Because of                                                                              words, or phrases is a simpler

                                                                                                                                                                                                                                                          session. Topics for the sentences
this, a new program was constructed                                                                               process. For example, a sentence such                                                                                                   varied from session to session. The
to meet this criteria.                                                                                            as "John Wryne, a famous actor,

                                                                                                                                                                                                                                                         speaker first presented the sentences
   It is important to realize that the                                                                            passed away this year" could be                                                                                                         without giving a topic or any


program described in this study does                                                                              changed to "The performer, John

                                                                                                                                                                                                                                      r^'                additional clues about the context of
not differ from present popular                                                                                   Wayne, passed away" without

                                                                                                                                                                                                                                                         the sentences. A general topic for all

speech reading training programs in                                                                               changing the number of visual sounds                                                                                                   of the sentences was then given and

the manner or type of training. Most                                                                              for that sentence. It could also be                                                                                                    the same sentences were presented

                                                                                                                                                                                                                                                                                           C-- .-I
of the present programs, such as that                                                                             substituted with a completely

                                                                                                                                                                                                                                                         again. The speaker then gave a topic

suggested by Alpiner (1978), also                                                                                 different sentence which contained

                                                                                                                                                                                                                                                         (or key word) per sentence as the


consist of speech reading drills of                                                                               the same number of visual sounds                                                                                                       same list was presented again. Upon


words, phrases and sentences. The                                                                                 such as "One famous group in early

                                                                                                                                                                                                                                                         reaching 90 percent criterion for the

primary difference between this and                                                                               silent shows were the Kev Stone

                                                                                                                                                                                                                                                         more difficult task (such as "no

other programs is the manner in                                                                                   Cops" "Transcription of the visual                                                                                                     topic" or "general topic"), the


which speech reading performance is

                                                                                                                  sounds for these sentences show that                                                                                                   remaining tasks of lesser difficulty


tabulated and measured.                                                                                           they each contain two /p/'s, two /w/'s,                                                                                                (such as "topic per sentence") were


   The word, phrase, and sentence                                                                                 one /f/, one /m/, and one /

                                                                                                                                                   /.                                                                                                    omitted for that list. A new list of
drills for this program were balanced                                                                             Similar substitutions can be made on

                                                                                                                                                                                                                                                         sentences was presented each session.

according to Jeffers and Barley's list                                                                            the word and phrase levels.
of most visual sounds (Jeffers and                                                                                        Procedure. Six individual therapy                                                                                              RESULTS
Barley, 1971). The purpose of this                                                                                sessions of approximately 45 minutes                                                                                                     Comparisons were made between


balancing was to insure that no one                                                                                in length were conducted in a quiet                                                                                                   the subjects' performance in session
session was biased in terms of                                                                                    environment over a three day period.                                                                                                   one and session six on the word,

visibility of sounds. This balancing                                                                              The subjects were seated approxi-                                                                                                      phrase, and sentence tasks. The


also permitted the subjects' speech                                                                               mately three feet from the speaker.                                                                                                    results for Subject 1 are shown in


reading performance to be measured                                                                                One clinician presented all of the                                                                                                    Table 1.

and compared from session to                                                                                      stimuli at a reduced voice intensity.                                                                                                    These results indicated a significant


session.                                                                                                             Word lists included single words of

                                                                                                                                                                                                                                                        improvement in Subject 1's ability to


   For the purpose of balancing, the                                                                              one to three syllables in length and                                                                                                  speech read from first to sixth

word, phrase, and sentence lists were                                                                             were grouped according to place                                                                                                       sessions on all levels of difficulty,


transcribed, and the total number of                                                                              feature of initial consonants of each

                                                                                                                                                                                                                                                        from "no reading" to "list available"


each visual sound per session was                                                                                 word. Each group contained a total of                                                                                                 or "no topic" to "topic per sentence".


calculated. The word lists were                                                                                   ten words. Feature categories included                                                                                                This improvement was demonstrated

further subdivided into categories of                                                                             bilabials, dentals, linguaalveolars, and                                                                                              on word, phrase, as well as sentence


place feature (bilabial, dental,                                                                                  palatals. For each session, the subjects                                                                                              tasks. The subject demonstrated the


linguaalveolar, and palatal). Phrases                                                                             were first presented a list of words by                                                                                               greatest amount of improvement




and sentences were also balanced                                                                                  the speaker for speech reading. The                                                                                                   on sentence tasks for all levels of

separately. These totals were then                                                                                subjects were not allowed to read the                                                                                                 difficulty. The least amount of im-


compiled in tabular form for                                                                                      list prior to or during this first                                                                                                    provement was shown on the word

comparison. Each list was then                                                                                    presentation. Correct responses were                                                                                                  level tasks.

balanced such that the number of                                                                                  totaled and converted to percentile

                                                                                                                                                                                                                                                          Comparative results for Subject 2

each visual sound per session was                                                                                 scores which served as the "no                                                                                                        are presented in Table 2.
within a ± 1 agreement (See                                                                                       reading" scores. The subjects were                                                                                                       As can be seen from the table,
Appendix A).                                                                                                      then given the same list of words to                                                                                                  Subject 2 did not demonstrate any

  Utilizing this ± 1 agreement                                                                                    read one time and the list was                                                                                                        improvement in speech reading

criteria, word, phrase, or sentence                                                                               presented again in a random order to                                                                                                  ability. In fact, a comparison of the                                                     3
                                                                    TABLE 1                                                                                                              TABLE 2
                                                                    Subject 1                                                                                                            Subject 2
                                                                        WORDS PHRASES SENTENCES

                                                                                                                                                                                                 WORDS PHRASES SENTENCES
    Lesson No.                                                                NR'              NR                    NT""               Lesson No.                                                   NR'                                                NT'"'


    One                                                                      42.5              29                         0             One                                                          42.5               53                             45
    Six                                                                       50               67                        64             Six                                                          45                 53                              9
          % Improvement                                                      +7.5             +38                    +64

                                                                                                                                               % Improvement                                         +2.5                   0                        - 36

                                                                             RIX"              RIX                 GT"`
                                                                                                                                                                                                     RIX"              RIX                           GT""'
    One                                                                      77.5

                                                                                               73                         9             One                                                          87.5              100                             55
    Six                                                                      90                87                        73             Six

                                                                                                                                                                                                     87.5               60                             36
          % Improvement                                                  +12.5                +14                    +64                       % Improvement                                                           -40                           -19


                                                                                               LA                  T/S"                                                                              LA"`               LA

                                                                                   96          100                       45             One                                                            95               -                              64
                                                                                   90          100                       91             Six                                                           100               73                             73
          % Improvement                                                            -7                                                                                                                                   -

                                                                                                0                    +46                       % Improvement

                                                                                                                                                                                                      -5                                              +9

            No Reading                                                No Topic
            Read One Time                                             General Topic
            List Available                                            Topic Per Sentence

      scores from session one to session six

                                                                                                     stimulus presentation was significantly                                         and was measured based on daily im-


      appeared to indicate a negative trend                                                                                                                       _.9
                                                                                                     reduced. His scores declined in direct                                          provement utilizing a strict
      for all the tasks with the exception of                                                        proportion with stimulus length. By                                             sLmdardized program model.
       no reading" tasks for words and                                                               the final session however, his scores                                              Second, it is believed that the lack


      "topic per sentence" tasks for                                                                 for stimuli containing longer sets of                                           of improvement (or negative percent
      sentences.                                                                                     information significantly improved;                                             of improvement) for Subject 2 is

                                                                                                     he performed sentence, phrase, and                                              similar to what is seen in many


                                                                                                     word level tasks with almost equal                                              speech reading therapy programs and

         The results of this study at first                                                          proficiency. Subject 2 again initially                                          is seen in studies which report that
      glance would appear confusing with                                                             demonstrated greatest proficiency on                                            speech reading therapy does not

      Subject 1 showing a significant                                                                tasks with reduced length of stimulus                                           improve ability to speech read. It
      improvement in speech reading

                                                                                                                                                                                     appears that one's performance on

                                                                                                     presentation performing best on


      ability and Subject 2 showing a lack

                                                                                                     phrase level tasks. By the final                                                speech reading tasks is highly
      of or a negative improvement for
                               OAS ^'y

                                                                                                     session, however, Subject 2                                                     dependent upon their motivation for

      most of the task levels.                                                                       performed best on tasks with only                                               the task; therefore individuality in the

         The possible causes of the vast                                                             minimal stimuli presentation and                                                assessment of performance in this
      difference in scores between Subject 1

                                                                                                     demonstrated greatest proficiency on                                            area is extremely crucial. Programs
      and 2 were, therefore, further                                                                 word level tasks. This would suggest                                            which are restricted to pre- and
      investigated. First, Subject 1 began the                                                       that Subject 2 was heavily dependent                                            post-testing for measurement of
      sessions with very low overall scores

                                                                                                     upon lipreading of individual                                                   improvement may give a biased

      with "no reading" scores below 50                                                              phonemes for interpretation of the                                              picture of an individual's perfor-

      percent correct for all task levels, thus                                                      stimulus presented. She therefore,                                              mance regardless of the reliability of

      leaving a great deal of room for                                                               could not retain long strings of this                                           the test used. For example, an


      improvement. In each session, his                                                              information in memory and recreate                                              individual may experience a personal

      scores became increasingly better and                                                          the correct phoneme combinations to                                             crisis just prior to post-testing which

      he reported confidence in his                                                                  formulate the sentences and phrases.                                            would significantly negatively


      improvement. However, Subject 2                                                                Subject 1, however, appeared to adapt                                           influence motivation and result in
      began the sessions with mid-range                                                              well to a "speech reading" approach                                             poor post-test performance. If a


        no reading", "read one time", and                                                            in which he utilized contextual,                                                therapeutic program which measured

      "topic per sentence" scores being                                                              facial, and environmental clues in                                              daily performance was utilized, the
      near or better than 50 percent correct

                                                                                                     addition to phoneme information                                                 person's progress could be

      for all task levels. During initial                                                            derived from "lipreading" to interpret                                          documented and fluctuations in

      sessions, this subject noted an                                                                the stimulus. Utilizing this type of                                            performance could be measured as
      awareness of the immediacy of her                                                              approach he was able to perform                                                 they occurred on a session to session

      twin brother's improvement. She

                                                                                                     equally well on tasks of varying                                                basis.

      reported that she felt discouraged                                                             stimulus length.                                                                  Additionally, utilizing this type
      during initial sessions that she was                                                              It is felt that these differences may                                        program one may differentiate those

      not improving also. Her scores began

                                                                                                     be suggestive of a number of factors                                            individuals who perform best on
      to decline in early sessions and she                                                           important to the field of aural                                                 tasks in which only limited
      showed less and less motivation for                                                            rehabilitation. First, the significant                                          information is given to be speech

      continuing the sessions.                                                                       improvement demonstrated by Subject                                             read (such as word level tasks) from



         Secondly, Subject 1 initially demon-                                                        1 is judged to be genuine in that the                                           those individuals who perform best


      strated greater proficiency on word                                                            improvement was over a number                                                   with maximal speech reading cues

4     levels tasks in which the length of                                                            of sessions, over a variety of tasks,                                           (sentence level tasks). This may serve
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                                                                 SOUND IDEAS FOR SCHOOLS AND INDUSTRY

as indicator of those persons relying                                      .9 directed independent research project
                                                                                                                               diuch appreciation is given to Mr J. Tim Holston, for
                                                                           initially presented to the graduate faculty of
on lipreading of individual phonemes                                       the Department of Speech Pathology and Audiology    his shared ktiowledge, guidance and encouragement,
and those who rely upon general                                            College of Allied Health Professions                and to Dr Dan .Sellers, for his editorial comments
                                                                           University of South Alabama                         and continued support in the devetopment of this
contextual cues for speech reading.                                                                                            research.
  Finally, these results do indeed
suggest the necessity of measuring                                                                               APPENDIX A
speech reading ability on a daily basis
such that the person may serve as his                                                            FREQUENCY OF OCCURRENCE

own control and his improvement is
judged solely on his own daily                                                                       OF VISUAL SOUNDS
performance. This type of measure-                                                                                       Per Session
ment cannot be obtained utilizing
present models of aural rehabilitative                                                                   WORDS
therapy which rely strictly on pre-                                                        BILABIALS DENTALS LINGUALM PALATALS

and post-testing for assessing                                                          p     5 ±1     1 ±1     2 ±1     2 ±1
therapeutic program benefits.                                                           b     2 ±1     2 ±1     2 ±1     1 ±1
                                                                                        m     4 ±1     2 ±1     2 ±1     3 ±1
REFERENCES                                                                              f     2 ±1     2 ±1     1 ±1     1 ±1
Alpiner, J. Handbook of adult rehabilitative                                            v     1 ±1     4 ±1     2 ±1     2 ±t
    audiology. Baltimore: William & Wilkins, 1978.                                      W     1 ±1     4 ±l     1 ±1     1 ±1
Berger, K. Speecbreading principles and methods.
                                                                                                       1 tl

                                                                                                                1 ±1     1 ±1

                                                                                        e     1 ±1

    Baltimore: National Educational Press, 1972.
                                                                                              1 ±1     3 ±1     1 ±1     1 ±1

Bruhn, M. H. The Mueller-Walle method of lipreading
    for the hard of hearing. Washington, D.C.: The                                            1 ±1     1 ±1     1 ±1     1 ±1
     Volta Bureau (1949).                                                              d'J
Bunger, A.M. Speech readingJena method.                                                tx     1 ±1       ±1     1 ±1 1   1 ±1
     Danville, Ill.: The Interstate Printers and
     Publishers, Inc. (1961).                                                               PHRASES                  SENTENCES
DiCarlo, L.M., and Kataja, R. An analysis of the Utley
     lip reading test. J. Speech Hearing Dis., 16,                                       p            3±1                                        p      10±1
                                                                                         b            2 ±1                                       b      10 ±1

     226-240 (1951).
Jeffers, J., and Barley, M. A re-evaluation of the (Jtley                                m            6 ±1                                       m      11 ±1

     lip reading sentence test. Papers presented at the

     annual convention of the American Speech and                                        f            3 ±1                                       f      11 ±1
     Hearing Association, Chicago (1967).
Jeffers, J., and Barley, M. Speechreading Hipreading).
                                                                                         v            2 ±1                                        v     6 ±1
     Springfield, Ill.: Charles C. Thomas (1971).                                        w            4 ±1                                       w      10 ±1
Kinzie. C.E. Methods of teaching lipreading to adults                                    6            1 ±1                                              2 ±1
     - A symposium, the Kinzie method of graded
    instruction. Volta Review, 4, 701 (1942).                                           1             3 ±1                                              11 +t
Utley, J. A test of lip reading ability. J. Speecb Hearing                             d3             1 ±1                                       d5     1 ±1
     Dis.. 11, 109 (1946).                                                              tf            1 ±1                                       tr     1 ±1                           5
                                          GUODELOMES [FOR G°EPORUDMO Q

                                                                                                   The phonological analysis of
                                                                                                 children's speech has been encourag-
                                                                                                 ed by some investigator's of disorders
                                                                                                 of speech production. Such an
                                                                                                 analysis is often completed in
                                                                                                 addition to a traditional articula-
                                                                                                 tion test. The purpose of this paper is
                                                                                                 to describe a recommended format
                                                                                                for reporting the results of'a
                                                                                                phonological process analysis. Use of
                                                                                                 this format will result in an accurate
                                                                                                and complete description of a child's
    Linda M. Laila Khan, M.S., CCC-SP                                                           phonological system.
     Clinical Supervisor
     program in Communication Disorders
     University of Texas at Dallas
    Allan K. Bird, Ph.D., CCC-SP
     Director of Communication Disorders
     University Affiliated Center
     University of Texas Health Science
       Center at Dallas

                       five years, several
    Wtthin the pastbecome commer-

                                                                 Thus, /f/ is produced as [p], [t], [t]                  There is a third phonological
          phonological process assessment                        and [0] *, depending upon the                        process which does not result in an
    instruments have                                             context. Although context obviouslv                  error. The process matches the adult
    cially available to clinicians (Weiner,                      affects production, the variability- is              pattern. This pattern may be describ-
    1979; Shriberg and Kwiatowski, 1980;                         usually labeled "inconsistent" That is,              ed as the retention of continuancy in
    Hodson, 1981; Ingram, 1982). In                              sometimes the child produces /f/                     postvocalic fricatives. Thus, but /s/

    addition, many clinicians have                               correctly and sometimes not.                         and /f/ are produced correctly in



     developed their own inventories of                             The understanding of phonological                 word-final position.
                    '.. 0.,

     words with which to assess children's                       processes would lead us to predict                      The clinician may better understand
     phonological productions. Although                          the following "inconsistent"
                                                       F', 0.O

     these assessments require consider-                                                                              disordered production and plan for
                                                                 productions of /s/:                                  its remediation through the use of
     ably more time than a traditional test                                                                           phonological assessment. It is clear
                                                                     /s/ in initial position becomes [t],

     of phoneme mastery, their value                                                                                  that an increasing number of
     exists in their ability to better explain                       /s/ in final position is correct.
                                                                     A/ in medial position becomes [tj.               clinicians are becoming familiar with

     the speech production of unintelli-                                                                              tests of phonological processes. Many
     gible children. The validity of                                 /s/ in clusters is deleted.
                                                                  Thus, /s/ is produced as [t], [s] and               actively pursue this information.
     phonological processes in the
                                    \0n 0..a


                                                                  [0 J. Our knowledge of the phono-                   Some are first introduced to the

     assessment of disordered speech has

                                                                  logical processes which are used by                 terminology in diagnostic reports

     been questioned (Dinnsen, Elbert, &                                                                              from centers which have adopted this
     Weismer, 1979). However, such an                             children to simplify the underlying

                                                                  representation (or adult form) enabled              procedure for use with moderately to

     approach is generally regarded as

                                                                  us to generate predictable errors                   severely unintelligible children.
     preferable when children's articula-                                                                             Clinicians are required to both write,
                                                                  which seemed, initially, to be

     tion otherwise appears inconsistent                                                                              interpret and apply results of
     and random. The value of phonologi-                          inconsistent. The phonological


                                                                                                                      phonological process analyses.

                                                                 processes which are used by our

     cal processes is that they help

     describe and identify production                            hypothetical child include:                          Therefore, it has become necessary to
     patterns which alter classes of                                 1. Stopping of fricatives both pre-              develop some conventions to be used
     phonemes. These patterns, or                                    and inter-vocalically. This                      when reporting these results. The
                                                                     accounts for /f/       [p/, [tj and              purpose of this article is to offer one

     processes, account for the apparent                                                                              set of guidelines for reporting the
     inconsistencies noted in production.                              /s/      [t].
                                                                                                                      results of phonological process
    An example of an "inconsistency"                                   2. Deletion of fricatives in
    might be as follows:
                                                                       clusters. This accounts for both
    /f/ in initial position becomes [pl.
    /f/ in final position is correct.                                  clusters.
    /f/ in medial position becomes [p]
          or [t].
6   /f/ in clusters is deleted.                                              the null sign, signifies a deletion.
WHEN TO REPORT                                                                  Vcincr. F. Phonologicrrl Processes.Irurhsis                                      fire processes to report. The data on


                                                                               I iodson. 11, The _lssesanerrt of Phorrologiccrl                                  sequence are available through several

PROCESS DATA.                                                                     Processes

                                                                               Shriberg. I.. and Kxx:mkowski. I..Aatturtl
                                                                                                                                                                 journal articles and diary studies. A
  It is not alwavs necessary to                                                                                                                                  reyinv of these is presented in

                                         C C


                                                                                     Process .I liall ISIS
complete a phonological process                                                                                                                                  Ed-wards and Shriberg (1983). For

                                                                                Ingrtm. D. Procedw-es for the Ph(irrologicell


analysis. In general, the more intelli-                                            Irralt'sis of children's                                                      example, processes affecting syllable



gible the child, the less necessary the                                                                                                                          shape are characteristic of very young

                                                    0.R      u
procedure. It is suggested that the                                             Whichever type of analysis is
                                                                                                                                                                 speakers. These processes include


following guidelines be considered:                                            completed, reporting the results in                                               deletions of consonants and syllables.

                                                                               the following sequence is suggested

  1. When the child is intelligible                                                                                                                              and cluster reductions are generally

                                                                               (refer to the sample report in the

and has a few error phonemes, the                                                                                                                                suppressed by age three. Unfortunate-



method of choice for- assessment                                                                                                                                 Iv, there is no data available from


would probably not be a phono-                                                    a) From your assessment, you                                                   longitudinal nor large cross-sectional
logical analysis. A standardized,                                              should be able to list the test pro-                                              studies. Nevertheless, when reporting
age-appropriate articulation test                                              cesses in order from most to least                                                results of a phonological analysis, it


(e.g., Templin-Darley. Goldman-                                                productive. "Productive" is used to                                               would be helpful to indicate which

                                                                               indicate how much or horv little the

Fristoe, Arizona) would be the                                                                                                                                   productive processes are usually

                                                                               process contributes to unintelligibili-

appropriate choice.                                                                                                                                              suppressed earliest. Where this
   2. When the child has frequent                                              ty It is roughly equivalent to percent                                            information is available, it should be
                                                                               of potential occurrences. List the

 error phonemes but is reasonably                                                                                                                                included.

 intelligible ("),nultiple misarticula-                                        processes along with the frequency-                                                  b) Reporting productive processes
                                                                               to-opportunity ratio for each. This

 tions'), the clinician may choose to                                                                                                                           should be accompanied by examples
                                                                               ratio is the number of tunes the

 complete a phonological analysis, a                                                                                                                            from the child's own responses as

                                                                               process was applied over the number

 distinctive feature analysis, OR a                                                                                                                             shown here:

                                                                               of opportunities that it could have

 standardized age-appropriate                                                  been applied. This [rill not be equal                                            Postvocalic Consonant Deletion

 articulation test.


                                                                               to the number of test items. For                                                 mad t/      - [11 ?e
    3. When a child presents with

                                                                                                                                                                /h ge ncl/                           [h at

                                                                               example, a word like bug cannot

 moderately to severely unintelligible                                                                                                                          /d tg/ - Id >l                                   I

                                                                                                                                                                                         - 0-
 speech (multiple misarticulations                                             have the process of Cluster
                                                                               Reduction applied to it because it                                               Prevocalic Voicing

 with unintelligibility), the method of                                        does not contain a cluster. A word                                               /tu/ -+ [du]


 choice would be a phonological                                                                                                                                 /t at / -

                                                                                                                                                                            [cl at I

                                                                               like pea cannot have the Postvocalic                                             /ki/ - Igil

 analysis. Until a standardized test of                                                                                                                C
                                                                               Consonant Deleted because there is

phonology becomes available, a


                                                                               no postvocalic consonant. The                                                    Cluster Reduction

 standardized, age-appropriate                                                 processes should be listed as follows:                                           /blu/                        [but


 articulation test should be admini-                                              Postvocalic Consonant                                                         Mr,)/                -       [CL)]
 stered first to determine an age score                                                                                                                         /grin/                       [ginl

                                                                                     Deletion (44/46)
 (or percentile rank) and to yield a

                                                                                   Prevocalic Voicing (15/20)                                                   Syllable Reduction

 substitution analysis. The
                    O U

                                                                                   Cluster Reduction (8/12)                                                     /clz a r ae f/ - [ss 9C


phonological assessment is used to                                                                                                                              /m ^j ki/


                                                                                   Syllable Reduction (10/15)

further describe the errors.                                                                                                                                    /i £ lo/ -a [if I

                                                                                   Glottal Replacement (7/13)

                                                                                   Stopping (14/30)                                                             Glottal Replacement

                                                                                   Postvocalic Consonant                                                        /w F_ g                  n/ - [w af. 9a nl

PROCESS DATA.                                                                                                                                                   /hvt ndo/ - [wL 9 of

                                                                                     Devoicing (2/15)


                                                                                                                                                                It fS ka nl                              [dZ ?T- n1

  Because clinicians who read your                                                 Gliding (2/20)

report may be unfamilier with                                                      Fronting (1/25)                                                              Stopping


process terminology, always include                                                Consonant Harmony (0/46)                                                     /si/                     [dil


                                                                                                                                                                /e Am/ -i It Atnl
actual examples of the child's                                                     Vocalization (0/22)

                                                                                                                                                                /zu/ - [dul



simplified productions. The following                                          From this list, identify approximately



format is suggested:                                                                                                                                              c) Calculate some overall measure

                                                                               five of the most productive processes


  1. First, report results from the                                            to report in your summary. (Refer                                                of proficiency. You may wish to





standardized articulation test. This                                                                                                                            calculate mean number of Pro-

                                                                               to Khan, 1982 and Edwards and


will usually include a percentile                                              Shriberg, 1983 for a description of                                              cesses Per Word (Khan and Lewis,


rank for age and a listing of                                                  commonly occurring processes.) In                                               1983). It is a type of severity index

substitution errors and/or                                                     the example above, we would choose                                              and a baseline measurement. The

consonants produced correctly in                                                                                                                               mean number of processes per word

                                                                               the top six since Stopping is almost


target contexts. There should also be                                          as productive as Glottal Replace-                                               (PPW) is calculated by dividing the


an intelligibility judgement, and, if                                          ment (50%), and the next process,                                               total number of processes applied by



applicable, a comment about supra-                                             Postvocalic Consonant Devoic-                                                   the total number of words attempt-



segmentals: voice quality, rate of                                             ing, is used only 2/15 times (14%).                                             ed. This yields a mean number of

speech, hypernasality, etc. (Shriberg                                          As a rule, do not include processes                                             processes which decreases as the child




and Kwaitkowski_ JSHD, August,                                                 which are productive less than                                                  becomes more intelligible. You may

1982).                                                                         25% of the time because they are                                                 choose to calculate Percent of



  2. Next, report results from your                                            suppressed (or not used) by the child                                            Consonants Correct (PCC)

phonological analysis. The analysis                                            75% of the time and thus generally                                              (Shriberg and Kwaitkowski, 1982)


may be completed on the words from                                             contribute little to unintelligibility                                          which is calculated by dividing

your articulation test (provided that                                          at the time of testing. (See also                                               the total number of consonants




you have transcribed the entire                                                                                                                                produced correctly by the number of

                                                                               McReynolds and Elbert, 1981, for a

word), or you may choose to use one                                            discussion of criteria for productivity.)                                       consonants attempted.

of the popular published phonologi-                                                                                                                                    d) Include a statement about

                                                                                  Information on the developmental





cal assessments. To date, these                                                                                                                                 phonetic inventory. A phonetic

                                                                               sequence of phonological processes


include (in chronological order):                                              may be considered when choosing                                                  inventory is an inventory of



    phonemes produced by the child in            Including these four components                             'The simplifications resulted in numerous
    tartlet or )loll-target contexts. For      will result in a complete report. In                          homonyms. For example. chicken, zipper.


    excnnple, the child ntaI, net,er           sonic situations and \\ ith certain                           fishing. this. finger, and sleeping wcre all
                                                                                                             produced [d 1.
    produce I/ in target contexts in till I.   children the clinician may prefer to                            :Although I.P. used very fevy phoneme-,
    position. However: if the child also'      include more cletail within the report                        correctly as target phonemes, he had scycral
    uses /j/ as a substitute jor another       (such as anaksis of homotionn).                               additional phonemes evhich he used corrcctlc

                                                                                                             XS substitutions for target phonemes. His
    phoneme (as in A/ - 1J1 in                 These guidelines represent the                                phonetic inventory illustrates this (compare this
    /hays/      (HaVfJ, /// is includ-         minimum information required to                               with the chart above for correct target
    ed in the phonetic inventory.              satisfactorily report the results of a                        phonemes):
     Tl)e completed inventory fields           phonological process assessment
                                                                                                              COPY 1)
    inf )r nlation about variety an(l tl pe    while enabling the reader to
    of consonants produced. This can be        understand and thus apply the
    diagnostic (limited repertoire vs.         diagnostic data.                                                  Initial                Medial               Final
    wide repertoire). It can also provide                                                                           in n                                         m n
    infornzattion which is icalrtable in
    choosing stimuli for therapy. Using
    only those productions listed above
                                               Sample summary of a phonological
                                                                                                                    cv h                                         f
    (in brackets), the child's phonetic        analysis for a child with unintelligible
                                               speech.                                                         In summary, J.P is a 3;9 }'car old with
    inventory would look like this:                                                                          unintelligible speech which is characterized
                                                  J.P. age 3:9, was administered the                         primarily by deletions (of svllables and
    COPT ,A                                                         articulation test. He scored             consonants), and numerous simplifications of
                                               an error score of 42. which receives a percen-                phonemes. His speech is slow and hypernasal.
                                               tile rank of 2 for his age His articulation errors
            I               M             F    consisted primarily of postvocalic consonant                  Since he has relatively few consonants in his
                                                                                                             phonetic inventory and deletes most final
        hill                              m    deletions, and substitutions of earlier-                      consonants, he produces a large number of
                                               developing phonemes for prevocalic                            homommous consonant-vowel (Cy) forms
       t it n                             n    consonants. All productions were monosylla-                   which contribute to significant overall
                                               bic Consonants which were produced                            unintelligibility.
                                               correcth in target contexts wcre.*

                                               COPY C                                                        REFERENCES
    SUMMARY                                                                                                  Dinnscn. 1) . Fthert. Al.. anet \X'eismer. G. (19-9) On
                                                                                                             the characterization of ttlnCtilmal misarticulations.
      The guidelines presented above                 Initial              Medial                   Final     Paper presented to the .Annual Convention of the
    were developed to assist both the
    writer and the reader of phonological
                                                                            -                           In
                                                                                                             Arneriem Speech-language-Hearing Association,
                                                                                                             I:dsyards_ \1. and Shriherg, 1- (198;) 111omOlogr
    analysis reports. The guidelines                   cn
                                                                                                             Applications in Communicative I)isordecs San Diego:
    included suggestions for deciding                                                                        College-Hill Press.
                                                                                                             Ho(bon. B. (1980) the Assessment of PhanmLagical
    whether or not to complete a                  I- s speech was generally unintelligible. In
                                                                                                             Processes. Danville. II.: Interstate Printer, and
    phonological analysis for a particular     addition to the articulation errors. his speech               Publisher,.
                                                                                                             Ingrain, D. (1981) I'mcealwres for The Phonological
    child.                                     was frequently hypernasal and his rate was

                                                                                                             Annll:sis of Children's tar;Swage. I imersaN Park. PA:
      The basic components to be               slow and labored.                                             I nicers6 Park Press.
    included in the report of a                  Because I.P.'s speech was unintelligible,                   Khan. L. (1982) A review of 16 phonological
                                               his productions were further analyzed                         processes. L.M.S.S. N.   li, p. ---85.

    phonological process assessment are:       phonologically. His spontaneous speech was                    Khan, L, and Irsvis, .N. The Khan-leivis
                                               too unintelligible to be glossed: therefore,                  Proto(W arld manual. Circle Pines: American
                                                                                                             Guidance Service. (In preparation.)
      1. A list of processes from most to      productions from the articulation test were                   Mcftevnolds. 1.. and Efficrt. XI. (1981) Criteria for
                                               used for this analvsis.
    least productity with frequency-to-          J.P. used several processes productively to
                                                                                                             phonological process anah'sis, jW/1). v. -16. p.
    opportunity ratios (approximately          simplify his speech. The mean number of                       Shrihrrg_ L, and Kvv'aiwwski, I. (1980) Natural Process
    fine processes).                           Processess Per Word was 2.63. The five most                   Analysis. SV': Wilcy and Sons.

                                                                                                             Shriberg. L. and Ksyaitkosvski. I. (1982) Phonological
       e.g., Stopping (14/30)                  productive processes with esamptes were as
                                               follows:                                                      disorders 1: A diagnostic classification system.
                                                                                                             j_ 2 12-256.
      2. Examples from the child's             'Note: These are the results of the articulation test.
                                                                                                                     P. (19-9) Phonological Process I nall:sis.
    speech production for each of the                                                                        t'niversm Park. PA: t niyersm Park Press.
    most productive processes
    (approximately the top five).               1.    Syllable Reduction (25/25)
       e.g., Stopping (14/30)                          It91afnl/      let s/
       /si/ - [dil                                     /t fs k a W                lcl s 1
       /Onm/ ---= ItAml                                /zz Pd /     -/elf 1
       /'zu/        [dul
                                               2. Postvocalic Consonant Deletion
      3. A severity index such as mean                 (42/4[5)
                                                       Lctovl           - /(15/
    number of Processes Per Word                       F1)E d/          - lh2 /
    (PPW) or Percent of Consonants                     fl3eg/ ; ih ae /
    Correct (PCC).                             3. Stopping (21/34)
       e.g., 92 (total # o f processes)
          -44- -(total # of words attempted
       PPW = 2.0
                                                   /zz P*-> ldf /
                                                   /C AM
                                                                l(In l
                                                               k a W - ld?1
      4. The phonetic inventory.               4. Prevocalic Voicing (15/23)
                                                      M01,/         - ldo l
                                                      /p£ Lisa Iz/ -- [h C'/
    COPT' B                                           /®n )n/               ldA /
    e.g.,                                      5. Cluster Reduction (11/22)
                                                      A)r                  lbol
       Initial             Medial     Final           /dr-nin/ - ldA/
            by                                        /heeg/ -x/1,9/
                                             I                   1


 DALLAS                             FORT WORTH                             HUMBLE
 Deborah Price Gebron,              Overton Speech and                     Northeast Speech and

       M.S., CCC/A                   Language Center, Inc.                  Language Center
  Audiologist                       4763 Barwick Drive, Suite 103          9810 FM 1960 Bypass, Suite 160
  Evaluation, Consultation          Fort Worth, Texas 76132                Humble, Texas 77338
  Hearing Aid Dispensing            (817) 294-8408                         Carolyn Wells, M.A., CCC/SP
  Hearing Professional Center       Valerie Johnston, M.S., CCC            Gayl White, M.A., CCC/SP
  5477 Glen Lakes Dr., Suite 106    Director
  Dallas, Texas 75231                                                      NACOGDOCHES
  (214) 987-4114                    Texas Christian University             Speech & Language Services
                                    Programs in Speech-Language              of East Texas
 Associated Speech and                Pathology & Habilitation of          418 E. Main
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  Beverly Lance, CCC-SP             Miller Speech and Hearing Clinic       Gilbert C. Hanke, M.Ed., CCC/SP

  Martha Villwock, CCC-SP           Texas Christian University             Frank H. Harrison, M.Ed., CCC/SP
 618 Clam Barton, Suite 6           Fort Worth, Texas 76129                EvaluationTherapy-Consultation
 Garland, Texas 75042               Phone: (817) 921-7621                  (409) 560-2664
 (214) 494-5691
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 Specializing in Disorders of the   10103 Fondren, Suite 160               A Medicare Approved Agency
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 12700 Hillcrest Road, Suite 104


                                    Houston, Texas 77096                   1901 Tenth St. , Suite 107
 Dallas, Texas 75230                Debra L. Hanovich, M.S. CCC/SP         Wichita Falls , Texas 76301
 (214) 233-4660                     Sue D. Rosenzweig, M.A.,000 A/SP       (817) 767-3215
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 Franklin Speech, Language and        M.A., CCC
   Myofunctional Clinic             119 Evanston, Suite 104
 Specializing in speech-language    Houston, Texas 77015
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                                    Jean O. Parrott, M.D., CCC/SP

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 Speech-Language-Hearing Clinic
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                                    James H. Hall, JR., M.A., CCC-A
                                    Deborah E Nager, M.A., CCC A


                                                    City and to 10 of their parents.                                                       have used monolingual Caucasian
     Earlene Tash Paynter, Ph.D.                                            `-'
                                                    Friedlander reported all misarti-                                                      children as their subjects (Mem-uk,
     Jackie E. Kennedy, M.S.                        Culations produced by the standard                                                     1968, also used Japanese children). To
     Jamie M. Green, M.S.                           English-speaking Anglo children were                                                   our knowledge there is no such
                                                    produced by both the Black and                                                         normative data for Mexican-American

                                                                                                                                 _L' ..y
     Texas Tech University
     Lubbock, Texas                                 Mexican-American children; and all                                                     children.
                                                    errors produced by the Mexican-                                                          The purpose of this study was to

        The articulation skills of 500              American children were also                                                            determine which English consonant
     Mavican-American children age                  produced by the Black children. He                                                     sounds are produced correctly and
                                                    concluded the sounds most fre-                                                         which distinctive features are

     four to eight years were tested to
                                                    quently tnisarticulated by the children                                                mastered by Mexican-American

     determine which of the English
                                                    were not due to regional or foreign                                                    children whose first or primary

     consonant sounds are mastered and              speech, and the language spoken by
     which distinctive features are present                                                                                                language is Spanish.
                                                    the parents did not determine the

     at each age level. The sequences of                                                                                                   METHOD

     English consonant sounds and                   articulatory proficiency of the child.
     distinctive features acquired by the              In a similar study, Williams et at.                                                 Subjects
                                                    (1971) attempted to identify a                                                            Five hundred Spanish-speaking
     Mexican American children were                                                                                                        Mexican-American children who
                                                    common group of errors or unique

     compared tvith earlier studies using                                                                                                  passed screening tests of hearing
                                                    groups of errors for 192 Mexican-

     monolingual English-speaking                                                                                                          acuity and oral speech structure
                                                    American first through sixth graders

     children.                                                                                                                             adequacy served as subjects. All
                                                    from San Antonio. They also found
          exican-American children are              no articulation errors present in the                                                  subjects were identified as Spanish-


     M frequently referred to thethey do
     language pathologist because
                                  speech-           Mexican-American children that were
                                                    not present in either the standard
                                                                                                                                           speaking Mexican-American children
                                                                                                                                           by their teachers or parent(s). The     0.'t


                                                                                                                                           sample was divided into five sub-

     not make all the sounds found in               English-speaking Anglo children or

                                                    the Black children. In addition they                                                   samples according to age: 50 male

     standard English. It has been assumed

                                                                                                                                           and 50 female four-year olds, 50 male

     by many that the absence of standard           were unable to differentiate dialect
                                                                                                                                           and 50 female five-year olds, 50 male

                                                    from developmental patterns across

     English sounds is the direct result of

                                                                                                                                           and 50 female six-year olds, 50 male

     English being learned simultaneously           grades for the Mexican-American
     with or being super-imposed upon               group.                                                                                 and 50 female seven-year olds, and
     the native Spanish (Cairns, Cairns and           Cairns et al. (1974) analyzed the                                                    50 male and 50 female eight-year

                                                                                                                                           olds. Each subject fell within six

                                                    articulation substitutions of Williams

     Williams, 1974). By 1995, 50 percent
     of the school age children in Texas            et alts (1971) three groups of children                                                months of the designated age; i.e., all
                                                    using a distinctive feature approach                                                   children in the four-year-old group

     are predicted to be Mexican-American
     (Cavazos, 1982). The speech-language           with binary feature values and                                                         ranged from three years, six months,
     pathologists are expected to identify          markedness values. By using the                                                        through four years, five months, etc.
     not only children with articulation            distinctive features approach, Cairns                                                  No attempt was made to identify

     errors which are deviant from                  et al. (1974) explained each substitu-                                                 subgroups in terms of proficiency in
     standard English, but must be able to          tion error as due to Black dialect,                                                    either language.
     differentiate those errors which are           Spanish-influenced-English, or                                                         Articulation Testing

     related to the Spanish language from           markedness.                                                                              The Templin Darley Revised
     those errors which are independent                A number of studies have been                                                       Diagnostic Test (Templin and Darley,

     of the Spanish.                                conducted to determine develop-                                                        1969) was administered to each

        As part of a study investigating            mental ages at which specific sounds                                                   subject. Only the first 126 items of
     the articulatory status of 150 cul-            are mastered (Wellman et al., 1931;                                                    the picture articulation subtest were

     turally disadvantaged preschoolers             Pool, 1934; Templin, 1957; Paynter                                                     administered. These items tested all

                                                    and Petty, 1974; Prather et al., 1975)                                                 the single consonants and consonant

     (Friedlander, 1965), articulation tests

     were administered to 49 children,              and at which ages distinctive features                                                 blends. The examiners attempted

                                                                                                                                           to administer the test using the

     41/2 - 6 years of age, with a Spanish          are acquired (Menyuk, 1968; Prather
     language background who attended               et al., 1975; Weiner and Bernthal,                                                     spontaneous method to elicit
                                                                                                                                           responses. However, due to the

     the Head Start program in New York             cited in Singh, 1976). These studies

10                                                                                                                                         limited English vocabulary in
the majority of the subjects. the                                               added six single consonants /j.m.n.b.t.
spontaneous method was abandoned                                                g/, 11 clusters /pl.bcdr.kckl,gl_fl.-d2',
in favor of the imitative method. The                                           - 1 m.tjk,-nip/, and /ju/. In addition,
responses were recorded according to                                            the seven-year olds articulated                                          14                          4 YRS                     5 YRS                   6YRS                7 YRS
the test manual (Templin and Darlev.                                            correctly /P.fr,-              d.-Ik/. Four single
1969). For a sound to be judged                                                 consonants /y,d , AX and 26 clusters                                                                                                                                          IIIIIIIIIIIIIIIIIMExICAN- AMERICAN

correct. the response had to sound                                              /spl.-nd.-ft.-kt.sm.sn.sp.st.sk.sl.sw.str.                                                                                                                                                              DER
and look like a correct production.                                             skr.-1-z5           g-p.- 3't. 3 k. c Ci


   The examiners for this studv -,were                                          slApAt. V


two female graduate students in                                                 -If,-sm-ks,-raps/ to their articulator


Speech Pathology at Texas Tech                                                  repertoire. Icss than 90% of the
University. Inter-judge agreement for                                           eight-year olds correctly articulated
the examiners was 94%; intrt-judge                                              seven single consonants //1 ,tf p
agreement was 99% for one examiner                                              s, z,     / and 10 clusters l r,,' r,spr,
and 97% for the other examiner. The                                                   t j ,- f,-Iz,-st,-sk,-nt,-pt/.
procedures used to obtain the relia-                                                Templin considered a sound
bility data are described elsewhere

                                                                                acquired if correctly produced by
(Green, 1979).                                                                  75(Y,, of her subjects. Table 2 presents
Analysis of the Data                                                            the single consonants and blends
  A sound was assigned to an age

                                                                                correctly produced by at least 75%, of
level when 90% or more of the                                                   the children in the present study and
subjects tested correctly produced the

                                                                                in Templin's study. As seen in Table 2,

sound in all positions in which it was                                          the Mexican-American children tend

tested.                                                                         to reach the criterion level at a later                                                                    IIIIIIIIIIIIIIIlIIIIIIIIIIIIIII IIIIIIIIIIIIIII

   From the 126 items tested, 65 items

                                                                                age than the Anglos in Templin's                                                                     'llllllllllllll IIIIIIIIIIIIIIII IIIIIIIIIIIIIIII IIIIIIIIIIIIIII
were used in the distinctive feature

                                                                                study and sequence of sound                                                    WIIIIWIIII                   (IIIIIIIIIIIII IIIIIIIIIIIIIIII IIIIIIIIIIIIIIII IIIIIIIIIIIIIII
analysis. The 65 items included those                                           acquisition is different for the two                                                                                                                                           (IIIIIIIIIIIII
items in which a single consonant                                               groups.

sound was tested in the initial,

medial, or final position, according                                              As seen in Table 2, 12 of the 23

                                                                                    single consonants and 22 of the 68
                                                                                                                                                              Illlf lif illf m l l l l l l l l l l l l l l l l l l l l l   lll IIIIIIIIIII   I I I I I I I IIIIIIII IIIIIIIIIIII   IIIIIIIIIIIIIII
to the Templin-Darley (1969)                                                        clusters were articulated correctly
                                                                                                                                                                                                         W :b ,..


classification. These sounds were                                                   by both groups by the same ages.
                                                                                                                                                               11111111111111111t11111111111111111111111111111111111111111 101111

then identified according to their                                                                                                                                                                                                illoom
                                                                                    Templin's subjects articulated cor-

position in the syllable, either
prevocalic or postvocalic The data                                                  rectly 11 of the single consonants and
                                                                                    30 cluster items at an earlier age than
                                                                                                                                                                                              r--e D                                                                                                  -

                                                                                                                                                                                                                                                                                   IIIIIIIIIIIIIII -
were then analyzed as described by                                                  the Mexican-American subjects.
Menyuk (1968) using the distinctive                                                                                                                                                                                                                                                csllllllllllll

                                                                                    However, the Mexican-American

feature classification proposed by
Jakobsen, Font, and Halle (1952). A                                                 subjects reached criterion at earlier
                                                                                    ages on 12 of the consonant clusters.
                                                                                                                                                                                                                                             .7 0
percentage of correct usage was                                                     The differences in the sequences maN
calculated for each distinctive feature                                             reflect differences in the environment

for each of the five age groups tested,                                                             the work of Weinreich (1957),

using the following formula:                                                        in which the two groups of children
                                                                                                    Stockwell and Bowen (1965),
                                                                                    learned English. It is not within the
        Tbtal number of times a                                                                     Williams et al. (1971), Cairns et al.
                                                                                    scope of this study to explain these
P _ Feature was used correctly                                                                      (1974), and Dubois and Valdes (1980).
                                                                                    discrepancies. For a critical discussion

        7btal number of oppor-                                                                        The data obtained from the
                                                                                    of this topic, the reader is referred to
       tunities for correct usage                                                                   Mexican-American children was
A feature was assigned to an age level                                                              compared with Sander's (1972)

when the percentage of correct usage Table 1. Consonants and Consonant                              presentation of range of average
by the subjects was 90 or above.                   Blends Mastered by at Least                      performance. Using Templin's (1975)


Percentages were calculated within     90% of the Mexican- American Children and Wellman et al's (1931) data,
each age group for boys, girls, and                                                                 Sander identified the ages at which
combined sexes in the prevocalic                                                                    correct production ranges from more
                                       Age                                                          than 50% to at least 90%. Figure A
position, postvocalic position, and
both positions for each of the 16                                                                   shows the comparison between the

distinctive features.                   4  n, h, w                                                  Mexican-American subjects' data and
                                           -m 2' , -n , , -p3,, -kV, -go-, -t q-, -3' n', -pl, -kl,
                                                                                                    Sander's analysis of Rmplin's and

                                           -gl, -bl,-P
RESULTS AND                                                                                         Wellman et al's data. The bars
DISCUSSION                              5  r, 1,k                                                   represent the range from 50% to
Acquisition of Consonant                                                                 gr, pr, tr, bl, tw, kw, -b2' ,    41
                                                                                                                                                                   90% correct production. When the
Sounds                                                                          6        j, m, n, b,t,g                                                            percentage correct at four years
  Table 1 presents the English                                                                                                                                     exceeded 51%, the lower limit of the

                                                                                         pl, br, dr, kr, kl, gl, fl, -de, -2'm, -11 n`, 9k, -mp,
consonant sounds and consonant                                                           ju                                                                        sound was placed at less than four
blends mastered at the different ages                                                                                                                               years of age. Similarly, when the

by at least 90% of the subjects. The                                            7        p
                                                                                         fr, -e'd, -Ik                                                              percentage correct at eight years was
four year olds articulated correctly                                                                                                                                less than 90%, the upper age limit of

three single consonants /n,h,w/, 11                                             8        v, d3 d, f                                                                 the sound was placed at more than 8

consonant clusters /-mgr ,-n21 -p                                                        spl, -nd, -ft, -kt, -sm, sn, sp, st, sk, sl, sw, str,                      years of age. As seen in Figure A, the
                                                                                         skr,          -f-6, -2Xp,     -vt, --pk,              sl, lp,
-k a' ,-g? -t a,,- 2r n,-pl,-kl,-gl,-bl/, and                                            -It, -If, -sm, -ks, -mps
                                                                                                                                                                    major difference shown is the later
/1 /. The five-year olds added 3 single                                                                                                                             age levels for the Mexican-American
consonants /r,l,k/ and 8 clusters /gr,pr,                                                                                                                           subjects. While the lower age limits

                                                                                    Appeared at age 4 at 90 percent, dropped at age 5, and
tr,bl,tw,kw,-bv ,-tl/. The six-year olds                                                                                                                            are below four years of age for 17 of

                                                                                    returned at age 6.                                                                                                                                                                                                     11
    the 24 sounds in the two analysis. the                                            acyuisition by the Mexican-American                   A comparison of the acyuisition of
    upper age limits are much later for 18                                            subjects is presented in 'fable 3. Eight            the minus features is presented in
                                                                                      of the 16 features reached criterion

    Of the sounds for the Mexican-                                                                                                        Table 5. Except for the features
    American subjects, and 10 more of'                                               for at least 90% of the suhject by                   compact and acuitC. the order of

    the sounds develop over a much                                                   four years of age: four more textures                acquisition for the Mexican-American
    wider span of time for the NIexican-                                             reached criterion by fire years: an                  subjects was almost the reverse of the
    American subjects. The N,iexican-                                                additional one by six vears: two more                order for monolingual English-

    American subject mastered only two                                               by seven vears, and the last one                     speaking children in that the features
    sounds /r.l/ at an earlier age and the                                           reached criterion by eight years of                  that were first to reach criterion for
    /y/ in a much narro-ver span of time                                             age.                                                 the tNlexican-American children, tense
    than reported by Sander. Four sounds                                               Nlem-uk (1968) explored the           and oral, NN-cre the last to reach


    l e , A,' .z/ would be expected to be                                            possibility of a universal ordering of  criterion for the Anglo children. It
    mastered by most monolingual Anglo                                               distinctive features as proposed by     should be noted that the order for

    children before one would expect                                                 Jakobsen. Part of her study included a  the Nlexican-American suhjects was
    51% of the Spanish speaking                                                      comparison of the order of plus         haled on the production of English
    Mexican-American children to be                                                  distinctive features between American   consonants and not Spanish.
    producing them correctly. Using this                                             children, age two to five, and             A comparison of the ages at which
    type of analysis maw be more useful                                              Japanese children, one to three years   six distinctive features reach criterion
    in determining a given child's need                                              of age. Prather et al. (1975) examined   for the Nlexican-American children

    for articulation therapy than an upper                                           distinctive feature acquisition in      and for monolingual English-speaking
    age limit chart.                                                                 Anglo-American children, two to four    children (Menwuk, 1968; Prtther et

                                                                                     wears of age. A comparison of the       al., 1975) is presented in Table 7.

      Figure A. Comparison of the Mexican-American
      subjects' with Sander's (1972, p. 62) analysis the
                                                                                     order of the plus distinctive feature    Metykuk's (1968) subjects ranged in
      Templin (1957) and Wellman et al. (1931) data showing                          acquisition in the present study with   age from two and one half years;
      average age estimate (50%) and upper age limits                                the two previous studies is presented    Prather et al.'s (1975) subjects were


      (90%) of customary consonant production. When the
      percentage correct at 4 years exceeded 51%, the bar                            in Table 4. The order found for         two to four years of age; the Spanish-
      extends to the left F < 4. When the 90% level was                              the Mexican-American children is        speaking Mexican-American children
      not reached by 8 years, the bar extends to the right                           identical to that of Prather et al.'s
       > 8 ---
                                                                                     (1975) monolingual English-speaking
    Acquisition of distinctive                                                       children and differs from Men}-uk's
    features                                                                         (1968) in the reversed order of the    Table 3. Distinctive Features
       The order of distinctive feature                                              features voice and diffuse.                       Acquired by at Least 90% of
                                                                                                                                       the Mexican-American
    Table 2. Consonants and Consonant Blends
             Mastered by at Least 75% of the
             Monolingual Anglo Children (Templin,                                                                                                                                        of Correct
             1957) and at Least 75% of the                                                                                                Age             Features                 Feature Usage
             Spanish Speaking Mexican-American
             Children                                                                                                                     4 years         nasal                            94.57%
                                                                                                                                                          nonvocalic                       93.15%
             Templin's Monolingual                         Spanish Speaking                                                                               consonantal                      92.95%
                                                                                                                                                          vocalic                          92.75%
     Age       Anglo Children                          Mexican-American Children                                                                          tense                            92.14%
                                                                                                                                                          oral                             92.05%
       4       j, 7 n, b, t, k, g, h, w
            r, I,     ,                                r,   I,    j, j   ,   n, b, t, k, g, h, w                                                          compact                          91.90%
           pr, br, tr, dr, kl, gl, bl, tw, kw          pr, br, tr, dr, kl, gl, bl, tw, kw

           -m v , -n a , -pr , -b v ,                  -ma , -nap , -pr, -by, -d x,                                                                 consonantal                            91.75%
            -dv, -k3, -g v, -um, -Vt                   -k is , -g o,, - r m, - it
            m, J, ,p,d,f,s                             gr, -tv, -an, -bl, -tl, -pl, -kl

                                                                                                                                          5 years         grave                            94.50%
            -3 k, -2, k, -ks, -m p, -mps                    I,    -sl, -Ik                                                                                diffuse                          94.39%
            -pt, A -sm, -It, kr, sk, sm,                                                                                                                  interrupted                      91.58%

            sn, sp, st, -Ip, pl                                                                                                                           acute                            90.32%
       5    fl, d,                                     fl, d                                                                              6 years         lax                              90.79%


                                                       m, p
            gr, ft, -If, -a p, -Td, -Tf,               kr, sw, -Ip, -sm, - yk, -mp                                                        7 years         continuant

            -in,- fT,str                               ju'                                                                                                strident                         91.25%
       6    -6d 3                                      -V d                                                                               8 years         mellow                           94.56%
           1,v                                         d,I,s'
            -nd,      2P ,      -pl, -kl, -bl, -gl     fr, pl, sm, sn, sp, st, sl, str
            -sl, -nt, -Ik, -rt f ,       -st           -;6,n, - 3 p, -a d, --s k, V c13 ,            -It,    Table 4. Order of Plus Distinctive Feature
            A)                                         -ks, -mps
       7     8r                                        6r++
             0, z, 2                                                           -S's,,-NtfJ ,sk

            J, r, sl,sw, -Iz, -sk, skr                 -nt                                                                                 Menyuk's (1968)               Prather et al.'s

            spl, spr                                                                                          Mexican-American              Monolingual                (1975) Monolingual
                                                                                                                  Children                 Anglo Children                Anglo Children
       8    -kt                                        -kt
            -t V                                       V,3

                                                       spl, spr, a' f, -nd, -pt, -ft, skr, -st,                        nasal                    nasal                           nasal

                                                       -sk, -If                                                        grave                    grave                           grave
                                                                                                                       diffuse                  voice                           diffuse
     " Sounds tested and acquired in the present study which were not tested                                           voice                    diffuse                         voice
        in Templin's study.                                                                                            continuant               continuant                      continuant
                                                                                                                       stident                  strident                        stident
    + Appeared at 6 at 75%,
12 ++ Appeared at 7 at 76x/0,dropped to 71% at age 7, and returned at age 8.
                             dropped to 72% at age 8.
 were four to eight years of age. For          groups acquired these distinctive                                     Ca%acos- 1) Teacher, need preparation. 1)fit cisiti
                                               features at about the same ages except                                Dctill' Texas -tech I m%crsin..lso,cmhcr Iii. 1983.
 this reason, the comparison of

                                                                                                                     Duhois. B.I._ mid \;aidcs. G. \tcxicm-:American child
 features was limited to the six features      for the mellow feature which reached                                  Ill li119LIAi,nt tl(ttlhle deficit' The hitiuguett Reriew lu
 conunon to the three study popula-            criterion three years later for the                                   Rcrisla Rilmgiw          1-- (1980),
                                                                                                                     Fricdlanger. (I H- Report on the .Aniculation :old
 tions. Comparing the ages of feature          Mexican-Arnericul children- Further                                   Intrlligihilit, sea[als Of SOCIAIN Di,ad,:uuagrd Pre-
 mastery hetween the two groups,               research should be directed toward                                    School Children. I uhlicanon of t S. (Micc of Ill-:11th
                                                                                                                     F:dmmion..and \\clfarc- IRR I D-111-1,31 119651-
except for the compact feature, the            identifying the order of distinctive                                  6rccn. LAI. Distinctive tcature a(+11s1tinn he Sp:uli,h-
Mexican-American children reached              featLlre masterv by )vlexlcan-American                                >pcaking Mexican-Amcricul chlcrcn tour to eight
criterion for these features from one          children when speaking Spanish.                                       ccar, of age. I npubli,hcd ma,[cr;s thesis. leas Iii-ch
                                                                                                                     jhi,crsity 119-91.
to four years later than the                                                                                         lakohscn. R- Pant. (-M.- and Hallc- M. Preliminaries
monolingual English-speaking                   ACKNOWLEDGEMENTS
                                                                                                                     to 5'pee(h .111a11lsis: fbe 1)istittctire feahn'es and 71eir-
                                                                                                                     011-W ales. Carnhridgc.MA . AIsssachusctt, Institute of
chldren.                                         lackic F. Kcnncdy. M.S., is :affiliated \\ ith the                  l1echnolog, Press 119531.
                                               South plains co-op. Iamic \I. Grccn. AI.S., is in                     VI:¢cika- L- A comparison of the phonologicll
    Mazeika (1971) noted that the Span-        private practice in Borger, Texas.                                    dccclopment of a monolingual and a bilingual
ish language has more consonant-                 This study vy:u supported. in part. by the                          (spanish I nglish) child. Papcr prescrlRd at [he
        combinations in its syllables                                                                                Biennial Alu'ting of the Socict, for Rcscmch in Child
                                               Institute of Collcgc Research (Arts and                               Dccclopnxnt, Vinncalloli, (19-1)
than does English, which has more

                                               Sciences), Texas "tech l'nivcrsity Portions of                       Vlenyuk, 1) The role of distinctkc features in
consonant-vowel-consonant syllables.           the data reported vv crc prescmcd at the                             children:. acquisition of phonolog,. Jnta'uat ofSpeedr
                                               American Speech-Language-hearing Association                         and Ifearittg Research. 11- 1;8-1-t6 (1968).
This "open syllable" characteristic of         Convention in San Francisco, 19-8.                                   Palmer. ET, and Pcto, N.A. Articul:uon sound
Spanish could account for the                     The authors are grateful to the Luhhock,                          acquisition of mo-,car-old children. Perceptual Jlolor
                                                                                                                    Skilks, 19. 111-9-191 (19-1),
significantly lower percentage of              Hereford, and Plaimicw Migrant Ccntcrs, file                          Pool. L Gcnctic dc,elopmcnt of arimikition of
correct feature usage in the post-             Luhbock and Slaton Heacl Start Programs, and                         IX lilulmall[ soun(Is in spccch. Flemeularl, 1:n"" isle
                                               the blur clementary schools in San Angelo.                            Rcricu;         159-161 (19i-1)-
vocalic position than in the                   'lexas. for their cooperation and assistance in
                                                                                                                     Prather. I:.. Hedrick, 1)_ and Kern, C. Artic-tiLmon
prevocalic position for 13 of the 15           securing the subjects for the study. The authors                      developnxnt in chlclrcn :aged mo to tour tears.
features.                                       yish to ackno\\ ledge the assistance of Dr.                         Journal of Spec h (till/ 11ecu'iug F)isotrlets. -11,
                                               David I. Draper, Dr. John R. Mama. Dr. Michael                        1-9-191 II9-5).
  A comparison was oracle of the               D. Smith, Mr. Jim Morgan, and Mr. Ken Payntcr.                       Sander, I:.F. Vyhen are speech sounds learned'
ages at which six distinctive features                                                                              /ottrnat otSpeech and Hearing Disorders, i-. 55-6j
                                                                                                                    ( 19-3).
reached criterion in the prevocalic

                                                                                                                    Stockwcll. R.P. and Bo\,cn. I.D. 7Zre Sounds o%
position for the Mexican-American              REFERENCES                                                           English cold Spanish. Chicago: t nicctNity of Chicago
                                                                                                                     Pres, (1965).
subjects and the ages at which they            Cairns. H.S.. Cairn,, C. F- an (I AC'illiams. F. Sonic               lemplin, Vt. Certain language skills in children, their
were mastered by the monolingual               theoretical considerations of articulation enh5[Itn11011
                                               phenomena 1,111glnage and .S'peech' 1611-1-i
                                                                                                                    development and interrelationships. Institute o/ 041d
children. As seen in Table 7, the two                                                                                lletf ire, Monograph Series, No. 36, Minncapolis:
                                                19--0.                                                               I ni,etsit, of Minnesota Press (195-)_
                                                                                                                    lemplin. M1 and Darlcy. F The 7emplin-Oarlo Tests
                                                                                                                    of Artictdalion. Second Pd. lov,a Cit, The t ni,cr,a,
             Table 5. Order of Minus Distinctive                                                                    of lovya (1969).
                                                                                                                    VAeincr, IT, and Bernthal, I. ;Acquisition of phonetic

                      Feature Acquisition                                                                           fe:ataarrs in children thvo to six wars old. In S- Singh.
                                                                                                                    1)icthrctive Features Them 1, and lidulation-
                                                                                                                    Baltimore Unkcr m Park Press. 1-8-20-1 (19-6).
                                                                                                                    VVeinreich. 1'. On the description of phonic
                                      Prather et al.'s                                                              interference Wind, 11, 1-11 (195-)-
                                    (1975) Monolingual                                                              VVcllman. B Case, I.. Alcngcrt. L. and Bctdhur,. D.
              Mexican-American       English-Speaking                                                               Speech sounds of ,dung ( hildren_ I niretsiti, of /ouva
                                                                                                                    Shleliec fn Child Wcl_lare 5. 1-83 (1911).       -   -
                  Children               Children                                                                   Vyilliams, F. Cairns. H.S-, and Cairns, C.L..Intilisis of
                                                                                                                    the L2n'iationsJrnm Standard Etiglisb Proncuuciaticnt
                                                                                                                    in file Phonetic Pertm-mctncc of 7uvt Groups of
                  tense              interrupted (-continuant)                                                      Wntslemdrnzl-Liug/fs'h-.Sperrkhrg Chitchrn. Project
                  oral               mellow (-strident)                                                             Report, Center for C(ImmunlCatlOn Research.
                  compact            compact (-diffuse)                                                             Inicersin' of lexas at Austin (19-1).
                  interrupted        tense (-voice)
                  acute               oral (-nasal)
                  mellow              acute (-grave)                                                                                                                     1%)
                                                                                    Table 7. Distinctive Features Acquired by at
Table 6. Distinctive Features Acquired by at                                                 Least 90% of the Mexican-American
         Least 90% of the Mexican-American                                                   Children in the Prevocalic Position
         Children and the Monolingual                                                        and by at Least 90% of the
             English-Speaking Children                                                       Monolingual English-Speaking
                                   Monolingual English-
                                    Speaking Children
               Mexican-American      (Menyuk, 1968;                                                                                         Monolingual English-
   Age             Children        Prather et al., 1975)                                                                                     Speaking Children
                                                                                                           Mexican-American                (Menyuk, 1968; Prather
   4 years                                                                               Age                   Children                         et al., 1975)
                  nasal                  nasal
                  compact                grave
                                         interrupted                                    4 years               nasal                                nasal
                                         mellow                                                               compact                              grave
                                         compact                                                              interrupted                          interrupted
                                         interrupted                                                          grave                                mellow
  5 years

                  grave                  lax
                  interrupted                                                           5 years               lax                                  lax

  6 years                                                                               6 years


  8 years         mellow                                                                7 years               mellow
                                                        HOUSTON, TEXAS
                      I ocIis Iratlitionalli. Iota (lirc( Ie(l its (ittenti(,rt ort 1cx(ls ((hr(
                     irrstitilliorls 11urt prcj)(tre sp('ech-hire"'lla)c p(tth(do" ists urr(! (tilthologists
                     !or proli'ssionnl ccn-((rs. 'Ii jas, labile looki)i(, to cxptln(l the horl_orrs n%
                     f71( I Jnrul(I it (lr((nn come Irlic." ill the fiwm of 'l llr Pariar Sdm( 1.
                     11050 7imhcrline Ill Houston
                     At one tiere or (mother c(ich of its has tol(lolihtc(lly wanted t() Step ortt
                       l the                  Service (Ic'lil'ery /)/()It/ (lilt/ 011('1' smn(thnl-   sp('( ull
                         tlrllc'r'crlt -- inlimatil'e (tilt11)(01aPs c'l,cr hello: !u oltr (1(t')/IS.
                     k'ohhill P(nrish. while opcrcitin,(' (i t)pi((il priltit( pructicc'. sei':c(I ((j)olt
                     rill opportimit), (took the prove)-hiul B11/14)y-the-horns! (m(I opencrl 'the
                     11(trish S(hool Ill /line 198j'.      AI ja,,. ill the lollowiir", intcrriell' hopes to
                     coil(ey ', a 1)r(tt1n (mw Irnc', wd only log' h'ohhirl hilt (llso !hilt I- -bit (t
                     to-t((uh" rhi/(lrrrl irr rtortblr(at /lorratolr.
     Robbin Parish                                                                                          Ulk(tfimr lWilm.

                                            Small groups, within the classroom, are designed to help children achieve specific
                                            goals. Here, Margaret, the Kindergarten teacher, instructs Nicole, Spencer and Trent in
                                            a lesson from the TRAM.
  cc              ew School Opens for the Hard-
        NTo Teach Child," reads the
 headlines of an article published in
                          ,., ,.y


 The Houston Chronicle, Monday,
 August 15, 1983. As the parent being
 interviewed begins telling her story,
 the reader should recognize the

    Here is a child with average to
 above average abilities with delays in

 verbal expression or comprehension,
 fine or gross motor skills, or personal
 social skills, who does not fit into the
 regular private or public pre-school or

 kindergarten programs, yet, is not
 "low enough" to qualify for special

 education or early childhood. We
 have seen this child in our case loads

 for years: a bright child with a poor
 self image, parents who are confused

 and teachers who have lost their
   Robbin Parish, M.A., CCC-SP,
 believes that if speech-language
 pathologists and audiologists and
 other identify these children at an
 early age, and if language intervention

 can begin in a group setting on an

 intensive basis, these children will be
 able to learn in an academic setting                                           Aide, Chris Jones, helps kilizabeth and Ashle%

 with little or no resource work. "If

                                                                                "discover" on the nature trail. Children are
 we can identify their learning styles,                                         encouraged to find different items in nature, learn

 individualize their education and                                              about them and report to the class.
 teach to their strengths, we can help
 these children succeed and feel good                                     identification and remediation can
 about themselves."                                                       prevent failure in academic endeav-
    Parish has been in private practice                                   ors," Parish said, "yet we are not

 in the Houston area for many years.                                      providing the services to the children

 During this time, she has spoken                                         who can benefit the most. We have
 to parents and teachers and has                                          seen the early childhood program

 observed the children gradually                                          work for children with severe

 becoming more and more aware of                                          problems, why wouldn't a language

 their weaknesses and "giving" up on                                      based pre-school program work for
 the learning process.                                                    marginal children?"

    Encouraged by parents of her clinic                                      Parish found a 20 year old house

 patients, Parish decided to open a                                       nestled on 2 acres, covered with oak

  school for these children - a school                                    trees, a pond, a grape arbor and rose


                                                                          garden. Hidden in a small sub-

  that would provide group language

  development to children 18 months                                       division off Interstate 10, in the
  to 6 years, emphasizing individualized                                  Spring Branch area, The Parish School

  programs for each child. The program                                    became a reality.
  utilizes teaching strategies which build                                   "When I first saw this house and

  upon the child's strengths in order to                                  the beautiful grounds, all I could

  overcome identified weaknesses.                                         think of was language experiences,"
  Group language therapy in a school                                      Parish said as she described the

  setting!                                                                nature trail, the vegetable garden and

        "Research has indicated that early                                the playground which is really a
     "vacant lot." 1"nlike the stereotyped

     playgrounds of slides, swings, seesaws

     and jungle gyms, The Parish School

     playground provides a place where
     children can explore, discover and


     construct their own creative ideas.

     Play is not considered a pastime;
     rather, play is used as a means of

     helping children discover basic

     information for future growth in

     academic and social skills. When
     parents first see the playground, they
     always ask, Where are the slides and
     swings? Asked what they remember
     the most about their own childhood

     playtime, they respond, "building a

     fort," or "climbing a tree," or "playing

     in a vacant lot" They ask no more
     about swings and slides!

       Children are admitted into the

     school program after a parent

     interview, a learning assessment
     screening and a majority vote of the                                          Teachers and aides meet once a week to discuss weekh progress toHnrd goals. There
     admissions committee. In order to                                             are three teachers and four aides for 30 children. From left: Chris Earle, 1I .Ed., CCC-
                                                                                   SP. Teri Rolph. M.A., CCGSR Chris Jones. Aide, Margaret loecker, B.A_
     qualify for admission, each child

                                                                                   Jeannine Smith. Aide Colleen McHugh, M.A., CCC-SP.
     must have average to above average
     abilities, determined by a develop-


     mental screening, but have weak areas
     that are below average and interfering                                                                                                                                                                I
     with the child's ability to perform at


     age level.                                                                    training and the background to
       After admission, an individual                                              identify weaknesses and strengths and

     educational plan is developed for                                             know how to program small steps for

     every child. Objectives and target                                            successful learning experiences. In

     dates for meeting the objectives are                                          addition, the Speech-Language
     included in each plan. The parents                                            Pathologist can provide the education

     meet individually with the teacher to                                         program for the parents. We all know

     develop this plan together and to                                             how important parent involvement is
     indicate how they will participate in                                         in the education of a child - yet
     the learning experience.                                                      how much time do we as profes-

        The pre-school and academic                                                sionals take to include parents?"
     program includes basic language skill                                           Parish has developed "Parent-
     training in oral language, reading,                                           Education" nights for all parents in

     writing, spelling and social-personal                                         the school. Each course is specifically

     development. If the children have not                                         designed for different age groups and

     acquired the content form and use of                                          for teaching parents about language

     language, they will not be exposed to                                         development and developmental


     the academics. Parish believes that                                           milestones. These courses in
     these early language skills are the                                           "language development" are followed

     basis for academic success.                                                   by parents participating in observing
        "I believe that Speech-Language                                            video tapes, identifying language
     Pathologists with good backgrounds                                            behaviors, and learning about the

     in language theory and practicum                                              teacher's goals for their children.

     make the best teachers for these

                                                                                      "We are really trying to educate as
     children. Children not only learn                                             many people as possible. If parents,


     from the teacher, they learn from                                             grandparents, and others close to the

     each other. The interaction with                                              child can begin to understand what                           21 month old Jack has discovered that a cardboard
     other children can be guided and                                              language is and how it affects                               box makes a good slide. Children are encouraged to

                                                                                                                                                create their own play with a variety of ordinary items:
     structured by a Speech-Language                                               academic success, we're half-way

                                                                                                                                                cardboard boxes, scrap pieces of wood, nails, old tires,
     Pathologist because they have the

16                                                                                 there."                                                      etc.
Concrete culverts were donated to the school for the                         A big oak tree on the hill provides a "safe" place for Nathan who created this game
playground. Here. Spencer "poses" in his private                             of tag with Robbie.

    In addition to Parent-Education                       Spurred on by the success of the

nights, Parish and her staff are                       summer program, Parish established a

offering in-service training seminars                  Board of Directors, filed for a tax

to public and private school teachers                  exempt private school status, and
who may be interested in learning                      opened the doors for the first school
about language development and                         year. The program, this year, is one-

disorders and how language                             half day and is for children 15

development plays an integral part in                  months to six years. Next year (1984)
readiness for academics.                               Parish will add a first grade and, in
    Parish introduced the school this                  1985, a second grade. At the end of
summer with an extended day                            second grade at The Parish School, a
program. She asked private and                         "transitional teacher" will work with

public pre-school teachers to send her                 the parents and their selected schools.
the children they could not teach and                  This teacher will help the parents
within two weeks, the school was                       choose the appropriate school, design
full. (No more than 10 children in a                   the educational plan and encourage
class; 1 teacher and 1 aide). "The                     teacher-parent-child interaction at the


progress noted in the children who                     new school.
came to the classes for 8 weeks, 7                       This language approach to early
hours a day, 5 days a week, was                        childhood education may appear to
remarkable, making others believe in                   some to be too idealistic, but it is a
what wP were doing. The children,                      dream come true for Parish. "Of all

their selt esteem, their motivation,                   my endeavors," says Parish, "this
and their approach to education had                    school gives me my greatest sense of
all improved. Teachers and principals                  accomplishment. It is my hope that

called us and said `What have you                      we set a trend for similar schools to
done with these children? They have                    open throughout the state and nation

made such drastic changes: "                           so that no child will go unserved"                                                                          17

                                                      QillD SNQME

                                                                                                                 Gardner Gateley, Ph.D.

       n his excellent article, "Principles                                                                      Bavlor University

       of Therapy," Dr. Joseph Sheehan

                                                                                                                 Waco, Texas
     (1982) discusses the role of guilt and
     shame in the origin of stuttering, the

     perpetuation of stuttering and the
     various complications these emotions       and shame are weapons of those who                     is created by pride. Why would 1 feel

     create in therapy. Aside from clinical     perceive themselves at a disadvantage,                 so guilty about this mistake if 1 am

     incompetence, guilt is probably the        and when the tables are turned, the                    not really it wonderful person or an
     most common cause of clinical              true nature of guilt and shame will be                 excellent speaker? Guilt, then, is an

     failure.                                   revealed: the guilty party will express                attempt to deny reality, usually an

        Dr. Sheehan classifies guilt into six   anger to the extent that he feels guilty               attempt to prove to one's self that he
     categories: (1) primary guilt which        or shameful (Perls, 1959).                             isn't a human being. If one can
     probably caused initial dysfluency;

                                                   When we feel guilt or shame, we                     accept the fact that he is a stutterer

     (2) secondary guilt over failure to                                                               and is taught how to stand up for his

                                                are expressing our hatred of people

     solve what he has been led to con-         who appear to be imposing their                        right to be one, guilt over stuttering
     sider a minor problem; (3) audience        standards on us, but out of fear of                    isn't a problem any more and the

     punishment guilt which stems from          retaliation, we turn this resentment                   problem of stuttering can be resolved
     the stutterer's perception of the          against ourselves and retaliate,                       through appropriate speech therapy.

     influence of his stuttering on his                                                                Dr. Sheehan has known this for many
     listener; (4) therapy-induced guilt        blushing, etc. in an effort to get back
                                                at our perceived tormentors.                           years.

     which is created by the Stutterer's           Recentlv I heard a deaf woman                          Guilt can also be understood as a

     perception that he is not doing                                                                   product of envy. The guilty party, due

     enough; (5) clinician-induced guilt        relate her reactions to being diag-
                                                nosed as mentally retarded when she                    to his position of inferiority, envies

     which stems from the stutterer's                                                                  the blameless. He feels cast out,

                                                was in elementary school. She

     belief that he is not meeting the          elaborated her guilt and anger. She                    indebted, and as such, is filled with
     expectations of the clinician; and         stated that her life's ambition was to                 resentment turned inward. As George

     (6) timing guilt which is caused by

                                                obtain a Ph.D., go back home and let                   Kelly (1955) stated, "Guilt is loss of
     attempting to do the right thing too

                                                all of her tormentors know about it.                   role;" the true "you" is revealed. The
     soon.                                      Her goal was to turn shame into                        solution to the problem for the stut-

        Few clinicians would disagree with      superiority, perhaps into arrogance! I                 terer is to stop admiring people for

     Dr. Sheehan.                               suspect that the foundation of the                     how they speak. Strength of guilt =
        The purpose of the article is to                                                               the strength of resentment or envy,
     present an approach to therapy which       stutterer's "Demosthenes Complex" is
                                                shame: finally he will show them all.                  but those whom we envy, we also
      minimizes or eliminates the problems         Guilt occurs when one cannot live                   appreciate or admire. One of the

      of guilt in stuttering therapy.                                                                  stutterer's basic problems is that he


                                                up to an arbitrarily imposed standard
     THE NATURE OF GUILT.                       with which he has partially identified                 judges people by how they talk. If he

       Stated quite simply, guilt is fear       and the resentment he feels cannot be                  could eliminate his appreciation or
     of shame, which stems from an              expressed directly but is turned in-                   admiration of people because of how
     awareness of being blamed. Shame is        ward: the guilty party tortures himself                they speak, resentment or envy,

     based on what we perceive as a fact;       rather than. somebody else, and every                  and consequently, guilt would be
                                                                                                       eliminated. We teach the stutterer not

     guilt is derived from fantasy. One can     clinician knows, as does every parent,

                                                                                                       to judge, period. To the extent he

     experience neither guilt nor shame if      the power of this aggressive act.


     he does not or had not cared.                 Interestingly, what one feels guilty                doesn't listen to us, he suffers. It
       Both guilt and shame are aggressive      about in one situation, he will be                     seems that to accept yourself, you
     acts, are expressions of hate, that is,    proud of in another.                                    must first accept others.
     they are forms of anger, the attempt          Moreover, guilt is an attempt to                       Finally, guilt over stuttering can be

18   to injure a hated object. Both guilt       prove that one is better than he is. It                 viewed as a product of paranoid
projection. To feet guilty over                                                                                                                                       because the adaptation effect is


stuttering, the stutterer must believe                                               THERAPY                                                                          occurring. Post-block relaxation

that he causes the listener's reac-                                                     (1) We make no demands on the                                                 makes learning new responses easier.
tions to his stuttering and that his                                                 client. Vie tell him that he is to do                                            Once a new response is learned,
stuttering is responsible for his own                                                nothing that he doesn't enjoy and to                                             following the example of Van Riper

guilt. The facts are that the listener                                               do nothing he dislikes. How can he                                               (1974), we create a stressful situation
chooses his reactions and the stutterer                                                                                                                               and allow the client to test himself.

                                                                                     fight with us, if this is the basic rule?

chooses to feel guilty out of his belief                                                                                                                              "There are no turn-arounds without
that feeling guilty over stuttering is an   <.%                                      I adopted this technique from Adler
                                                                                                                                                                      changes in speech.

                                                                                     (1969) and it has fascinating results.

appropriate response.

                                                                                     The stutterer, at a certain stage of                                             RELAXING THE CLIENT'S

   Guilt and shame are effective                                                     therapy, always compels me to do                                                 CONSCIENCE:

weapons to the extent that expres-                                                   desensitization work or practice on
sions of guilt and shame Great guilt                                                                                                                                    Guilt or low self-esteem is created

                                                                                     newly acquired speech patterns                                                   by ones awareness that his ac-

and shame in those who are making                                                    outside the clinical setting.                                                    complishments are less than his

their guilt causing demands. Most                                                       (2) We turn the stutterer around.
emotional reactions seem to create                                                                                                                                    expectations. As a general rule,
similar emotions in other people.                                                    We do this by making the stuttering,                                             guilt = accomplishments.
                                                                                     negative emotions, rejecting listeners,
   But how do we deal with this                                                      etc., respected friends instead of hated                                                    expectation

problem in therapy?                                                                                                                                                    Obviously, we can deal with guilt

                                                                                     enemies. We show the stutterer how                                                in two ways (1) we can increase

DEVELOPING A                                                                         to appreciate and enjoy stuttering. We                                           accomplishments or (2) decrease
CLINICAL SET.                                                                        do this by making therapeutic success

                                                                                                                         'CS ,`3
   There are two things that we                                                      depend on the presence of stuttering.                                            expectancies or demands on the self.
                                                                                     No progress can be made in therapy                                                   In working with stutterers, it is
can do.                                                                                          ',A
                                                                                                                                                                      probably necessary for us to help
   (1) We can appreciate the stutterer's                                             without stuttering, except, of course,
                                                                                                                                                                       them change expectancies first, so

                                                                                     an awareness of the feeling of fluency.

stuttering as a clinical problem.

Irrespective of how much he and                                                         All that we teach the stutterer is                                            that increased accomplishments will
                            ."r '3'

                                                                                     taught when actual stuttering or the                                             follow. Dr. Sheehan, for example,
others have suffered because of it, it                                                                                                                                attributes the solution of stuttering to
developed out of necessity and was,                                                  actual impulse to stutter occurs. The                                            the stutterer's renunciation of his
and perhaps is, a technique for                                                      more the stutterer stutters and gets

psychological survival. No matter                                                    upset over it, the more expert we                                                pretenses of being a fluent speaker. Of
how obnoxious he appears or how                                                      become, and the more progress he                                                 course, Dr. Sheehan doesn't deny the

silly his efforts, when he speaks to                                                 makes. The stuttering becomes useful                                             necessity of speech therapy.
you, he is showing you his life                                                      to the clinician, and the only way the                                              Most persons who receive psycho-
                                                                                                                                                                      therapy must disidentify with their

preserver, and it should be regarded                                                 client can frustrate him is by speak-

as sacred territory. Whether or not he                                               ing fluently. Under this system,                                                 arbitrary should's and should not's
                                                                                                                                                                      and place their morality on a more

can give it up will depend on the                                                    the stutterer comes to welcome

strengths of his other supports. Under                                               assignments and his complaints are                                               rational system.


no circumstances should your client                                                  about speaking fluently, accepting                                                  We help the stutterer understand
                                                                                                                                                                      that there is no way a person should

be blamed or shamed for his stut-                                                    listeners, and his loss of anxiety. He

tering. Your client has a right to                                                   behaves somewhat like the meek                                                   or should not talk. Speaking is a
stutter and that right has to be                                                     person who takes assertive training                                              means of communication, and so is
respected. Every human being has a                                                   and then goes out of his way to find                                             speaking stuttering. There is nothing
right to human weaknesses.                                                           a bully to cope with, or goes about                                              wrong with speaking stutteringly.

                                                                                                                                                                      When the stutterer accepts this, he is

   (2) Recognize that resistance to                                                  asking for criticism, and who seeks

                                                                                                                                                                      then free to experiment with different

behavior change is inevitable and not                                                manipulators.

                                                                                                                                                                      kinds of stuttering for purposes of

blameable. Resistance is always caused                                                 We make the stutterer aggressive

                                                                                                                                                                      communication. If it is okay to

by fear and manifests itself in several                                              and his guilt dissolves to some extent.
                                                                                                                                                                      stutter, then why not make it easier
ways: (a) fear of additional respon-                                                   (3) Another way to put guilt aside
sibilities; (b) fear of loss of secondary                                            for the stutterer is to join him in his                                          on yourself by stuttering easier? Why

gains; (c) fear of actually having a                                                 sin. We learn to stutter as the stutterer                                        work so hard? Why struggle?

problem (fear of illness); (d) fear of                                               stutters, take him to the shopping                                                  We steer the stutterer away from
inferiority (having to take directions                                               centers with us and turn it on. He                                               arbitrary shoulds and oughts and

                                                                                                                                                                      show him that instead, given his
                                                                                                                                                                             `v, .;n
from the clinician); (e) fear of                                                     watches and learns. If an old school
                                                                                     teacher can do that, can it be that                                              wishes, there are certain things he
becoming superior (fear of becoming                                                                                                                                   has to do. If he wants to watch TV,
a superior speaker whom he, at the                                                   wrong?

moment, may envy and hate; (f)                                                                                                                                        he can't go to the movies. If he wants

                                                                                        (4) In order to turn the stutterer                                            to pay his bills, he has to get the

transference resistance (the statements                                              around, however, we have to give                                                 money to do so; if he wants to speak


of the therapist are perceived as

                                                                                     him success at modifying his speech.                                             differently, there are certain things he
advice given by parents, friends, and                                                When he goes out seeking the feared                                              has to do; given his wishes, there are

acquaintances and are automatically

                                                                                     situation, he has to be somewhat

discounted); (g) implication resistance
                                                                                                                                                                      certain responsibilities he cannot
                                                                                     confident he can handle himself. In                                              avoid. If he wants to stop feeling


(anger at not having gotten better

                                                                                     the clinical situation, we make use of                                           guilty over stuttering, he has to
sooner and thus avoided so much                                                      two well-known phenomena, the                                                    change the way he speaks or stop
suffering); and (h) fear of loss of                                                  adaptation effect and post-block                                                 blaming himself for stuttering.

equilibrium (if I have been so wrong                                                 relaxation. We work on particular                                                   The greatest resistance to giving up

about all this, what about everything                                                passages or statements until the                                                 perfect ionistic, absolute standards, of

else?) That your patient will resist is                                              stutterer can accomplish his goal. The                                           course, is the fact that when you give

not only determined, resistance is

                                                                                     stutterer perceives himself as working                                           them up for yourself, you have to
overdetermined: it will occur. The                                                   harder and harder while the task gets                                            stop demanding the impossible of

clinician who is upset over it needs

                                                                                     easier and easier, and he learns from                                            others. Many people just can't make
therapy himself.

                                                                                     his experience. He doesn't forget                                                this sacrifice.                                                                   19
        .\lost successfullN treated stutterers
     will need little formal psychothertp}
     to deal xvith other guilt producing
                                                                      SURVEY OF THE
     behaviors. Therapy for stuttering will
     generalize to other areas. Stuttering                            NONSPEAKING POPULATION
                                                                      AND THE USE OF

     cannot be treated as an island in the
     stutterer's personality.
     I. Adler. Altrcd, The Scfenty n_/ I it ing- Nevc link.
                                                                      COMMUNICATION IN TEXAS

        Anchor Books. Doohlcdac and Co.. Inc_ 1969.
     -. Kcllc, George. The 11s10vdogl of Personal
          Conshucts - .a ]henry of Persotuditl. Ncsc )ork
        \%_VC_ Norton and Co.. Inc. 1915,
     i. Verb, Frederick Gestalt Therapy                        Ncss
        li>rk. Bantam Books, 1959.
     t. Shechan, I_ Cinutseling stlitteren. Speech
         Foundation of America, Memphis, 1982.
     5.    All Riper_ C.. The Ireattnent o/ Stuttering.
          1,rcntice-fiAl_ Englcscood Cliffs. N.)       19-i.                                                                           individuals were identified, and only

                                                                        No data has been previously
                                                                      gathered regarding the numbers of                                half were benefitting from the use of
                                                                      nonspeaking individuals in Texas,                                augmentative communication. The
                                                                      their use of augmentative com-                                   majority of professionals working        J
                                                                      munication devices, and the                                      with this population are apprehen-
                                                                      preparedness of the professionals                                sive" when dealing with advanced
                                                                      serving them. The TSHA (Texas                                    devices, they are eager for continuing
                                                                      Speech-Language-Hearing Associa-                                 education, and are open to the use
                                                                      tion) Task Force on Augmentative                                 of area augmentative communica-
                                                                      Communication set the goal of                                    tion evaluation centers. Since
                                                                      gathering this and other information                            funding is always a problem, it was
                                                                      through a state-wide survey. From                                hoped that this survey might identify
                                                                      260 survey respondents representing                              new payment sources. Unfortunately,
                                                                      six major service provider groups,                               no real new possibilities were
                                                                      approximately 2000 nonspeaking                                  identified.

                                                                        Until recently, communication
                                                                      L possibilities for nonspeaking a few

                                                                      individuals were limited to only
                                                                      of the most intelligent who had the
                                                                      brightest sparkle in their eyes. And
                                                                      sadly, as stated by Ricky Creech,
                                                                      through his voice synthesizer, "The
                                                                      closest simile as to how people treat
                                                                      nonspeech people is how they treat
                                                                      pet dogs ... think about that for a
                                                                      minute. How much difference is
                                                                      there? People take good care of pet
                                                                      dogs. They give them love, food,
                                                                      warm homes, attention when they are

                                                                      not busy and people don't expect


                                                                      much out of their pet dogs. just


                                                                      affection and obedience. This is the                            Ginger H. Sallzman, M.S., CCC - SP
                                                                      sad part. People just don't expect                              Scott and White Clinic

                                                                      much from nonspeech people"                                     Temple, Texas
                                                                      (Musselwhite and St. Louis, 1982).

                                                                      With the onset of the computer age,                             making a long needed shift from
                                                                      communication is now a possibility                              "speech" to "communication"

                                                                       for many more individuals, even                                (Silverman, 1980). Hopefully the


                                                                       those who are limited to a single                              frustrations (for both patient and


                                                                       muscular movement. Also, the                                   clinician) of 15 years of /p/, /b/ and
                                                                       new technology is providing                                    /m/ articulation therapy for a cerebral
                                                                       opportunities for some nonspeaking                             palsied individual or six months of

                                                                       individuals to enter the regular                               single word imitation tasks for an

                                                                       classroom, graduate from college, and                          aphasic individual can now be put
                                                                       be gainfully employed. Augmentative                            aside. Of course, frustration is not
                                                                       communication aids and techniques                              totally gone, as there are still too
                                                                       are keys which are opening locked                              many nonspeaking individuals whose
                                                                       doors for the first time.                                      grasp is just short of successful

                                                                         The possibilities of augmentative                            communication. This is a new field
                                                                       communication are new to speech-                               for speech-language pathologists and
                                                                       language pathologists and we are now                           we have much to learn.
  A review of the Bibliography of              In Texas, individuals around the         METHODS

Non Vocal Communication Tech-               state were becoming interested in            In late January. 1983. 596 surveys
niques and Aids (Trace, 19-9) revealed      augmentative communication, and             were mailed out to Texas Education

that the first publications in the art of   continuing education opportunities          Agencti. (TEA) special education
augmentative communication began            were being offered by the late 1970's.      programs, (independent school
appearing in the mid-1950'x, primarily      In 1981, a special interest group was       districts and cooperatives), private

M._ vim.

in occupational therapy, medical, and       begun under the Texas Speech-               practice individuals and Texas
cerebral palsy journals. In 1966 the        Language-Hearing Association (TSHA),        Department of Mental Health and

first augmentative communication            which became a Task Force the next          Mental Retardation (TDMHMR)

article was published in the Journal        year. One of the first goals of this        facilities such as state schools and
of Speech and Hearing Disorders             Task Force was to survey speech-            regional centers, hospitals and
QSHD), entitled "Communication              language pathologists working with          medical clinics, rehabilitation centens,
 Aids For Patients With Amyotrophic         the nonspeaking population in Texas.        and university training programs
 Lateral Sclerosis" and authored by         It was hoped that a survey could            (See Table 1). The mailing list was


 Martin R. Adams. The next augmen-          fulfill a number of purposes and            gathered from the 1982 TEA Special
 tative communication article in JSHD       needs, and in a cover letter sent with      Education Programs listing, the 1982

 (which was not until 1973), was            each survey form it was stated,             TSHA membership directory, the 1982
 authored by E. McDonald and A.R.             "We want to determine the                 ASHA Guide to Professional Services
 Schultz and was entitled "Com-               approximate number of individuals         in Speech-Language Pathology and
 munication Boards For Cerebral               who are nonspeaking, their present
                                              methods of communication, and the
 Palsied Children" There has been an          diagnoses involved. We also hope to be
 ever increasing amount of published          able to gain a better understanding of
 evidence of speech-language                  the need for personnel, equipment,
 pathologists' interest and involvement       education, and financial assistance to
                                              better serve these individuals. We plan
 in augmented communication. In               to share this information with Texas
 November, 1980, a position statement         state legislators, agencies involved in
 on nonspeech communication was               serving this population, plus other
 adopted by the American Speech-              people and groups wbo can make an
                                              impact on the growth of these services
  Language-Hearing Association, and           in Texas. "
  was published in August of the
  following year (ASHA, 1981).
  Involvement in all aspects of service
  delivery was recommended, and
  appropriate training for provision of
  these services was stressed as a
  professional responsibility.

   Audiology, the 1983 TDMHMR                                                      TABLE 1
   Director of Services. Easter Seal list of                  Number of surveys sent in each service provider
   rehabilitation centers, several regional                   group, and the number and percentage returned from

   speech, language, and hearing                              each group.
   association lists of programs, and

                                                              Service Provider Group                    # sent              # returned      %age returned
   word of mouth. The primary service                         Special Ed Programs                         336                  161              48%
   provider group not surveyed was                            Private Practice                                125               29              23%
   home health agencies. No surveys                           TDMHMR Facilities                                50               17                 34%
   were sent outside of Texas.                                Hospitals &
      Each survey was sent out with a                            Medical Clinics                                 36             16                 44%
   cover letter stating the purposes of

                                                              Area Rehab Centers                                 26             19                 73%
   this effort, and requesting that each                      University Programs                                23             10                 43%
   survey be completed after consul-                                                          596           260                                    44%
   tation with colleagues, so that each                       ' 8 surveys were returned without stating name of employer
   institution, school system, etc. would

   be fully represented in the results as a
   whole. Deadline for return was March
   1, 1983, but surveys were accepted

   until April, 1983.
      To aid in the completion of the
   survey, definitions of the terms                           training and assessment in use of                                              10 patients on their caseload to
   nonspeaking and augmentative                               augmentative communication                                                     almost 1100 patients. The largest
   communication were stated as                               methods, and interest in use of                                                group of responses came from those
                                                              services of augmentative communi-                                              serving between 20 and 30 patients.

                                                              cation centers were also surveyed.                                             Sixty-five percent of all those
      "Who is nonspeaking? A nonspeaking                         Sources of funding for communica-                                           responding served 100 patients or

      person is an individual u-bo is unable                  tion devices is a problem for most all                                         less. The total number of speech
      to express himself through speech, in
      spite of functional receptive language.                 nonspeaking individuals, so                                                    handicapped patients reportedly
      If he/she can talk, the speech is                       respondents were asked to list sources                                         being served by the respondents was
      unintelligible for very difficult to                    through which they would seek                                                   31,740.

      understand.                                             payment. Name, employer, position,                                                 The 260 respondents reported a

         What is augmentative communica-                      and total number of patients on                                                 total of 2097 nonspeaking individuals


      tion? Augmentative communication is

      the improvement of a nonspeaking                        caseload of respondents were also                                               with whom they are working, 7% of

      person's communication through the                      requested.                                                                      the overall caseload. One-quarter of

      design and use ofsupplements. These                       Results of this survey were entered                                           these nonspeaking individuals are

      supplements (such as communication                      on computer, where total counts were
      boards, gestures, etc.) utilize and                                                                                                     currently using augmentative com-
      increase the effectiveness of the                       tabulated, and frequency distributions                                          munication aids and techniques such
      individual's speech or nonspeech                        were run. Surveys from individuals,                                             as manual communication boards,
      abilities."                                             group practices, institutions, etc. were

                                                                                                                                              electronic devices, and gestures. One-
                                                              each considered as a single response,                                           quarter of these individuals are
      To determine the types of speech                        or as one respondent. Respondents                                               making little or no attempt to

   handicapped populations profession-                        had been asked to state the number

                                                                                                                                              communicate, and one-half are
   als were working with in Texas, those                      of hearing impaired patients with                                               producing unintelligible, nonfunction-

   surveyed were asked to state the                           whom they worked, and this number                                               al speech without the benefit of
   diagnoses of their speech handi-                           was then subtracted from the total                                              augmentative communication. Almost

   capped patients (such as severely-                         number of nonspeaking individuals. It                                           50% (845 individuals) of the

   profoundly handicapped, stroke and                         was felt that this group, who most                                              nonspeaking population in this survey
   head injury, mental retardation, etc.);                    likely did not need augmentative                                                reportedly could benefit from use of

   how many of their patients could be                        communication evaluations, would                                               or evaluation for augmented
   classified as nonspeaking; and how

                                                              distort the percentage of those who                                            communication.
   many could benefit from use of,                            were nonspeaking compared to those                                                Only 11% of those responding to
   or evaluation for augmentative                             who needed evaluation.                                                         this survey report working with no
   communication systems. Respondents                                                                                                        nonspeaking individuals at this time.
                                                                                                                                                                                                     0.p, ...

   were also surveyed regarding their                         RESULTS

                                                                                                                                             Forty-two percent of the respondents

   nonspeaking patients' current                                By April 1, 1983, 265 surveys                                                are working with between 1 and 5
   communication systems (varying from                        were returned. Five had not been                                               nonspeaking persons, while 32% are
   little or no attempt to communicate                        completed, but were returned with                                              working with between 6 and 20
   to use of computers), the types of                         statements that they were not serving
                          G." 3y.

                                                                                                                                             persons. Only 25 respondents (less
   symbol systems used (such as                               the nonspeaking population in any,                                             than 10%) work with more than 20
   gestures, pictures, and Blis-symbols),                     way. Of the 260 completed surveys,                                             nonspeaking individuals.

   and the patients' motor responses                          the lowest response percentage was                                                The largest diagnostic group being

   (such as head-pointer, eyes, hand).                        from the private practice group and                                            served by the respondents of this
      Each respondent was also surveyed                       the highest response percentage was

                                                                                                                                             survey was the mentally retarded,


   regarding his/her knowledge of and                         from rehabilitation centers.                                                   representing 14% of the total speech

   comfort with augmentative communi-                         Almost half of those sent to school                                            handicapped population. Nine per-

   cation devices, using a 5 point rating                     programs were returned, with the                                               cent of the patients being served can

   scale as follows: 1-no knowledge,                          other three groups returning between                                           be classified as severely-profoundly-

   2-apprehensive, 3-somewhat                                 34% and 44%. The number and                                                    multiply handicapped and/or cerebral

   comfortable, 4-comfortable, and                            percentage of responses from each                                              palsied, and 4% of the total caseload
    5-very comfortable. Opportunities for                     group survey is listed in Table 1.                                             included the diagnoses of stroke,

   consulting with other disciplines to                         Those responding to the survey                                               head injury, apraxia, autism, and
22 share knowledge, interest in receiving                     varied from serving a total number of
 neuromuscular disease.                                                                                 and SUrely many of the professionals                                                         4. lncrecrse public mul professroncd
   The Symhol systems of gestures                                                                       working with the nonspeaking vyere                                                                awareness of the needs and
 and pictures yvcre being used vyith                                                                    not contacted, it appears that the                                                                abilities of the nonspeech
 approximately equal frrquencv'. Blis-                                                                  numbers of nonspeaking individuals                                                                population.
 sv mbols and Rebus were being used                                                                     making use of, and not making use of
 less frequently-.                                                                                      augmentative communication could                                                                Ve plan to put this information

   The most common response mode                                                                        he doubled or tripled.                                                                       before educational administrators,
 for the nonspeaking individual was                                                                        The majority of those being served                                                        governmental officials in funding


 hand movements (83%,), with only                              ---                                      fall into the diagnostic categories of                                                       agencies, the Texas Legislature, univer-


 8`%, using eve movements, and the                                                                                                                                                                   sity program directors, plus other

                                                                                                        mental retardation and/or severe-                                                            people or groups who can make an
 remaining 9'%, using the following:                                                                    profound multiply' handicapped. It

 head pointer, lighter pointer, or foot
    The professionals responding to

 this survey overwhelmingly (8"%)
                                              'r. _^.

                                                                                          CA!           appears that most of these patients
                                                                                                        are being served in the public schools
                                                                                                        and TDMHMR facilities. The large
                                                                                                        majority of respondents are serving at
                                                                                                                                                                                                     impact on the growth of augmenta-
                                                                                                                                                                                                     tive communication services in Texas.
                                                                                                                                                                                                     It is hoped that the data from this
                                                                                                                                                                                                     survey will reinforce the importance

 stated that the\' would be interested                                                                                                                                                               of the Task Force goals.
                                                                                                        least one or more nonspeaking

 in receiving training in assessment,                                                                   individuals, so it is evident that ser-
 prescription, and usage of augmen-                                                                     vices are being provided throughout

 tative communication methods.                                                                          the state.

 Approximately -5% of the respon-                                                                          Many of the professionals working                                                         Adam.. M.R. communication aids for patients kith

 dents rated their knowledge and skill                                                                  xvith the population rued themselves

                                                                                                                                                                                                        am}otrophic lateral sclerosis. Journal of.Spee(b
                                                                                                                                                                                                        rain Hearing Disorders, 1966. Al. 2-+5-
 at a "somew-hat comfortable" level                                                                     as "apprehensive" in dealing with the

                                                                                                                                                                                                     American Speech-language-Hearing Association.
 or better with word or picture                                                                         newly available aids and techniques,                                                            Position statement on nonspeech communication-

 communication boards. Fifty percent                                                                                                                                                                    ASHA, 1981. 21-
                                                                                                        and they are anxious to learn more.                                                          ylcDonald. F.I- and SChultz. A.R Comnwnication
 felt comfortable with Blissymbols                                                                      They would be very willing to make

                                                                                                                                                                                                        hoards for cerebral palsied children. Journal o/
 or gestures, and only 15% felt                                                                         use of area augmentative communica-                                                             Speech and Hearing Disorders. 19-1. 38. -1-88_

                                                                                                                                                                                                     Slussehvhitc. C.R_ and St, la)uis, Kyy. Communication
 comfortable with electronic devices                                                                    tion centers if informed of their                                                                Programming Jbr the Severe'lr Handicapped
 such as scanners, direct selection

                                                                                                        availability. Area augmentative

                                                                                                                                                                                                         tr,cal and Non-vocal .Strategies Houston:

 devices, and computers. Two-thirds of                                                                                                                                                                  College-Hill Press. 1982.
                                                                                                        communication centers may be able

                                                                                                                                                                                                     Sihennan. F.H. Communication for the Speechless.
 the professionals stated that they did                                                                 to more easily stay informed of the                                                              rnglewood Cliffs. NJ: Prentice-Hall, Inc.. 1980.
 have opportunities to offer consulta-                                                                  rapidly changing technology and the                                                          "Trace Research & Development (:enter 19-9



                                                                                                                                                                                                         Hibliograph), on Non-tbcal Communication
 tive services to teachers or other                                                                     many variables to investigate when                                                     :!.

                                                                                                                                                                                                         7echniyues and Aids. Madison, V'1: t'rinersitc of
 disciplines, and to share their

                                                                                                        choosing augmentative communica-                                                                 \yisconsin Board of Regents. 19-9.

 knowledge with colleagues.                                                                             tion aids and techniques. However,

    If the services of an augmentative                                                                  the professionals carrying out the
 communication center for matching                                                                      recommendations need to have a                                                               ACKNOWLEDGEMENT
                      r;' r;'

 communicative needs of children or                                                                     base of knowledge on which to                                                                  The author would like to acknowledge the

                                                                                                                                                                                                     contribution of the TSHA Task Force on
 adults with appropriate devices were                                                                   follow-through on the suggested

                                                                                                                                                                                                     Augmentative Communication for development
 available, 63% of those surveyed


                                                                                                                                                                                                     of the survey: Dclva Culp, Pat yXasson, Paula

 stated that they "yes, definitely"                                                                        Funding is a serious problem, as                                                          Gardner, Sallc Grace}, Cris Blair; my Scott and


 would take advantage of such a                                                                         there is no "easy money" available for                                                       VL'hite colleagues Ke'llee Thorpe. Dee
                                                                                                                                                                                                     Ann Gillam, Jean Herzog, and Anne Lueck, and
 service. Twenty-seven percent stated                                                                   communication devices. Both private

                                                                                                                                                                                                     also the significant help from Dr. Argye Hillis
 that they would "probably" take                                                                        and governmental third-party                                                                 and Krista Carlson in Biostatistics.
 advantage of such a service, and only                                                                  payment is rarely obtained, which

  10% were unsure or uninterested.                                                                      indicates our need to "sell" our
    Almost half of the respondents                                                                      recommendations, and educate

 stated that they would seek funding                                                                    insurers regarding the gains communi-
 for devices through local service                                                                      cation offers. We must be careful to
 organizations (Lions Club, Jaycees,                                                                    make the best and most appropriate

 Sertoma), public school funds (local                                                                   recommendations for devices and
 district money, service center help, or                                                                then solicit funding with persistance.

 federal special education funds),                                                                         Because of the results of this
 and/or the patient's family and their                                                                  survey, the TSHA Task Force on



 medical insurance. Less than 25%                                                                       Augmentative Communication
 stated that they would apply to                                                                        reaffirms these goals:
 state and federal programs such as
 Medicaid, Medicare, CCD and TRC.                                                                       1. Establish educational
 Several respondents suggested seeking                                                                     opportunities in the field of
 aid from private foundations and                                                                          augmentative communication
 grants.                                                                                                   at both the university and
                                                                                                           continuing education levels.


   There are obvious needs to be filled                                                                 2. Compile and provide
 in the provision of services for                                                                                 information on funding sources
 nonspeaking individuals in Texas.                                                                               for communication aids.
 Fortunately, almost 1000 nonspeaking
 individuals are benefitting from                                                                       3. Maintain a current list of centers
 augmentative communication aids                                                                                     in Texas prepared to serve the
 and techniques, but an equal number                                                                                 nonspeaking population.
 are not benefitting. Since only 44%

 of the surveys sent out were returned,

     Paula Graham
     Faster Seal Society
     Sherman, Texas                                     This paper Concerns business
                                                  procedures fur speech-language
     Linda Chlipala                               pathology services in the State of
     Faster Seal Society                          Texas. Current trends in fees for
     Sherman, Texas                               services, public relations methods,
                                                  collection niethods, and funding
                                                  sources are presented and discussed.

                                                      Current interest in the topics of business and financial


                                                       aspects of speech-language pathology may be evidenced
                                                  by the increase in the number of recent publications
                                                  (Chapey, Chwat, (;urland, & Pieras, 1981; Fox, 1980; Hester,


                                                  1981; Lubinski & Chapey, 1980; Lueck, 1980). Moreover,

                                                  financial matters have been cited as the most prevalent
                                                  problems encountered by the private practitioner in speech-

                                                  language pathology (Chapey et al., 1981). These problems
                                                  included "processing third-party payments, lack of adequate
                                                  financial coverage, inconsistent income, collection of
                                                  income, overhead, session fees, inexperience in business

                                                  and accounting procedures, and inflation" (p. 338). Chapey


                                                  et al. further suggested that these problems may not be
                                                  unique to private practice but may exist throughout the

                                                  entire profession. For example, in an earlier survey of

     Elizabeth Holmes, M.A.                       clinical service facilities (i.e., community speech and
     Park Cities Speech-language-Hearing Clinic   hearing centers, non-university hospitals and health
     Dallas, Texas                                facilities, university hospitals and health facilities, college
                                                  and university clinics, and private practices), Curlee (1975)
                                                  found that the major barrier to expanding clinical service
                                                  programs was lack of financial support for additional
                                                  personnel, additional equipment, and additional space.          .",

                                                  Curlee's findings suggested that financial aspects have been
                                                  a problem of most clinical service facilities and, therefore,
                                                  are not unique to private practice. Further, financial aspects

                                                  have been discussed in the speech-language pathology

                                                  literature as early as 1959 (Summers, 1959). Topics of
                                                  discussion have been: fees in general, determination of fees,
                                                  fee collection methods, and funding sources (Aleo & Pece,
                                                   1977; Bangs, 1970; Battin & Boland, 1978; Brantman, 1973;
                                                  Chapey et al., 1981; Chapey, Lubinski, Salzberg, & Chapey,

                                                   1978; Curlee, 1975; Fox, 1980; Goates & Goates, 1977;
                                                  Hester, 1981; Keys, 1964; Knight, 1961, 1968; Landes &

                                                  Battin, 1962; Lubinski & Chapey, 1980, Lueck, 1980;
     Randolph E. Deal, Ph.D.                      Strandberg, 1977; Stryker, 1976; Summers, 1959).

                                                     Fees in general associated with speech-language

                                                                                                                        OVA 6°J


     Texas Woman's University
                                                  pathology services have been reported by Aleo and Pece

     Denton, Texas
                                                  (1977), Landes and Battin (1962), Strandberg (1977), and

                                                  Summers (1959). The first readily available reference to fee

                                                  schedules was a survey of the involvement of public school
                                                  speech-language pathologists in private practice in Indiana
                                                  (Summers, 1959). Summers employed a two-page

                                                  questionnaire which included one question concerning

                                                  fees: "Based on terms of a half-hour therapy session, what

                                                  fee do you think ought to be charged a private patient with

                                                  a functional articulation disorder?" (p. 53). Forty-six
                                                  individuals responded to this question.


                                                     Thirty of the respondents indicated that the fee should
                                                  be the same regardless of the diagnosis; thirteen felt that

                                                  the fee should vary; and three had no opinion.
   Additionally. Aleo and Pece (19--) surveyed 58 speech
and hearing clinics ,vithin hospitals, community centers.                                                                                                 BUYER'S GUIDE

and colleges in New York State. These findings indicated


that in centers having fee schedules, the mean fees for                                                                                                Integrated Systems for Clinical Care
speech and language evaluations were similar, but the fee
variation for community centers was less than half of that

for hospital and college centers. For a half-hour treatment


session, hospitals with fee schedules had the greatest

average fee, standard deviation, and the largest range. The

fee for this service was considerably less in community
centers and was least in college centers. The need for a

more appropriate cost-accounting system was indicated by

the large range of fees for services that existed among the
various clinical settings.
   Determination of appropriate fees for speech-language


pathology services has been identified as a problem (e.g.,
Bangs, 1970; Chapey et al., 1981; Knight, 1961). Bangs
(1970) noted that the question of what is an appropriate fee


was a difficult problem to solve and suggested that the


variability in charges made by speech-language pathologists
caused concern among insurance carriers. Additionallv, in

 1961, the Committee on Ethical Practice of the American

Speech and Hearing Association (ASHA) surveyed the field                                                                                             TRACOUSTICS' Integrated Clinical-Diagnostic

in an attempt to recommend specific fees, but could not,                                                                                             Systems provide the utmost in capability and econ-

due to inconsistent fee patterns (Knight, 1961).

                                                                                                                                                     omy. The TRACY Evoked Potential System presents
   Numerous bases for determining fees have been suggested


                                                                                                                                                     the ultimate in obtaining, analyzing and storing

(Alex & Pece, 1977; Bangs, 1970; Battin & Boland, 1979;

                                                                                                                                                     auditory evoked potentials at the lowest price in the
Fox, 1980; Keys, 1964; Knight, 1961, 1968). For example,

                                                                                                                                                     industry. EARSCAN opens new vistas to the mea-

the ASHA Committee on Ethical Practice advised ASHA
Members to study the fees charged in the practitioner's                                                                                              surement of middle-ear immittance and reflexome-
community (Knight, 1961). Bangs (1970) supported this                                                                                                try. The PROGRAM III Clinical Audiometer holds its

recommendation by advising that fees be "within the range                                                                                            place as the first and mo8t full-featured micro-

of usual and customary charges in the community" (p.                                                                                                 processor based audiometer available.


418). Battin and Boland (1978) and Knight (1961,'1968)

further stated that fees should be within rational limits.                                                                                           Continue to look to TRACOUSTICS for the highest
Also, it has been recommended that the study of fees

                                                                                                                                                     quality in Audiometric Rooms and Suites with a
charged both by speech and hearing professionals and by

                                                                                                                                                     complete line of enclosures for clinical, medical and

related professionals and by related professions be

                                                                                               0.r ACS

                                                                                                                                                     research use. We have the flexibility to design a
considered (Battin & Boland, 1978; Knight, 1961, 1968).                                                                                              Room or Suite to meet most any need or budget.
Investigation of the allocation of the professional's work
time was recommended by Aleo and Pece (1977). The                                                                                                    Our planning assistance will save you space, our

economic status of the patient (Battin & Boland, 1978;                                                                                               shipping schedule will save you time, and our de-

Knight, 1961, 1968) and the socio-economic level of the                                                                                              signs will save you money.
community (Keys, 1964; Knight, 1961, 1968) were also

included as considerations for fee determination.                                                                                                                          Increase diagnostic capabili-

 Examination of operational costs and overhead, and the                                                                                                                    ties with the addition of a
establishment of a cost-accounting system have been                                                                                                                        TRACOUSTICS ENG System,
suggested (Aleo & Pece, 1977; Battin & Boland, 1978; Keys,

                                                                                                                                                                           complete with a mobile inte-

 1964; Knight, 1961). Fox (1980) stated that "in a private

 practice, income from patient care must support the entire                                                                                                                grated cart, ENG examination
 cost of service delivery" (pp. 383-384). Battin and Boland                                                                                                                table, and a digital light bar
 (1978) noted that the practitioner should realize a                                                                                                                       with stationary, optokinetic and


 reasonable return for professional work and for monetary                                                                                                                  pendular targets.

 investment in the practice. Specifically, they suggested that
 when attempting to establish a fee structure, one should


 calculate what the return would be on the initial
                                                                      0.C 0.C


 investment if it were invested in stocks and bonds. In                                                                                                      Clinical Audiometers
 addition, lower fees were suggested for speech-language                                                                                                   Evoked Potentials - ENG

pathology services provided in training centers and tax-


 supported clinics than charged by well-trained and                                                                                                           Immittance Systems
 experienced private practitioners (Knight, 1961). Battin and                                                                                             Audiometric Rooms & Suites

 Boland (1978) and Knight (1961) further suggested that

 nominal or no fees be accepted in some instances as a
 moral and ethical responsibility.                                                                                                                               TRACOUSTICS
    Collection of fees has also been reported to be a problem
 in private practice and in clinical settings (Keys, 1964,
 Knight, 1961). Knight (1961) suggested that in some                                                                                                          P.O. Box 3610 Austin, Texas 78764

 instances the writing off of an account would be better                                                                                                         800-531-5412 512-444-1961
 than causing ill will by submitting the account to a

 collection agency. Keys (1964) noted, however, that the fear

 of bad public relations should not be a deterrent to fee
     collection beCausC people a ho fail to pay their hills vyill                                                                                                                         keep up to date on current regulations. Further. Brantnm:um

     likely criticize an way. Guidelines for the collection of fees                                                                                                                       (19-3) and Goates and Goates (19--) concluded that the

     have been recommended (Battin & Boland. 19-8: Kcys,                                                                                                                                  key to increased third-party payment for speech-language

                                                                         '"J :.C


     196-4: Knight. 1961). Knight (1961) specified a sequence of                                                                                                                          Pathology services might be increased public :m arcrtess and
     procedures to be utilized in the collection of delinquent                                                                                                                            political action. Lueck (1980) historically traced Medicare
     accounts: (a) First. a friendly reminder should he sent.                                                                                                                             laws and regulations concerning coverage of speech-
     (h) If payment is not received, a telephone call to arrange                                                                                                                          language services and concluded that "individual members

     payment should be made by a tactful sccretar. (c) After all                                                                                                                          of the profession and the ASHA professional staff must

     other means have been exhausted, a reputable collection                                                                                                                              continue to maintain contacts -,vith congressional leaden
     agency may he engaged or the account may be -'vrittcn off                                                                                                                            and dialogue with policy writers" (p. 29).

     as a bad debt. Kevs (196-4) reported that some clinics enlist                                                                                                                           It seems appropriate to consider the need for current


     the aid of a credit bureau in the collection of dclinyuent                                                                                                                           information, pertaining to business procedures, in the field


     accounts and advised that the procedures employed be                                                                                                                                 of speech-language pathology. The purpose of this study.

     business like, consistent, and efficient. Battin and Boland                                                                                                                          therefore, was to obtain, for the State of Texas, data
     (19,8) proposed that the receptionist/typist call after 60                                                                                                                           regarding current trends in fees for services, public rela-

     clays and suggest that in the future, payments including                                                                                                                             tions methods, collection methods, and funding. It was
     partial payment on the past due account be made on a cash                                                                                                                            thought that the results of this study might be helpful to



     basis at the time of the appointment. Battin and Boland                                                                                                                              practitioners in establishing and revising business pro-
     also reported the procedures of an independent practicing                                                                                                                            ccdures. Additionally, it was assumed that this report would

     psychologist: (a) First, send a note requesting an                                                                                                                                   generate interest in investigating business procedures in the
     explanation and arrangements for payment. (b) The next                                                                                                                               field of speech-language pathology on regional and national
     step for many is a letter threatening legal action. (c) As a                                                                                                                         levels.

     last resort, enlist a collection agency. (d) An alternate


     procedure may be to analyze the underlying causes for                                                                                                                                METHOD
     non-payment and take steps to alleviate the problem.                                                                                                                                 Subjects
        A variety of funding sources for speech-language                                                                                                                                     Facilities were selected from the Membership Directories
     pathology services has been reported (Chapey et al., 1981;                                                                                                                           of the Texas Speech-Language-Hearing Association (TSHA)

     Chapey ct al., 1978; Lubinski & Chapey, 1980; Str4ndberg.                                                                                                                            for the years 19-9 and 1980. Only those facilities offering
      19"); yet, inadequate funding has remained a problem                                                                                                                                both evaluation and therapy services were selected. State
     (Chapcy- ct al., 1981; Hester, 1981; Lubinski & Chapey,                                                                                                                              agencies and schools were excluded. Names were omitted




     1980). For example, in a national survey of hospitals,                                                                                                                               from the response form to assure anonymity.
     Strandberg (19'') found that government health insurance


     programs are the primary source of fees, followed by

                                                                                                                                                                                            A three-part questionnaire was developed to obtain

     private health insurance carriers and private patient

                                                                                                                                                                                          information regarding the following research areas: (a)

     payments. Agencies, e.g., Faster Scal Services for Crippled

                                                                                                                                                                                          general business procedures, (b) fee information, (c) funding

     Children, accounted for the lowest percentage of support.                                                                                                                            sources, (d) billing methods, and (e) collection procedures.
     Chapev et al. (19'8) surveyed day-care centers in 35 states

                                                                                                                                                                                          The first two parts of the questionnaire dealt with

     and found that the sources of funding for speech and

     hearing services were, in rank order: federal government,                                                                                                                            demographic information and some business-related
                                                                                                                                                                                          procedures. For example, Part I asked for type of facility,

     parents, state, county, school district, city or city health
                                                                                                                                                                                          location, age range of patients, and a subjective rating of

     department, hospitals, colleges or universities, volunteers,

     grants, and others. Lubinski and Chapey (1980) surveyed                                                                                                                              facilities provided. Part 11 asked for referral policies,


     home health care agencies in the eight states having the                                                                                                                             number of paid speech-language pathologists and

     largest populations of elderly persons and reported that                                                                                                                             audiologists, services offered, public relations methods and
                                                                                                                                                                                          their effectiveness by rank order, and goals of the facility.

     sources of funding for speech pathology services for these


                                                                                                                                                                                          Part III, therefore, contained questions concerning financial

     patients were :Medicare, commercial insurance carriers,
     Medicaid, the individual client and others, e.g., Iinited                                                                                                                            information. A cover letter which explained the survey
      Fund and civic groups. In most instances, Medicare paid for                                                                                                                         accompanied the questionnaire.

     90`% of the services and private insurance or Medicaid                                                                                                                               Procedures

     covered the remaining 10%). Goates and Goatcs (19'')                                                                                                                                   Questionnaires were addressed to "Director of Speech-
     reported that almost one-half (49.5`x,) of the private                                                                                                                               Languagc Pathology" and mailed to 110 selected facilities.

     practitioners responding to a national study did not accept                                                                                                                          Cover letters, printed questionnaires, and enclosed self-


     third-party payments. Follow up interviews revealed that                                                                                                                             addressed, stumped envelopes were utilized to increase the

      "many practitioners voluntarily chose not to become in-                                                                                                                             probability of a greater rate of return (Brogan, 1980). Data
      volved with third parties - some were not acquainted with                                                                                                                           were analyzed with selected programs from the Statistical


      third-party matters, and others refused to be burdened by


                                                                                                                                                                                          Package for the Social Sciences (SPSS) (:Vie, Hull, Jenkins,


      the restrictions and paperwork. Most private practitioners,                                                                                                                         Steinbrcnner, & Bent, 19'5). Computer facilities at 'tex:as

      however, had been excluded from participation by the                                                                                                                                V'a)man's University were utilized.
      limiting conditions, qualifications and prerequisites set by

      third parties" (Goates & Goates, 19'7 pp. 88'-888).

         Various suggestions have been made concerning third-                                                                                                                             RESULTS

                                                                                                                                                                                          Identifying and General Information

      party payment sources in attempts to increase payment

      from government and private health insurance carriers                                                                                                                                  Responses to the questionnaire (Appendix A, Part 1) were

                                                                                                                                                                                          received from -4 (673%) of the 110 facilities and were

      (Bangs, 19'9; Brantman, 19'3; Goates & Goates, 19'';
      Lueck, 1980; Stryker, 1976). Bangs (19-0) reminded ASHA                                                                                                                             categorized by facility types. Due to the small number


      Members to observe the guidelines and regulations of the                                                                                                                            received from home health facilities and community clinics,
                                                                                                                                                                                          and because of their similarity to rehabilitation clinics,

      Medicare program to secure payment for services. In

      discussing procedures relating to Medicare and other                                                                                                                                responses from the three settings were combined under the



      third-party payments, Stryker (1976) suggested that the                                                                                                                             title of community/rehabilitation (Com/Rehab) clinics.


      speech-language pathologist should implement proper                                                                                                                                 Further, hospitals and other medical facilities were
      documentation, use acceptable terminology, seek other                                                                                                                               combined under the title of medical facilities. Of the '4
                                                                                                                                                                                          respondents, 31 (41.9%) were private practices, 13 (17.6`x,)

      funding sources after exhaustion of Medicare benefits and


,,N-erc communitnrehabilitation clinics Nyhich included two                                                                                                                                                   Table 1

community clinics and three home health facilities. 15

                                                                                                                                                                                                           Response Rate
(20.3`%,) xvere uniycrsity clinics, and 15           acre

medical facilities which included 12 hospitals. Most
facilities (973' ) served clients of all ages. Patient referrals                                                                                                              Facility Type                  # Mailed # Received % Received

were accepted from ".gym Source" by -70'% of the


respondents, from "Medical Only.. by 9.5'%, from ".1ny
                                                                                                                                                                               Private                           56         31           55.4

Professional Source" by 5.-t 44> and -Service Restricted to

                                                                                                                                                                               Community/Rehabilitation          21          13           61.9
Military Personnel and/or Netectns" by 8.1%. Because the


number of responses to each question varied Nvithin facility


                                                                                                                                                                               University                        15          15          100.0
types, the number of respondents for each facility type is


presented in each table.                                                                                                                                                       Medical                           18          15           83.3
   Table 1 shows the response rue by facility type. It is

interesting to note that although over one-half of the                                                                                                                         Overall                          110         74            67.3

questionnaires were mailed to private practices, the least

percentage of questionnaires was received from private

practices. Conversely, although the smallest number of

questionnaires was mailed to universities, the largest                                                                                                                                                        Table 2
percentage of questionnaires was received from universities.                                                                                                                                Percent of Facilities Reporting Locations

   Table 2 summarizes the reported locations of the
 responding facilities. The largest percentage of respondents                                                                                                                                                    Facility Type

 (41.1`%,) indicated that their location was in South Texas.                                                                                                                                     Private   Com/Rehab     Univ. Medical Overall



 The smallest percentage of respondents (9.6'%) indicated                                                                                                                     Location           n=31        n=12       n=15 n=15 n=73
 that their location was in Vest Texas.
                                                                                                                                                                               North Texas          9.7        25.0        33.3   20.0      19.2
   The number of speech-language pathologists and
audiologists employed by the facilities surveyed is reported

                                                                                                                                                                               South Texas         61.3        33.3        20.0   26.7      41.1
in Tables 3 and 4, respectively. Table 3 shows that the
number of speech-language pathologists range from .50 to                                                                                                                       Central Texas        9.7

                                                                                                                                                                                                               16.7        20.0   33.3      17.8

 14, with a mean of 3.13. The maximum number was                                                                                                                               East Texas          12.9         8.3        13.3   13.3      12.3
reported by a university clinic, and the minimum number
was reported by two private practices. Speech-language

                                                                                                                                                                               West Texas           6.5        16.7        13.3    6.7          9.6
pathologists who were employed either half-time or as both

speech-language pathologists and audiologists are indicated

by .50. The number of audiologists ranged from 0 to 6,
with a mean of .95, as shown in Table 4. The maximum                                                                                                                                                          Table 3
number of audiologists was employed in a medical setting.

The minimum number of audiologists was reported by 20                                                                                                                                       Reported Number of Speech-Language


private practices, 3 universities, 5 medical facilities, and 5                                                                                                                                     Pathologists Employed

community/rehabilitation clinics.
   Table 5 compares the services offered by the various                                                                                                                                                          Facility Type


facility types. All respondents indicated that speech-                                                                                                                                           Private   Com/Rehab     Univ. Medical Overall


language evaluations and therapy were offered. Other than                                                                                                                                        n=30        n=13       n=15 n=15 n=73
evaluation and therapy, the most frequently offered service,

over all facilities, was speech and/or hearing screening                                                                                                                        Mean               2.22        4.15        5.17   2.03      3.13


(89.2%). Table 5 also indicates that over all facilities, the
                  .-: Q.¢

                                                                                                                                                                                Mode               1.00        2.00        5.00   1.00      1.00
least frequently offered service was homebound therapy
(37.8%). Although not specifically asked, 12.9% of the                                                                                                                         Median

                                                                                                                                                                                                   1.92        3.38        4.67   1.22      2.23
private practices wrote in that Special Services, i.e.,

psychological counseling and social work were available on                                                                                                                     Minimum              .50        2.00        1.00   1.00           .50

a consultative basis.                                                                                                                                                          Maximum             7.00       12.00     14.00     4.00     14.00
   Public relations methods are shown in Table 6. Subjects
were asked to rank public relations methods in order of                                                                                                                        Standard

their effectiveness. The most frequently listed public                                                                                                                            Deviation        1.56        2.70        3.44             2.54

relations method employed was the Yellow Pages (68.8%);

however, the "Other" category was considered by subjects                                                                                                                                                      Table 4
to be the most effective method by respondents who write

                                                                                                                                                                                         Reported Number of Audiologists Employed
in such methods as personal contact, television, and patient
referrals. Personal contact was most frequently named in


the "Other" category. Table 6 also shows that the least used                                                                                                                                                     Facility Type
public relations method was fund raising projects (15.6%).                                                                                                                                       Private   Com/Rehab     Univ. Medical Overall
   Table 7 presents the reported goals of the respondents.                                                                                                                                       n=30        n=13       n=15 n=15 n=73
For example, the major goal reported by private practices

                                                                                                                                                                                Mean                .33         .58        1.63   1.80           .95
was to provide competitive services (7.0%); the major

goal of community/rehabilitation clinics was to provide                                                                                                                         Mode              0.00         0.00        1.00   0.00      0.00
affordable services (72.7%); the major goal for university                                                                                                                      Median              .13         .50        1.07   1.88           .60
clinics was to train students (100.0%); and the major goal



of medical facilities was to provide the best services for                                                                                                                      Minimum           0.00         0.00      0.00     0.00      0.00
limited patient types (50.0%). Overall, the most frequently

reported goal was to provide affordable services (47.1%);                                                                                                                       Maximum           2.00         2.00      5.00     6.00      6.00

the least frequently reported goal was to provide free


services (8.8%). Many facilities listed more than one goal.                                                                                                                       Deviation         .53         .61        1.54   1.70      1.28

                                                Table 5                                                                        Table 7
     Percent of Facilities Indicating Service is Offered                                                        Percent Reporting Goals of Facilities

                                                    Facility Type                                                                    Facilities
Services                            Private   Com/Rehab     Univ. Medical Overall                                  Private   Com/Rehab    Univ.                           Medical Overall

Offered                             n = 31      n = 13     n = 15 n = 15 n = 74            Goals                   n=30        n=11            n=13 n=14 n=68
 Speech/language                                                                            Provide afford-
   evaluation    100.0                           100.0      100.0          100.0   100.0      able services          36.7       72.7                  76.9                  21.4    47.1

 Speech/language                                                                            Provide free
   therapy       100.0                           100.0      100.0          100.0   100.0      services                0.0        18.2                       7.7             21.4     8.8

 Hearing eval.                        38.7        69.2       80.0           73.3    59.5    Provide best
                                                                                              serv. for
 Speech and/or                                                                                limited patient


                                                                                              types                                                         8.5              0.0     6.8



   screening                          90.3        84.6      100.0           80.0    89.2
                                                                                            Provide competi-
                                                                                              tive services          73.3        18.2                  15.4                 21.4    42.6


 Aural rehabilita-
                                                                            46.7    63.5    Provide service

   training                           61.3        61.5       86.7
                                                                                              where none is
 Homebound                                                                                    available              26.7        63.6                 30.8                   7.1    29.4
   therapy                            61.3        53.8        6.7            6.7    37.8
                                                                                            Other (training)          0.0                0.0         100.0                   0.0    19.1
 Hospital in-
   patient eval-
    uation therapy                    74.2        61.5       40.0           93.3    68.9
                                                                                                                                Table 8
  Hospital out-pt.                                                                                              Percent Reporting Fee Scales Used
    eval. therapy                     61.3        53.8       33.3           93.3    60.8

  Staffed special                                                                                                                   Facility Type
    services                           16.1       76.9       26.7           66.7    39.2
                                                                                                                   Private   Com/Rehab      Univ. Medical Overall
  Consultative                                                                             Fee Scale               n=31        n=13             n=15 n=15 n=74
    spec. services                     12.9                                          5.4
                                                                                            Fixeda                   93.5           53.8               40.0                 46.7    66.2

                                                 Table 6                                    Slidingb                  9.7           46.2               33.3                  6.7    20.3
   Percent of Facilities Using Public Relations Methods                                     Patient-

                                                                                              determinedc            12.9           61.5               26.7                  6.7    23.0
                                                    Facility Type
                                                                                            No fee                    0.0                0.0           26.7                 40.0    14.7
Public Rela-                        Private   Com/Rehab     Univ. Medical Overall
tions Methods n = 30                            n = 13     n = 12 n = 9 n = 64
                                                                                           aFixed fees refers to standard or established fees for services.
 Newspaper An-

   nouncements                        46.7        53.8      41.7            22.2   43.8    bSliding fees refers to a flexible scale of fees which can be adjusted.
                                                                                           cPatient-determined fees are those which the patient deems appropriate.
  Mailed An-

   nouncements                        53.3        30.8       33.3           11.1    39.1
                                                                        and/or patient-determined fee scales. Fixed fee scales were

  Pamphlets and

                                                             58.3       the most frequently reported (66.2%), and no fees were the
                                                                            44.4    60.9

    Brochures                         50.0       100.0
                                                                        least reported (14.7%). Although the majority of private

 Business Cards 90.0           38.5         8.3     55.6     59.4       practices (93.5%) employed a fixed fee scale, it is

                                           25.0      11.1    32.8       interesting to note that a total of 22.6% (sliding fee scale,

 Open House         40.0       38.5
                                                                        9.7%; patient-determined fee scale, 12.9%) of the private
 Fund Raising                                                           practices also included fee scales which arrange for reduced


   Projects          3.3       61.5          8.3         0    15.6
                                                                        fees. Of further interest, 26.7% of the university clinics and
 Yellow Page                                                            40.0% of the medical facilities charged no fees.
                    96.7       61.5        33.3      33.3     68.8      Combinations of fee scales were also frequently reported.


                                                                           Fixed Fees. Subjects employing fixed fees were asked to

 Other Methods:                                                         list the procedures used when patients express an inability
    Personal con-
   tacts, T.V.,                                                         to pay the stated fee. The procedures listed are displayed
    rehab team, in-                                                     in Table 9. The most frequently listed procedure was to
    house news-                                                         refer the patient to another facility (40.9%). The least

    letter, patient                                                     reported procedure was to refuse service (2.3%). Table 9
    referral        43.3       23.1        33.3      55.6     39.1
                                                                        also shows that 61.5% of the private practices with fixed

                                                                        fees referred to another facility if the patient could not pay.
    Fee Information                                                     A relatively low percentage of the private practices (23.1%)

        Fee scales. Respondents also indicated which types of fee indicated that patients were assisted in obtaining third party
    scales were used Fixed fees refers to standard or established payments. Because other health related professions
     fees for services; sliding fees refers to a flexible scale of fees frequently negotiate time frame for payment but rarely
     which can be adjusted; and patient-determined fees are              negotiate fee amount, it seemed surprising to note that
     those which the patient deems appropriate. Table 8                  38.5% of the private practices negotiated terms if the
28 summarizes the percentages of facilities using fixed, sliding, patient was unable to pay the so-called fixed fee.
                                               Table 9                                                                                         Table 10
 Procedures Used by Facilities Having Fixed Fee Scales                                                  Procedures Used by Facilities Having Fixed Fee Scales
        When Patient Indicated Inability to Pay                                                                     When Patient Does Not Pay

                                       Percent Reporting Procedure is Used                                                               Percent Reporting Procedure is Used
Reported                       Private     Com/Rehab     Univ. Medical Overall                         Reported                 Private      Com/Rehab     Univ. Medical Overall
Procedures                     n=26           n=6               n=6 n=6 n=44                           Procedures               n=26           n=6            n=6 n=6 n=44
 Refer to other                                                                                         Attempt to
   facility                     61.5                                                 33.3   40.9          collect fee            38.5           83.5           33.3    16.7    40.9
 Make available                                                                                         Refer to another

  an installment                                                                                          department               3.8                         16.7    66.7    13.6
  plan           19.2                                                 16.7           16.7   15.9

 Apply sliding fee                                                                                        services               34.6           16.7                           22.7
   scale                                           33.3               16.7                    6.8

 Negotiate terms                38.5                                  50.0            -     29.5
                                                                                                        Continue services

                                                                                                        Write off after
                                                                                                                                                               50.0             6.8

 Assist in third-
   parry payments 23.1                             66.7                -             16.7   25.0
                                                                                                         attempts to
                                                                                                         collect                   7.7          16.7           16.7    16.7    11.4
 Refer to another
   department                                       -                 16.7           50.0     9.1
                                                                                                        Renegotiate with
                                                                                                          patient                 -              -             16.7     -       2.3
 Refuse service                                    16.7                -              -       2.3       Consult attorney          11.5                                          6.8

 Do not charge                   3.8                -                 33.3            -       6.8       Notify credit
                                                                                                          bureau                 23.1                                          13.6
   individually                  7.7                                                          4.5       Turn matter over
                                                                                                          to coll. agency 38.5                  16.7                           25.0
 Reduce fre-
   quency of                                                                                            Legal suit/small
   therapy or                                                                                             claims court            15.4                                          9.1
   place in a
   group                         7.7                                                          4.5       Handled
                                                                                                          individually            -             16.7           -       16.7     4.5

                                                                                                                                              Table 11
   In answer to the question, "What is your procedure if

                                                                                                      Procedures Used by Facilities Having Sliding Fee Scales
the patient fails to pay?", respondents using fixed fees listed                                               When Patient Indicates Inability to Pay
the procedures shown in Table 10. The most frequently
reported procedure was to attempt to collect the fee

(i0.9'%>). The least reported procedure was to renegotiate                                                                           Percent Reporting Procedure is Used

terms with the patient (2.3%). More procedures were listed                                            Reported                  Private Corn/Rehab     Univ. Medical Overall

by private practices than by any other facility type. Only                                            Procedures                n= 2          n= 6            n= 4 n= 1       n= 13

two of the eleven procedures were utilized in some degree
                                                                                                       Refer to another
by all facility types. They were: attempt to collect the fee                                            facility                 50.0                                           7.7
and write off after attempts to collect. It is interesting to
note that private practices and medical facilities typically                                           Assist in ob-
turn delinquent accounts over to some other agency                                                      taining third-
                                                                                                         party payment                         16.7           25.0             15.4
for collection whereas universities and community/
rehabilitation centers do not.
    Sliding fee scales. Respondents reported the percentage
of patients who paid according to a sliding fee scale. The
                                                                                                       Refer to another
                                                                                                         department               -             -              -      100.0     7.7

 responses ranged from 0.0% to 100.0%, with a mean of
470%. Of those facilities utilizing a sliding fee scale,
                                                                                                       Handled by
                                                                                                         Board                    -            33.3                            15.4

 50.0% required the patient to present documentation to
 reduce fees and 50.0% did not require documentation.
                                                                                                       Waive fee                 50.0           -             25.0     -       15.4

                                                                                                       Negotiate with
    Similar to the questions asked of subjects using fixed fee                                           patient                               50.0           25.0

 scales, subjects indicating sliding fee scales were also asked

 to list the procedures used when patients express an                                                  Apply patient-

 inability to pay. The listed procedures are presented in Table                                          determined
 11. Although 86.7% of those facilities offering a sliding fee                                           fee scale                             16.7           25.0             15.4

 scale answered this question, the number was so small

 that it was difficult to generalize. Nonetheless, the most                                         by 33.3% of the 15 reporting facilities. Further, a minimum
 frequently reported procedure (30.8%) was to negotiate                                             payment was stressed for all patients by 73.3% of the 15

 if the patient indicated inability to pay according to the

                                                                                                    respondents. Approximately one-fourth (26.7%) of the

 sliding fee scale.                                                                                 respondents employing patient-determined fees indicated

    Patient-determined fees. Regarding patient-determined                                           that patient-determined fees are usually less than the patient



 fees, 100% of the respondents (n = 16) reported that                                               can afford, while none of the respondents indicated that
 patients were informed of the full charge for service.                                             patient-determined fees were more than the patient could
 Additionally, 60% of the 15 respondents indicated that fees                                        afford. Further, 73.3% of the 15 respondents having

 were suggested according to the patient's income or ability                                        patient-determined fee scales indicated that patient-

 to pay. Also, patient-determined fees were used exclusively                                        determined fees were usually appropriate.


   Suhjects using paticnt-determined fees were asked to                                                                                            Table 12
estimate the percentage of patients ,yho honor their fee                                                                           Ranks of Hourly Fees for Speech and

                                                ,,, J,,
agreement. Overall, the estimates (n = 14) ranged front                                                                                   Language Evaluations

-5.0" to 1110.0';, with a mean of 89.1",,. Subjects using
patient-determined fees were also asked to estimate the                                                                                                Facility Type
percentage of patients who were paving less than they
                                                                                                                                       Private   Com/Rehab     Univ. Medical Overall
could afford. Overall, the estimates (n = 6) ranged from                                                                              n=23         n=5        n=2 n=3 n=33
6.01%i, to 30.0'i,, a ith a mean of 20?",,. Two-thirds
(667'%,) of the 14 respondents haying paticnt-determined                                                          Mean fee                2          4           3          1

fees also used a combination of other fee scales i.e., fixed
and/or sliding; and one-third (33.3"4)) reported that all fees                                                    Mode                    1          4           2         3
were patient-determinccl.                                                                                         Median fee              2          4           3
Fees for services.                                                                                                                                                          1

   'table 12 shows rinks of hourly fees for speech-language

                                                                                                                  Minimum fee             3          4           2          1

evaluations (xvhere      represents the highest fee and -f the


lowest). The lowest fee per hour was charged by conunun-                                                          Maximum fee                        4           3         2


itv rehabilitation clinics. and the highest fee per hour was


charged by private practices. Additionally, the standard

                                                                                                                       deviation     ($) 13.73      10.38      3.54      12.83
deviation associated with the hourly fees was least for

university settings and greatest for private practices.
                                                                                                                Note. Fee ranks shown in this table were reported by respondents who
Additionally, the overall standard deviation associated with                                                    charge by the hour only for speech-language evaluations.
hour/}, fees for speech-language evaluations was S1578.
    Table 13 presents the ranks of set fees for speech-                                                                                            Table 13

language evaluations. The lowest fee was charged by                                                             Ranks of Set Fees for Speech and Language Evaluations

community/rehabilitation clinics and the highest was
charged by private practices. Additionally, the Overall

                                                                                                                                                       Facility Type
standard deviation associated with the set fees Nvas 515.49.

    'Iable 14 shows ranks of fees for hearing screenings. The                                                                          Private   Com/Rehab     Univ. Medical Overall

lowest fee was charged by community/rehabilitation clinics                                                                            n=10         n=9        n=8 n=5 n=32
and the highest fee was charged by private practices.                                                            Mean fee

                                                                                                                                          2          3           4

Additionally the overall standard deviation associated with
the hearing screenings was 5759.                                                                                  Mode                    1          2           2          1

    'table 15 shows the ranks of set fees for half-hour                                                           Median fee              2           3          4          1
individual therapy sessions. The lowest fee was charged b}'

universities and the highest was charged by private                                                               Minimum fee                         4          3



practices. Additionally, the overall standard deviation
associated with half-hour individual therapy sessions was                                                         Maximum fee             2           1          4          3


    Table 16 presents the fee ranks for half-hour group                                                                deviation     ($)11.60       17.69                  3.56

therapy sessions. The lowest fee was charged by
community/rehabilitation clinics and the highest was                                                            Note. Set fees are the established or standard fees charged for a specific
charged by private practices. Additionally, the overall

standard deviation associated with half-hour group therapy
sessions was 55.54.                                                                                                                                Table 14
    Table 17 shows the fee ranks for half-hour homebound                                                                     Ranks of Set Fees for Hearing Screenings

therapy sessions. Only private practice and community/

 rehabilitation facilities responded to this question. Both the                                                                                        Facility Type

 lowest and highest fees were charged by community/                                                                                    Private   Com/Rehab     Univ. Medical Overall

 rehabilitation facilities. Additionally, the standard deviation                                                                      n=17         n=8        n=7 n=3 n=35


 associated with half-hour homebound therapy sessions was
                          C.. 'J'

                                                                                                                      Mean fee            2                      4
 510.71. An additional outcome of the questionnaire not                                                                                              3                     1

 shown in Table 17 but of interest was that of those subjects

                                                                                                                      Mode                2          2           2         1

 reporting fees for homebound therapy, 29.2% charged
 additionally for travel expenses. Further, all facilities                                                            Median fee          2                      4

                                                                                                                                                     3                     1

 charging for travel were private practices.


                                                                                                                      Minimum fee         2          4           3          1

     Fee determination. Subjects were asked to indicate bases
 for determining fees for services. Table 18 reveals that, in                                                         Maximum fee         1          3           4         2
 determining fees, consideration of overhead costs (65.0%)                                                            Standard
 and comparison to other similar facilities (65.0%) were the

                                                                                                                       deviation      ($) 8.62       6.74       3.08      4.07
 most frequently indicated bases. it is of interest, however,

 that the universities sampled in this study did not indicate
 overhead costs to be a prime consideration. Additionally,
 of the reporting facilities, 6.7% determined their fees                                                          Additional information gained from the questionnaire
 arbitrarily.                                                                                                  regarding fee determination indicated divided respondent

     Table 19 summarizes respondents' opinions concerning                                                      opinions concerning the effect of their fee plan on patient
  their current fee levels. Fees were considered to be                                                         performance in therapy. For example, 42.9% felt that the

  adequate by 58.3% of the respondents. Fees were                                                              fee plan did affect therapy performance and 57.1% felt that
  considered to be too low by 40.0%. The least indicated                                                       it did not. Moreover, in answer to the question, "When
  opinion was that fees were too high (1.7%). It is interesting                                                were your fees last adjusted?", most respondents (69.9%)
  to note that this order prevailed for each facility type.                                                    reported that their fees had been adjusted during the
                                                      Table 15                                                                                          Table 18

 Set Fee Ranks for Individual Half-hour Therapy Sessions                                                            Percent Indicating Bases for Determining Fees

                                                         Facility Type                                                                                      Facility Type
                               Private             Com/Rehab     Univ. Medical Overall                                            Private            Com/Rehab      Univ. Medical Overall

                               n=30                   n=10             n=4a n=7 n=51                        Bases                 n=30                 n=12        n=10 n=8 n=60
   Mean fee                             2                    3               4          1                    Overhead costs            83.3              66.7       20.0    50.0          65.0

   Mode                                 2                    3               4          1                    Comparison to
                                                                                                               other similar
   Median fee                           2                    3               4                                 facilities              73.3              41.7       60.0    75.0          65.0


   Minimum fee                          3                    2               4          1                    Comparison to
                                                                                                               area facilities         36.7               8.3       30.0     0.0          25.0
   Maximum fee                          1                    3               4      2
                                                                                                             Arbitrarily                3.3               0.0       20.0    12.5               6.7
        deviation             ($) 5.90                  2.38                5.07   7.09
                                                                                                                                                       Table 19
 aFee ranks reported in this column are those listed by university clinics as                                     Percent Reporting Opinion of Current Fee Level
 set fees. Tuition per semester is not reflected in this table.
                                                                                                                                                           Facility Type
                                                      Table 16
                                                                                                                                  Private            Com/Rehab     Univ. Medical Overall

   Set Fee Ranks for Half-hour Group Therapy Sessions                                                       Opinion               n=30                 n=11        n=11 n=8 n=60
                                                         Facility Type                                       Fees are too high         0.00              9.9         0.0     0.0               1.7
                              Private              Com/Rehab     Univ. Medical Overall
                              n=13                    n=7             n=2a n=4 n=26                          Fees are too low 43.3                      36.4        36.4    37.5          40.00

                                                                                                             Fees are
   Mean fee                         1                   4                   3      2                           adequate            56.7                 54.5        63.3    62.5          58.3
   Mode                             1                   2                   3      2

   Median fee                      2                    4                   3       1                                                                  Table 20
                                                                                                                  Percent Reporting Types of Payment Accepted
   Minimum fee                     2                    3                   2


   Maximum fee                     1                    4                   3      2                                                                        Facility Type
                                                                                                        Type of                   Private            Com/Rehab      Univ. Medical Overall

            deviation         ($) 5.91                 2.33                 6.01   5.06                 Payment                   in = 31              n = 13      in = 10 n = 7 in = 61
                                                                                                             Cash only                 32.3             15.4         0       0            19.7
aFees reported in this column are those listed by university clinics as set
fees. Tuition per semester is not reflected in this table.                                                   Credit cards              25.8              7.7       20.00    143           19.7

                                                     Table 17                                                  payment                 64.5             84.6       100.0   100.0          78.7
                 Set Fee Ranks for Half-hour Homebound
                           Therapy Sessions                                                                  Combination of
                                                                                                              cash, credit
                                                                                                               cards, and
                                                                 Facility Type                                 third-party pay. 22.6                     7.7       20.0     14.3          18.0
                                            Private                Com/Rehab                Overall
                                            in = 19                  n = 5                  n=24
                                                                                                      and method of delivery. In general, results indicated that of
                                                                                                      the 61 facilities responding to the question concerning

   Mean fee                                    1                       2
                                                                                                      billing frequency, 73.8% billed patients on a monthly basis,

   Mode                                                                                               13.1% billed weekly, 11.5% billed per semester, 6.6% billed


   Median fee                                  2                        1
                                                                                                      per session, 4.9% billed bimonthly and 3.3% billed
                                                                                                      quarterly. Additionally, pre-paid billing was employed by
   Minimum fee                                 2                        1                             32.7% of the 52 facilities responding to the question
   Maximum fee
                                                                                                      concerning billing time, while post-paid billing was used by

                                                                                                      76.9% of the respondents. Further, one-half (50.8%) of the
   Standard                                                                                           61 respondents who answered the question concerning

        deviation                   ($)       9.12                    17.04                           billing delivery methods reported that bills were delivered
                                                                                                      by mail only, while 18.0% hand-delivered their bills at the
Note. Private Practice and Community/Rehabilitation Facilities were the                               time of appointment and 31.1% used a combination of the

only respondents to this question.                                                                    two methods.
                                                                                                         Types of payment. Table 20 presents the types of
                                                                                                      payment accepted by facilities. Table 20 shows that 78.7%

  previous year; 12.1% adjusted fees from one to two years                                            of the reporting facilities accepted third-party payment.
  ago; 17.2% adjusted fees from two to three years ago; and                                           Additionally, 19.7% of the respondents accepted credit card
  1.7% adjusted fees five years ago.
                                                                                                      payment. Further, 19.7% accepted cash only. A combina-

  Billing Procedures                                                                                  tion of cash, credit card, and third-party payment was
    Subjects were asked to supply information concerning                                              reported to be accepted by 18.0% of the responding
  their billing procedures i.e., frequency and time of billing                                        facilities.
                                                                                                                   Table 24
                                                                                       Mean of Estimated Percentage of Total Billing
                                       Table 21                                                Covered by Income Sources
       Percent Reporting Person Responsible for Billing
                                                                                                                       Facility Type
                                           Facility Type
                                                                               Income              Private       Com/Rehab     Univ. Medical Overall
                                                   Univ. Medical Overall
                                                     n=9 n=6 n=47              Sources             n=29            n=9           n=9 n=2 n=49
                                                                                 Patient Payment 79.1               30.3           71.8       40.0         67.22
   pathologist   36.4                                                17.0        Third-party
 Other person:                                                                      Insurance         12.6          19.1            3.0       45.0         13.34

   director, office                                                                 Medicare           2.6          21.9             .6        7.5          6.06
       bookkeeper.                                                                  Other

       other depart-                                                                Agencies           4.8          18.1           20.7        2.5         10.07
       ment             63.6            100.0        100.0   100.0   82.9
                                                                                 Other Sources:
                                                                                    Grants, Private
                                       Table 22                                     Medicaid,

          Percent Reporting Patient Billing for Sessions                            Comp.               5              .4            .0             .0       .06

                                           Facility Type                       Note. Total billing refers to the total amount billed by the facility for

                       Private       Com/Rehab Univer. Medical Overall         services.
                       n=28            n=10          n=10 n=4 n=52
                                                                                                                   Table 25
 Sessions missed
   but not                                                                          Mean of Estimated Percentage of Operating Costs
                                                                                              Covered by Income Sources

   cancelled     75.0                    50.0        60.0    25.0    63.5

 Conferences            71.4             20.0        30.0    75.0    53.8
                                                                                                                       Facility Type
 Make-up                                                                        Income             Private       Com/Rehab     Univ. Medical Overall
                                                             25.0                                  n=29            n=10           n=8 n=3 n=50

  sessions              64.3             40.0        20.0            48.1
 Sessions can-
   celled before                                                                 Collected Billings 93.6             47.0          24.1        75.0        72.06
   deadline              7.1             10.0        40.0     0      13.5

                                                                                 Charitable Org.        0            16.7             .3        3.3

                                                                                 Other Agencies:
                                       Table 23                                    TRC, DHR             1.4          15.3           18.8            .0      6.86
             Percent of Facilities Receiving Income from                          Private Donations         .0       18.5             .4        3.3         3.96
                          Various Sources
                                                                                 Other Sources:
                                            Facility Type                          Budget, Small

Sources of             Private       Com/Rehab      Univ. Medical Overall          Business

Income                 n=31            n=13          n=11 n=9 n=64                 Loans, Con-
                                                                                   tracts, Un-
                                                                                   specified                .4         .5            6.5        6.7         1.34
 Patient payment 100.0                  100.0        90.9     88.9   96.9

 Insurance               61.3            92.3        72.7    100.0   75.0

                                                                                 Person responsible for billing. Table 21 indicates that, in
 Medicare                29.0            53.8        27.3    100.0   43.8     community/rehabilitation, university, and medical facilities,
                                                                              an employee other than the speech-language pathologist
 Other Agencies:                                                              was responsible for billing the patients. Additionally, 63.6%
   TRC, DHR,                                                                  of the private practices reported that another person was
   State Crippled
                                                                              responsible for the billing. It can also be seen, however,

   Child.                  4.5                 2.3     1.8     6.7    3.4
                                                                              that private practices were the only facility type which
                                                                              reported that billing was the responsibility of the speech-

 Organization:                                                                language pathologist.
   United Way              3.2            69.2        18.2    33.3   23.4
                                                                                 Session Billing. Table 22 shows that, overall, 63.5% of
 Private Donations                                    45.0    44.4   31.3     the responding facilities billed the patient for sessions

                           3.2            76.9
                                                                              missed but not cancelled. Of the facilities answering the

 Grants                    0              53.8        54.5    22.2   23.4
                                                                              question on session billing, most private practices (71.4%)
 Other Funding                                                                and medical facilities (75.0%) billed the patients for
 Sources:                                                                     conferences. Additionally, most private practices (64.3%)
   Medicaid,                                                                  billed for make-up sessions. Further, few facility types billed


   Memorials                    .2             8.5     5.5     1.1    8.8     for sessions cancelled with reasonable notice; however,
                                                                              40.0% of the responding universities did bill regardless.

  Income Sources. Table 23 reycals data regarding income                                                                                                                aspects of speech-Lulguage pathology. analysis of the results



xnarccs of facilities responding to this question. Overall.                                                                                                             reyealcd some general information ahout the surycy
96.9 of the facilities rccciyed patient reimbursement for                                                                                                               population. For example, private practice represented the



scryices. Additionally, -5.0",, received income from                                                                                                                    largest portion of the sample even though the rate of

imUruiCC, and -3A(;(' received payment from other                                                                                                                       response from all facility types -,vas relatively high.

agencies, e.g. Texas Rehabilitation Commission (TRC) and                                                                                                                Regarding the large number of private practices, it is

Department of Human Resources (I)HRI. Other funding                                                                                                                     possible that either there arc more private practices than

sources. e.g. Medicaid and fund-raising projects, were the                                                                                                              any other facility tN pe in the State of Texas or that priyatc


least reported 08.8()")). It can also be seen from '[able 23                                                                                                            practices are more aware of the need for visibility and
that insurance was a more frequently reported source of                                                                                                                 therefore make a greater effort to he listed in the State

income for community/rehabilitation (92.';%) and medical                                                                                                                association directory.

(100'%')) facilities than for private practices (61.3' , I and                                                                                                              Gcneral results concerning geographical location
university clinics             Additionally, Medicare Nyas                                                                                                              indicated that the distribution of the responding facilities

                                                                                                                                                                                                        ^r- ,^J

a more frequently reported source of income for                                                                                                                         corresponded with the distribution of the State population


community/rehabilitation (53.8'%) and medical (100` "))                                                                                                                 even through respondents suhjectiyely listed a general


facilities than for private practices (29.0'%,) and university                                                                                                          location. In considering these results, therefore, future


clinics (2,.It is interesting to note that private practice                                                                                                             surveys should include a clear definition of geographical
was the only facility type -,which did not report grants to be                                                                                                          boundaries.

an income source.                                                                                                                                                           Regarding the number of speech-language pathologists



  Coverage of tote! billing. Respondents estimated the                                                                                                                   and audiologists employed in the responding facilities, the

percentage of their total billing (i.e., the total amount billed                                                                                                         ratio of the mean number of speech-language pathologists


by the facility for services) covered by the various income                                                                                                              over all facilities to the mean number of audiologists was

sources. Table 24 shows the mean of the reported estimates-                                                                                                              approximately 3 to 1. Moreover, findings revealed that 33

The mean estimates revealed that, overall, patient payment                                                                                                               speech-language pathology facilities did not employ an



covered the largest percent (672%,) of the total billing,                                                                                                                audiologist. These results may indicate that either


followed by insurance (13.3%), other agencies (10.11%,),                                                                                                                 audiologists arc not considered to be an integral part of the

Medicare         and other sources (2.1%). In private                                                                                                                    speech-language pathology- program, or that audiologists

                                                                                                                                                                                                        ''7  01G
practice and university facilities, patient payment                                                                                                                      are employed in settings other than those surveyed, e.g.

 was estimated to cover over half of the total billing.                                                                                                                  private audiology practice or hospital otolaryngology



Additionally, in community/rehabilitation and medical                                                                                                                    departments.

facilities, third-party payment was estimated to cover over                                                                                                                 Subjects also responded to questions concerning the


half of the total billing.                                                                                                                                               services offered. The findings indicated that all facilities


   Coverage c f operating costs. Respondents also estimated                                                                                                              offered evaluation and therapy, a major criteria for

the percentages of their operating costs covered by various                                                                                                              inclusion in the questionnaire mailing. Of the surveyed

income sources. 'table 25 presents the mean of the reported                                                                                                              facilities, 89.2 'Yo indicated that speech and/or hearing


estimates. The mean estimates revealed that, in private                                                                                                                  screenings were offered. Indeed, hearing screening should

facilities, collected billings covered 93.6% of the operat-                                                                                                              be routine in every speech-language pathology program.
ing costs, and that other agencies and other sources                                                                                                                     Moreover, speech and/or hearing screenings should be


covered 1.4       respectively. The mean estimates for                                                                                                                   profitable as a source of income, a source of new patients,


community/rehabilitation facilities revealed that collected                                                                                                              and a public relations method. An additional finding


billings covered 47.0% of the operating costs, while                                                                                                                     indicated that university clinics generally do not extend

combined income from third parties covered over half of                                                                                                                  services to include homebound or hospital patients. This


the operating costs. In university clinics, other sources,                                                                                                               may be interpreted to imply that student clinicians are not
             C\\         :-j

primarily the university budget, covered an estimated                                                                                                                    receiving homebound or hospital practicum experience


56.5% of the operating costs, collected billings covered                                                                                                                 except through externship experiences. In general,


24.1%, and other agencies covered 18.8%. Responding                                                                                                                      homebound therapy was the least offered service. Further

medical facilities estimated that collected billings covered                                                                                                             study may be indicated to determine whether the needs of

-5.0% of their operating costs, and other sources, e.g.                                                                                                                  homebound patients are being met.

contracts, covered 167%.                                                                                                                                                    The findings also suggested that respondents employed a


                                                                                                                                                                         variety of public relations methods and that most facilities


                                                                                                                                                                         are listed in the Yellow Pages. Specific public relations

   Interest in the business and financial aspects of speech-                                                                                                             methods seemed to be favored by certain facility types

language pathology has been evidenced in the recent

                                                                                                                                                                         which may indicate that certain public relations methods



literature of our profession. Additionally, the relatively high                                                                                                          are more appropriate for different facility types and their
rate of response to the present survey may be an indication                                                                                                              clientele. For example, the public relations methods most
of such interest for the State of Texas. It may be speculated                                                                                                            frequently listed for private practice were the use of the


that much of this interest has been generated by problems                                                                                                                Yellow Page advertising and business cards; for community/


associated with business and financial aspects, e.g., third-                                                                                                              rehabilitation facilities and university clinics, pamphlets and


party payment, fees for services, etc. It may be further                                                                                                                 brochures; and for medical facilities, business cards,
speculated that these problems are the result of a general

                                                                                                                                                                         personal contact, and in-house newsletters. If visibility and

lack of experience in business matters across the profession.                                                                                                             awareness are important to the profession, then more
This lack of experience may come from years of employ-                                                                                                                    interfacility communication and further study seem

ment in non-profit settings (such as public schools,                                                                                                                      warranted.

universities and non-profit rehabilitation centers), fostering                                                                                                              Regarding facility goals, findings revealed that certain

a mind-set that monetary matters are not the concern                                                                                                                     goals seemed to be preferred by each facility type. For

of the speech-language pathologist. The increase in                                                                                                                       example, the most frequently stated goal of private practice



membership as well as increased concern for the economic                                                                                                                  was to provide competitive services, while the most


viability of the profession, however, have fostered the                                                                                                                   frequently stated goal of community/rehabilitation clinics
realization that business and financial matters are germane                                                                                                               was to provide affordable services. Further, training

to speech-language pathology.                                                                                                                                             students was the primary goal of university clinics, while



   Although the aim of this study was to provide some                                                                                                                     providing the best services for limited patient types was the



basic information regarding the business and financial                                                                                                                    major goal of medical facilities. It is interesting that only

   private practices tinted that providing competitive seryiceti                                                                                                                                                             medical facilities. Overall. the fees for speech and language




   \yas a primary goal. Tlic responses from conununity                                                                                                                                                                       eyalu:ations yaricd the most. and the fees for both group

   rehabilitation clinics and from university clinics reflected                                                                                                                                                              and individual therapy sessions varied the least. 'I finding

   the fact that they were not in business to make Homey but                                                                                                                                                                 of a ,vide range of fees is consistent with previous findings


   chose to provide affordable services to the extent of                                                                                                                                                                     reported in the literature (Aleo & Pece. 19'-: Bangs. 19-0:

   charging no fees. While it is understandable that universities                                                                                                                                                            Knight. 1961: Strandberg, 19°). It was surprising to find a

   are not in the business to make money or compete for the                                                                                                                                                                  vyidr range of fees for services in this study, however, in

   dollar, it is well knoiyn that the majority of our profession                                                                                                                                                             yicNv of the fact that over half or 65.0'%o of the respon-



   is employed in rehabilitation and other non-profit agencies,                                                                                                                                                              dents reporting indicated that fees Nverr determined by


   c.g. public schools and universities. It appears possible.                                                                                                                                                                comparison to similar facilities. Additionalh, almost half
   therefore, that such a preponderance of our professionals                                                                                                                                                                 Ito.o`i,) of the facilities reporting opinions of their current


   employed in settings associated with non-competitive                                                                                                                                                                      fee level, considered their fees too low. This finding may



                                                                                                                                                     r', r'.


   (profit) goals, may be a detriment to the economic standing                                             .7^
                                                                                                                                                                                                                             indicate that reorganization of fee determination strategies is


   of our profession.                                                                                                                                                                                                        ,,N arranted in those facilities. Further, because it was found
      Concerning billing procedures, findings indicated                                                                                                                                                                       that over half or 65%) of the respondents based their fees
   that song respondents hilled for missed sessions and                                                                                                                                                                      i_m overhead costs, it may be assumed that the xvidc range


   conferences. It may be that facilities charging for missed                                                                                                                                                                in fees exists because the actual cost of service delivrrv



   sessions and conferences have realized that time is monev                                                                                                                                                                 varies. Converselv, for sonic facilities, actual cost of service





   and that other facilities not charging for these sessions                                                                                                                                                                 may not be a factor in determining fees, e.g. non-profit

   should be. Findings also indicated that while most facilities                                                                                                                                                             facilities. An additional speculation, previously mentioned


   hilled patients following delivery of service, almost one-                                                                                                                                                                by Aleo and Pece (19"), is that more appropriate cost-



   third of the respondents billed in advance. One respondent                                                                                                                                                                accounting systems arc needed. If fees were more uniform,

   reported that pre-payment decreased absenteeism and                                                                                                                                                                       perhaps third parties i.e., private and government health


   eliminated the problem of delinquent accounts. The effect                                                                                                                                                                 insurance, would more readily provide reimbursement for
   of billing time on patient absenteeism and delinquent                                                                                                                                                                     speech-language pathology services.


   accounts should be a topic for further study. Another                                                                                                                                                                        Although findings suggested that more private practices

   finding was that private practice ,vas the only facility type                                                                                                                                                             are accepting third-party payments than in a previous study


   reporting that billing was the responsibility of some speech-                                                                                                                                                             (Goates & Goates, 1977), assisting in obtaining third-party

   language pathologists. It may be that sufficient income is                                                                                                                                                                payment for patients was not a frequently reported

   not being generated by these speech-language pathologists

                                                                                                                                                                                                                             procedure of private practices. This failure to pursue third-

   to afford an employee to handle the billing because of                                                                                                                                                                    party payment would result in a larger portion of the total


   small caseloads or inadequate fees for services. It also may                                                                                                                                                              fee being paid by the patient treated in a private practice


   be that universities should consider training their students                                                                                                                                                              facility when compared to patients being treated in other

   in principles of management-marketing-accoutrting related

                                                                                                                                                                                                                             facilities. It may be that private facilities are unaware of the

   to the profession.                                                                                                                                                                                                        availability of third-party payments for speech-language
      Subjects also responded to questions concerning fee                                                                                                                                                                    services or of the procedures necessary to obtain third-

   scales. It was found that fixed fee scales were the most                                                                                                                                                                  party payment. Findings also suggested that community/
   frequently reported for the entire sample; however, all                                                                                                                                                                   rehabilitation facilities are more aware of the availability of

   facility types employed reduced fee scales to some extent.                                                                                                                                                                and procedures for obtaining third-party payments. Results


   It was most surprising that some private practices reduced                                                                                                                                                                further suggested that, in universities, the university budget


   fees. It may be speculated that to maintain caseloads,                                                                                                                                                                    e.g., the taxpayer, student tuition, or other supporting

   facilities employing fixed fees reduce their fees to compete

                                                                                                                                                                                                                             agencies may be "footing the bill" for speech-language



   with facilities employing reduced fees. It may be further                                                                                                                                                                 services. Moreover, it may be that if speech clinics were



   speculated that perhaps facilities employing reduced fees                                                                                                                                                                 self-supporting, budgeted monies could be released for




   are making it difficult for other facilities to charge fixed                                                                                                                                                              other improvements - either to the speech clinic or to the


   fees only.                                                                                                                                                                                                                university in general. Thus, further study regarding fees

      It appears that most facilities employing patient-

                                                                                                                                                                                                                             associated with university clinics may be indicated. The


   determined fees informed the patients of the full charges

                                                                                                                                                                                                                             limited response by medical facilities to the questions



   for services, suggested an appropriate fee, and stressed a                                                                                                                                                                concerning business procedures and income sources made


   minimum payment. It seemed surprising that 73.3% of the                                                                                                                                                                   generalization difficult. It may be that other facility types


   respondents who employed patient-determined fees                                                                                                                                                                          could profit from information concerning the business

   indicated that patient-determined fees were usually                                                                                                                                                                       procedures of the medical facilities, and future studies



   appropriate. Perhaps the patients are determining                                                                                                                                                                         should collect these data.

   appropriate fees because of appropriate counseling

                                                                                                                                                                                                                               The procedures for handling delinquent accounts that



   methods, e.g., suggesting appropriate fee and stressing                                                                                                                                                                   have been reported in the literature (Battin & Boland, 1978;



   minimum payment. Further study may reveal the                                                                                                                                                                             Keys, 1964; Knight, 1961) are being used to a small degree


   relationship between counseling methods and patient-                                                                                                                                                                      by some of the respondents, primarily by private practices.

   determined fees.                                                                                                                                                                                                          Additionally, the fact that universities and community/
      When the patient indicated inability to pay according to                                                                                                                                                               rehabilitation centers do not typically turn delinquent

   the fixed or sliding fee scale, overall procedures were                                                                                                                                                                   accounts over to some other agency for collection suggests

   similar regardless of the fee scale employed by the                                                                                                                                                                       that these facilities may, be teaching their patients that

   responding facilities. This implies that so-called fixed fee


                                                                                                                                                                                                                             speech-language-hearing services are not worth initiating


   scales are not rigid and can be negotiated. In addition, the                                                                                                                                                              formal procedures to collect overdue accounts. Perhaps all



    fact that private practices reported procedures such as make                                                                                                                                                             facilities should be more concerned with the collection of


    installment plans available, negotiate, waive fee, handle                                                                                                                                                                monies due for services rendered.

    individually, and reduce frequency of therapy or place in a                                                                                                                                                                The purpose of this study was to obtain data regarding




   group may be a result of attempts to maintain case loads


                                                                                                                                                                                                                             business and financial aspects of speech-language

    and compete with non-profit facilities for patients.

                                                                                                                                                                                                                             pathology. Current information regarding fees for services,


      The actual fees for services were relatively variable, both                                                                                                                                                            business procedures and income was reported. Results

    within and across facility types. In general, the fees for

                                                                                                                                                                                                                             obtained from this study may prove useful to practitioners

    services were lower in community/rehabilitation clinics and

                                                                                                                                                                                                                             in establishing or revising fee scales and service emphases;

34 universities, and fees were higher in private practice and

                                                                                                                                                                                                                             and in increasing income from various funding sources.

Ihle to the large numhcr of private practices included in                                    Guate,- I s & (-Jtcl- AA  Increasing third pare uovcragc of spec-ch-language

                                                                                                p.tthiilug\ And audiolog\ cn icc, Isha. 19__. P). 88--881)
the sun cy. perhaps the results may he better generalized to                                  Heater. I 1 14.11111 pLuuting agencies and speech -language pathnlo>;%    Isha. 1981. 23.
that group of practitioners. However, some meaningful                                             85-t,;2
information nlay be gained for all facility types. This study                                 Kev1. I AA.:Wmi nist ration. -lsha. 1964. 6 i--- 486.
                                                                                              Knight, 131) . iFdi. Private practice in 111eec11 pathologc and audiologs. Asbct. 1961. _i.
also presented previously cited problems associated with                                              123'- WO
the business aspects of our profession. The solutions to                                      Knight. PI). PnNate practice in sprah p:athologs Asha, 19621, /t). t16-4il.
                                                                                              Ltndcs. It .4_ & Battin. RR. Prn arc practice in speech thergiN in lesas. latltber»
these problems may be found through better interfacility                                          peeeh /unr-rral. 1962.      284-289.
communication and through further study. It is anticipated                                    Luhinski. R.. A (.hapce R.                    serv ices in home health care agencies:
that this study will generate interest in further investigations                                   k,ailahilm and scope. lshct 1980. 22, 929-91 1
                                                                                              I urck. A.G. Wdicarc and .perch language pathology and auetiologv. Historical
of business and financial aspects of speech-language                                               perspectives and current statras. ktas- 19811. Slii. 2i-29.
pathology.                                                                                    \ie. H.H . Hull. ( It Jenkins. I.G.. stcinhrcnncr. K.. A Bcnt. D-H- 1P1.S (211d cd.1

                                                                                                   \c, )ork_ AIc(,rns°8111, 19-5
                                                                                             Slrandherg- T.F.. A national stitch of Initcd titacs hospital speech pathology seniccs-
                                                                                                  Asha. 19--. /9, 69--6
                                                                                             Striker, S. Procedures relating to Medicos- and other third-parts payments. Ashes.
ACKNONMEDGEMENT                                                                                       19-6. 18. i91-i95.
                                                                                              Summers- R. Prisate practice of public school therapists in Indiana. Juanurl of Speech
  This reptrl eras based ten ntaster'.c theses trritten blPrnlla (.rabentt mul l itrdu           card Hearing l)isordet:s, 1959. 2 t. 51-5 i.
( blipala under the rlh-ertinn et% Raudnlpb l_. Decd, lhpartment o/ ((,mm nhation
lci"n,es. l vas Ri,In,m:s l>tiren-it I. the authta:s e press their appre( uuion to the
&avts lpeecb-/uugaage-l/earing Asso, I'Itiou it bich sul)J)" -tnl the data ,ollectitut
/base o/ the project.                                                                        Address for Correspondence:
                                                                                             Randolph G. Dcal, Ph-D
                                                                                             lexas Woman, I niycrsity
REFERENCES                                                                                   Box 21--5, T\\1- Station
                                                                                             Dcn« n. lest -620A
Aleo, F..L_ & Pece. CO. Rcc-icy of time allocation and professional tees of spcech-          81-18--6169
    language pathulogiets and audiologists- ASha, 19     19. -55--58.
Bangs,     Third party payment abuses. Asha, 19-0, 12. 418.
Battin. RR.. & Boland. 1-L- Business aspects of the practice lit R-R Battin & 1).R-
    Fox (Gds.). Private praclice in audiolugl aml speech palhologr \ecy Bark:
    Grune & Stratton, 19-8.
Brantman. Nl The status and outlook for commercial health insurance coverage of
    speech and hearing sen-ices. Asha. 19,3. /5. 181-18--
Brogan, D.R. Nonresponse in sample surce)-s: The prohlem and solutions. PbYSi(al
    Therapr. 1980, 60, 1026-1031.
(.hapc%. R.. Chu'at. S.. Gurland, G.. & Pie-as. G. Perspectives in private practice: A
     nationwide amahsis. Asha. 1981, 2,3. 335-3+0.
Chape), R-, Lahinski. R., Salzberg, A.. & Chap", G.D. The ayailabilin of language.
    speech and hearing services in da) care centers. Asha. 19-8, 20, 1030-10ii'
Curlee, R.F Clinical service facilities sunec Asha, 19-5. /', 448--144.
Fox, D.R Competence and commitment- Ashes, 1980. 12. 383-384

                         The University of Texas at Dallas
                   Callier Center for Communication Disorders

             Training is offered in the areas of Speech-Language Pathology and Audiology leading to a M.S. or

           Ph.D. degree in Communication Disorders. The program utilizes the facilities at Callier Center, an inter-
           nationally recognized center in communication disorders with over 22,000 patient visits per year, a school
           for the deaf and close affiliation with otolaryngology, pediatrics and neurology in adjacent medical

           centers. Over 20 full-time faculty and staff members are involved in teaching and clinic supervision.
                      speech-language pathology clinic          speech science laboratory
                      audiology clinic                          auditory physiology labs
                      deaf-blind program                        psychophysics lab
                      language development preschool            psychology and special education electives
                                                                deaf education program pending

                      child development center
           Research and teaching assistantships available.
           For more information contact:                    Dr. Robert Stillman
                                                           The University of Texas at Dallas

                                                            Callier Center for Communication Disorders
                                                            1966 Inwood Road
                                                            Dallas, Texas 75235

                                            ETB accreditation in speech-language pathology and audiology
                                                               an equal opportunity /affirmative action university
                                                                                                                                                        UT               D
                                             FUTURE OF THE AMERICAN SPEECH-

                                             LANGUAGE-HEARING ASSOCIATION
                                                 PREDICTIONS  YEAR 2000               -
                                                Tina Beings, Ph.D., Professor, The t'niversitl, oj'Texas Health Science
                                             Center tit Houston, has a history in Communication Disorders
                                             highlighted bl, the publication oj'a number of texts and articles. Dr.
                                             Bangs' work has always been punctuated by a practical, yet forward
                                             thinking nature, with the clear purpose of provoking improvement.
                                             Miring a presentation at the 1983 TSHA convention, she offered some
                                             of her thoughts on the future of the profession. Tejas retakes an effort to
                                             identij}, and seek opinions on major scientific, educational and
                                             professional issues facing our profession. Professional autonomy, the
                                             professional doctorate, reduction in the quality of graduate students
                                             entering the profession, third-part y funding and our professional/public
     Tina E. Bangs, Ph.D.                    image are but a few of the issues we face. Dr. Bangs has offered to share
     Speech and Hearing Institute            some historical reflections as well as some predictions on our future.
     The L`niversity of Texas                                                                      Larry Higdon, Editor
     Health Science Center at Houston

         We have been the Academy of Speech Correction
      (1927-29), American Society for the Study of Disorders of

      Speech (1929-1930, American Speech Correction
      Association (1934-1947), American Speech and Hearing
      Association (1947-1979) and currently the American Speech-
      Language-Hearing Association (1979-). Curriculums for
      training speech-language pathologists and audiologists are
      currently being offered in departments of: Communication

      Disorders and Sciences; Speech Communication, Theatre
      and Communication Disorders; Audiology and Speech
      Sciences; Speech Communication and Theatre;
      Communications: Speech and Hearing Area; and Speech
      Pathology and Audiology.
         Those who are certified in speech-language pathology
      are known to other professions and the general public as

      speech therapists, speech-language therapists, speech
      clinicians, speech-language clinicians, speech pathologists,
      speech-language pathologists. Those certified in hearing
       have the distinction of only one title - audiologist. It is
       not that the titles are so poorly chosen but what we most
       likely need is an all encompassing title for what it is that

       we investigate and teach, who we are and for whom we

       provide clinical services.

          In my crystal ball I see the American Speech-Language-
       Hearing Association changing its name to the American
       Association of Communication Disorders. (The term
       "disorders" refers to the disturbance of the regular or

       normal functions (dictionary definition) of speech and/or

       language.) Training institutions will offer courses in
       Departments of Communication Disorders and services will
       be provided by communication disorders specialists to

       clients with communication disorders. The selection of a
       common denominator will help us move forward in the
36     recognition of our Association as an autonomous


       organization and public visibility as to what it is that we
CIO. Although as a profession we are interested in normal                                                                 operational definition thcN earn a Ph.D. degree.

             ^^O :'^
language and speech function. our goal is to conduct                                                                         It appears to me that oN-cr the tears man Ph.D. training


ongoing research to advance knowledge in the field of                                                                     programs in our profession have deemphasizcd the
                                                                                                                          scientific goal and have emphasized the clinical goal. As a


communication disorders, and to provide Services for

persons who are diagnosed has haying communication                                                                        result Nve have many Ph.D. professionals whose skills lie in



disorders.                                                                                                                teaching and supervising NI.S. students -,vho trill become

                                                                                                                          certified/licensed speech language pathologists and

II. UNIVERSITY TRAINING PROGRAMS       V~1  ICI                                                                           audiologists. These Ph.D. degree members of our profession



WILL OFFER A PROFESSIONAL                                                                                                 are different from the scientists in our profession who
DOCTORATE DEGREE IN                                                                                                       choose to study single cells related to audition, or are

                                                                                                                                                                                                           0.w  '='


                                                                                                                          interested in the dissection and study of human organs


                                                                                                                          which Icad to such medical feats as cochlear implants.

  Over the rears, members of the American Speech-                                                                         From my point of yicNv, there is a clear distinction between
Language-Hearing Association have discussed the pros and

                                                                         `^' 0.G
                                                                                                                          goals and objectives of the Ph.D. and D.CD degrees. This is


cons of a professional doctorate. To date, however, there                                                                 evidenced in our profession's need for two journals - The
has been no ASHA legislative move to offer a professional                                                                 journal of Speech and Hearing Research and the journal of

doctorate. In fact at the 19113 National Conference Oil

                                                                                                                          Speech and Hearing Disorders.
Vndergraduatc, Graduate, and Continuing Education                                          .,.
                                                                                                                            In my crystal hall I see Departments of Communication

Programs in Speech and Language Pathology and

                                                                                                                         Disorders offering a professional doctorate in communica-

Audiology, Issue III: Professional Doctorate, was

                                                                                                                         tion disorders - D.CD as well as a Ph.D. Such a move will

summarized as follows:
                                                                                                                         stimulate the growth of scientific endeavors which, as


        "The majority of participants felt that the existing

                                                                                                                         pointed out by Minifie, are crucial to the future of our

       Ph.D., Ed.D., or Sc.D. were robust enough to include
       doctoral programs that emphasized preparation ffnr
       a clinical career. The need does not exist for a                                                                  III. THE ROLE OF THE AUDIOLOGIST



       separately tagged doctoral degree.                                                                                WILL BE REDEFINED

   2. It was stressed that scholarly, scientific and creative

       components are essential elements in any doctoral                                                                   Through the late 1930's until the early 19'0's audiolo-
       program of study in human communication sciences                                                                  gists and members of related professions were actively

                                                                                                                         engaged in learning more about the normal and impaired

       and disorders. "'
                                                                                                                         auditory mechanism. It was the impact of hearing impair-

   I cannot agree with the opinions of the majority of

                                                                                                                         ment on World War II soldiers that was greatly responsible

participants at the conference, because, in my mind, there                                                               for the establishment in 1943 of the first oral rehabilitation

is a clear distinction between a doctorate of philosophy-

Ph.D. and a professional doctorate such as an M.D., DDS,                                                                 program. During these early years audiology came of age,
or D.O. In the field of science the Ph.D. is operationally                                                               and over time audiologists and researchers in related areas
                                                                                                                         made mariv contributions to the scientific study and

defined as an academic or scientific degree which is earned

                                                                                                                         management of hearing impairment including the

by persons who choose to continue with their scientific

endeavors, to teach and to train upcoming scientists in the                                                              following:
field of their choice. Operationally defined, the professional

                                                                                                                                          Indepth attention was given to the scientific study of

doctorate is a clinical degree, and is earned by persons who                                                                              the anatomy and neurophysiology of the auditory

choose to provide clinical services through private practice,                                                                   mechanism.

to teach and train students to become clinicians, and                                                                       2. Productive scientific studies were conducted in the

to conduct research in areas closely related to the                                                                             area of psychoacoustics.

identification, assessment, treatment and performance

                                                                                                                            3. The development of pure tone audiometers, speech


follow-through of persons with communication disorders.                                                                         audiometers, GSR, EEG, ENG, etc., provided the

Currently the Ph.D. in our profession is earned by these                                                                        hardware for measuring hearing.
clinical specialists as well as scientists.                                                                                 4. New designs in hearing aids made them more

   It is interesting to note that the early history of our                                                                      wearable and functional.

profession states that it was formed by a small group                                                                       5. Auditory tests for identifying medical problems as
of scientists whose goal was to conduct scientific                                                                              well as the feasibility of using hearing aids to



investigations into the mysteries of communication                                                                              improve communication were developed.
disorders and to train scientists to do likewise. Over time                                                                 6. Research related to auditory training lip reading

we have shifted our emphasis from a scholarly scientific                                                                       and other assistive devices was initiated.
organization wherein the primary commitments were to the                                                                       Otolaryngologists in collaboration with audiologists


development of new knowledge, to where we now are a

                                                                                                                               used the new instrumentation and diagnostic tests to


professional organization heavily committed to the delivery                                                                    study intervention techniques for otosclerosis, otitis


of clinical services. This trend is commendable, but it                                                                        media and other medical problems related to
appears that there has been a steady decrease of new                                                                           hearing.

scientific studies published in our field, a trend which is                                                                 With the audiological tools and techniques available
not commendable. Minifie expressed these feelings in an                                                                  for medical diagnosis of hearing impairment, a close
article published in Tejas. `Although our commitments                                                                    relationship was established between otolaryngologists and
today are to provide the best clinical service to the                                                                    the term "medical audiology" was coined. However, not all
individuals we serve, we cannot continue to transmit                                                                     audiologists were interested in medical audiology and we
yesterday's knowledge. We must advance knowledge and                                                                     find that as far back as 1966 a group of audiologists, whose


emphasize the basic scientific aspects of our field or we will                                                           interests were directed toward rehabilitation of the hearing

gradually become dated as a profession. We must have a


                                                                                                                         impaired, formed the Academy of Rehabilitative Audiology.


commitment to new knowledge which will be the hope of                                                                    This dichotomy of medical and rehabilitative audiology still



our future"2 The message is clear and I concur that we                                                                   exists, with the exception of the "generalists" who work in
must return to the training of scientists in our field who                                                               public school settings. They provide both the diagnostic

will conduct basic research and teach other students to                                                                  and rehabilitative audiological services for children in the

become scientists and enter the teaching/research arena.                                                                 age range, birth to 22. This raises the issue of how one
These scientists are not concerned with offering clinical                                                                separates rehabilitative audiology from deaf education

services to persons with communication disorders. By my                                                                  within this age group.
       TO further complicate the trends in the jot) descriptions                                                                             adult form as well as the dcvelopment of tests and teaching

                                                                                                                                             techniques for those children and :adults «-ho denumstrate

     Of' audiologists. there has been, ON er the years. a mov c by

     otolaryngologists to include audiology as a subset of their                                                                             disabilities in the content. form and/or use of language.


     medical practice. In fact, in 1982 this moyencnt culminated                                                                             Early on, speech pathologists became interested in the field

     in the following stand written in their Policies ol'the                                                                                 of language disorders and, because of their training, were

     American Academy (# Otolaryngology - Head and _\eck                                                                                     better qualified perhaps than special education teachers to


     .Stogeri' 1A('O), "The audiologist is one -,vho is trained and                                                                          assess and plan programs for children with language and/or


     has the expertise to measure hearing and to participate                                                                                 learning disorders. Ho-,veyer, these speech pathologists had
     in non-medical rehabilitation measures under the super-                                                                                 been trained as clinicians, and not as teachers. who work

     vision and Nvith the consultation of the otologist or                                                                                   with groups of children in preacademic or academic


     otolaryngologist."I This statement is of concern to man                                                                                 classrooms. Consequently the majority of these clinicians
                                                                                                                                             have not been teaching in self contained classrooms, but

     audiologists. Some NI.S. degree audiologists working in

     physicians' offices are fearful of serving as technicians who                                                                           h:n-e become a part of the public schools' related services

                                                                                                                                             teams providing language therapy outside the classroom.

     perform the testing and submit the results to the physicians

      who interpret the findings to their patients. Furthermore,                                                                             Herein lies my concern.
                                                                                                                                                In 19-5 President Ford signed a bill to provide free and

     some medical audiologists complain that not only their job

     description but also their salaries are commensurate with                                                                               appropriate public school education for all children in the


     that of a technician and the opportunity to advance                                                                                     age range three to 21 with a few exceptions. In the State of



     financially is grim. Opportunities to "buy into" medical                                                                                Texas there are services also in the age range birth to three

                                                                                                                                             for deaf, blind, deaf-blind and mentally retarded. I believe

     clinics and share the profits is not a common practice.


     'T'hese same audiologists are beginning to question their                                                                               that language disorders are common to all. Like the


     role within the medical model. Thev realize that the                                                                                    children in regular education, the goal of children with
     groundwork for developing tests and techniques for                                                                                      language disorders is to help them achieve as far as possible


     measuring hearing has been carefully planned over the                                                                                   in academia. It follows that academic achievement includes


     last -40 vears. The result has been the manufacture of                                                                                  acquisition of the "basics" which have been defined as

     sophisticated instrumentation and researched procedures                                                                                 reading, writing and arithmetic. Because all of the


     for testing the hearing of children and adults. The ques-                                                                               handicapped children under discussion have oral language




     tion now remains, "is it necessary to complete a two year                                                                               delay, it seems appropriate to include oral language as one

                                                                                                                                              of the "basics" of their education. Who, then, will teach

     master's program to be qualified to measure hearing, or can                                                                                      .:+

     the skills be learned by audiology technicians?"                                                                                         oral language which forms the framework for reading,
        In addition to supervising the audiologists who measure                                                                               written composition and arithmetic? To my way of


     hearing, the ACO has taken the stand of supervision of the                                                                               thinking, teaching oral language skills is a part of the daily
     audiologists who provide rehabilitative services. Some of                                                                                educational process, and not to be treated as a special
     the rehabilitative audiologists do not believe that their                                                                                therapy provided by speech-language clinicians who are
      services should be placed under a medical model and ask                                                                                 classified as a related service.
      the question, "What do the majority of otologists and
      otolaryngologists know about auditory training, lip reading                                                                              In my crystal ball I see the following changes in the role
      and use of amplification systems?" Furthermore, I wonder                                                                               of the speech-language pathologist:
      how these medical specialists will manage the supervision                                                                                1.  Training programs in Special Education will revise

      and consultation with the audiologists who work in public                                                                                    their curricula to include developmental stages in
      school settings? All of these historical and current events                                                                                       acquisition of child language to its adult form as

      have lead to a diffused and confused profession of                                                                                                well as teaching strategies and techniques applicable
     audiology.                                                                                                                                         to all children with language disorders irrespective of
       In my crystal ball I see the following changes in the field                                                                                      their handicapping condition(s). Those of us who
     of audiology:                                                                                                                                      have come up through the ranks of language

                                                                                                                                                        development and intervention in early childhood
        1. The terminal degrees - Ph.D. and D.CD will offer                                                                                             programs would be the logical choice to teach such

          an area of concentration in audiology. Persons with                                                                                               courses.
          the D.CD will be licensed by the State and will serve                                                                                2.  The speech-language pathologist, unless State
          in the capacity of private practitioners and members                                                                                    certified in Special Education, will no longer serge
          of rehabilitation teams that are service providers for                                                                                  children with language disorders through the related
          the communicatively handicapped. Teaching and                                                                                           services division of the schools.
          research also are options.                                                                                                           3 Although language therapy will be deleted from their
       2. Audiology technicians will be trained on a Bachelor                                                                                     role, speech pathologists will be licensed by the State

              degree level in Schools of Allied Health Sciences or                                                                                and will provide related services in the phonological
              comparable technical training institutions. They, will                                                                              aspects of language: articulation, voice and fluency.

              be licensed by the Texas Committee of Examiners for                                                                              4. Persons with a D.CD degree and an area of

              Speech Pathology and Audiology and will work                                                                                        concentration in speech-language pathology will be

              directly under the otologist/otolaryngologist, or the                                                                               licensed by the State of Texas and will serve in the

              D. CD.                                                                                                                              capacity of private practitioners, and members of
          Departments of deaf education, specifically on                                                                                          the rehabilitative teams in medical and nonmedical

          the Early Childhood Level, will incorporate                                                                                             environments. Teaching and research, of course, are
          rehabilitative audiology procedures into their                                                                                                    options.
       4. Considering the above, there no longer will be                                                                                      V. THE AMERICAN ASSOCIATION OF
          Masters degrees offered in audiology.
                                                                                                                                              COMMUNICATION DISORDERS WILL

     LANGUAGE PATHOLOGIST WILL BE                                                                                                             ENDORSE SPECIALITY CERTIFICATION
                                                                                                                                                 our profession has been known by the public to include
     REDEFINED                                                                                                                                primarily generalists who provide assessment and treatment
       Since the late 1960's and early 1970's there has been an                                                                               services for all kinds of communication disorders. It is

38   influx of research in the acquisition of child language to its                                                                           inconceivable for me to believe that one person can keep
ahrcast of the current techniques in the management                                                                                    Communication Disorders that are located in medical
and treatment of persons of all ages with all types of                                                                                 environments, health science centers or comparable
communication disorders. The question is being asked.                                                                                  geographic areas. Such a move n-ill provide clinical

''Will our profession survive if all our clinicians remain

                                                                                                                                       experience with a wide variety of communication disorders

generalists"" Feldman spoke to the issue in his presidential                                                                           as well as an opportunity to interact -Nvith the team of
address. "the track we are noNN on denies that true                                                                                    professionals most often involved with the communica-

specialization has gro-,yn out of generalist training. In

                                                                                                                                       tively handicapped. Such an environment also will provide
reality, the path we are now following is one that will                                                                                a training ground for speciality certification.


ultimately lead to the training of glorified technicians.
Speciality certification is one way to avoid this pitfall.                                                                             CONCLUSION


   In 1980 the Committee on Speciality- Certification met to                                                                             Time is of essence if the are to develop a professional
discuss the issues of speciality certification within our                                                                             image and provide yisibilit in the public domain. If my

                                                                                                                                      predictions cone true, t believe our profession will be as

profession including areas such as craniofacial anomolies,


vocal tract disorders, dystluency, language disorders.                                                                                identifiable as the professions of psychology, medicine,

Guidelines were drawn up, submitted to the ASHA                                                                                       dentistry and optometry to name but a few. I expect that

Executive Board and subsequently published in the Asha                                                                                some of VOL) who read this article will take issue with one

Journal. Nothing transpired until the 1983 meeting of the                                                                             or more of the predictions. That is all right. What is not all

National Conference on t ndcrgr dLIate, Graduate, and                                                                                 right is for you to disagree and not share your rationale for
                                                                                                                                      disagreement with the readers of (Jas.

 Continuing F(ILICation. The concensus of this
group was:                                                                                                                                  Write to:          Lawrence W. Higdon, Editor
Issue NIL Speciality Certification was summarized as                                                                                                           South Texas Speech, Hearing & Language Center
follows:                                                                                                                                                       P.U. Box 638,
                                                                                                                                                               Corpus Christi. Texas -8+11
      "There was general support for recognition of
      1.                                                                                                                                All comments will be summarized and presented in the

      specialization that would come after obtaining                                                                                  next edition of Tejas.

      clinical certification (generalist preparation).

  2. The group was divided on whether specialization                                                                                  REFERENCES
      should lead to a particular certificate. "I                                                                                           Licensurr of Speech-language Pathologists and Audiologists in the State of 'lesas.


                                                                                                                                            Senate Bill 811 An Act. kjas 1981, Aol IX- No. I. pp. 5-10.
This is where our profession currently stands on the issue                                                                                  Minifie. Fred D.. Knoxcledge and Serv ice: Does the Foundation of the Profession

of speciality certification.                                                                                                                Need Shoring 11v le%2s, 1982, ti>I. \'lll. No. 2, pp. +A.
   In my crystal ball I see the American Association of                                                                               3.    Policies of the American Academe of Otolarcngolop - Head and Neck Surgerry_
                                                                                                                                            Ashu- \'ol. 25. -2, Feb- 1981. P, 22.
Communication Disorders completing protocol for the

                                                                                                                                      -+.   Feldman. A 1,     the Challenge of Autonomc. Asha. Vol, 23, z12, Dec.. 1981, p. 94 2.

      1.  Categories for speciality certification
      2. Guidelines listing qualifications for speciality

      3. Issuance of speciality certificates to qualified



   It is not uncommon for an employer to hire a speech-

language clinician who has extensive textbook and lecture

learning but limited opportunity in practicum. Some

University training programs are located in geographical

areas where there is little or no opportunity to learn from

certain populations such as laryngectomy, stroke and closed
head injury, or to participate in high risk infant clinics or

cleft palate teams to name but a few. It is to the clinician's

advantage to have access to a wide variety of subjects for
both practicum and research. Furthermore, there is a need

for communication disorders specialists to understand what
it is that other professions provide our clients and how to

communicate with these professionals including: physicians,


dental surgeons, social workers, and psychologists.
   Ideally, University training programs, l) should be located
in a setting where students will have practicum experience

with children and adults who exhibit a wide variety of

communication disorders, 2) should have a budget for

purchase of the specialized and often expensive equipment
needed for student teaching. An alternative is to he in an

environment where such equipment is shared among
professions, and 3) to learn the interdisciplinary or team

approach to the management of persons with communica-

tion disorders.
   In my crystal ball I see the American Association of
Communication Disorders accrediting only departments of
    1984 TSHA Convention
                     February 23-26, 1984
                     The Shamrock Hilton
Theme: Commitment
Featured Speakers:
                                         - Caring - Competency
* Mariana Newton, Ph.D. - Computer Applications in Communication Disorders
* Frederic Darley, Ph.D. - Apractic Articulation: What we think we know
                            about it
* Audrey Holland, Ph.D.            Head Injury in Children: Some Subtle hand not so
                                   subtle) Problems in the Schools
* Dean Garstecki, Ph.D.            Older Adult Aural Rehabilitation: Nuts and Bolts
* Richard Dowling, J.D.            Influencing Governmental Policies on Local, State &
                                   Federal Level
                                   Our Place in Rehabilitation, Education and Allied
                                   Health Professions

For further info contact:
Barbaranne Benjamin, Ph.D.
Dept. of Special Education
Southwest Texas State University
San Marcos, TX 78666
AC 512 - 245-2157

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