Dr. Shannon Hall-Mills, Ph.D., CCC-SLP

1
Context for Change

• Dr. Shannon Hall-Mills, Ph.D., CCC-SLP
• FLDOE/BEESS
• Dr. Carolyn FORD,Ed.D., CCC-SLP
• USF / Dept. Communication Sciences Disorders

2
Background Context for Change

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

3
Background Context for Change

• Changes affect all program areas of
  exceptionality, including speech and language
  impairments.
• Professionals are challenged to embrace shifting
  roles and responsibilities to meet the diverse
  needs of students.

4
Background Context for Change

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

Parents
Teachers, etc.
SLPs
School Administrators
Community
District Administrators
FLASHA / ASHA
University Faculty
Government Officials
5
History of Speech/Language Rule Revision in
Florida

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

6
Workgroups Topics of Discussion

• Included in the discussion
• Federal state regulations
• Rules of eligibility from other states
• Rule vs. policy vs. guidance
• Implications for implementation
• Role of ongoing TA and updated resources
• Concurrent SLD and general rule revision
• Clarity flexibility of requirements in rule
• Role of clinical/professional judgment

7
Workgroups Challenges

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

8
Key Changes General Education Intervention
Procedures Activities

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

9
Key Changes Evaluation

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

10
Key Changes - Evaluation

• Office of Special Education Programs (OSEP)
  letter to ASHA (2007)
• public agency must use a variety of assessment
  tools and strategies to gather relevant
  functional, developmental, and academic
  information.

11
Key Changes - Evaluation

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

12
Key Changes Eligibility

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

13
Key Changes - Eligibility

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

Few
Some
All
14
Key Changes - Eligibility

• Relation between LI and SLD
• Explicit acknowledgement of similarities between
  academic manifestation of LI and SLD
• Alignment of LI and SLD rules

• Allowance for pragmatic language impairment
• Additional observation required

15
Key Changes - Eligibility

• Requirement to document the adverse effect of the
  speech or language impairment on the students
  ability to perform and/or function in the typical
  learning environment, thereby demonstrating the
  need for exceptional student education.

16
A Note Regarding Adverse Effect

• Office of Special Education
• Programs (OSEP) letter to
• ASHA (2007)
• Education performance is not limited to academic
  performance.
• Effects determined on a case-by-case basis,
  depending on unique needs of a child, not based
  only on discrepancies in age or grade performance
  in academic subject areas.

17
Key Changes In Summary

• Increased reliance on
• Significance educational impact of the
  communication impairment
• Collaborative problem-solving team and data-based
  decision making
• Review of all available data from multiple
  sources
• Clinical/professional judgment

18
Tell me more

• More about the Relation between language and
  cognition and why cognitive referencing for
  eligibility decisions is a past practice for LI

19
Language and Cognition

• The relationship between language and cognition
  is dynamic and complicated (ASHA, 2002 Casby,
  1992 Cole, 1996 Notari, Cole, Mills, 1992).

• Correlational data suggest multidirectional
  relationships between language and cognition
  (Casby, 1992 Kamhi, 1998).

20
Language and Cognition

• The notion that cognition limits language
  development so that language cannot exceed
  cognitive performance levels is unfounded (Kamhi,
  1998 Lahey, 1996).
• Scores on IQ tests can fluctuate across within
  tests over time, so discrepancies can be
  unstable.

21
Language and Cognition

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

22
Cognitive Referencing

• Evidence of children with commensurate language
  and cognitive abilities benefiting from language
  intervention at least as much as children with
  the discrepancy between language and cognition
  (Cole, Dale, Mills, 1990 Dale Cole, 1991
  Notari, Cole, Mills, 1992) and in some cases,
  more so (Cole, Coggins, Vanderstoep, 1999 Fey,
  Long, Cleave, 1994).
• IQ scores reflect current abilities, not
  potential for language learning (Krassowski
  Plante, 1997).

23
The Discrepancy Approach

• Shaywitz, Escobar, Shaywitz, Fletcher, and Makuch
  (1992) defined reading disability as a
  discrepancy between the level of reading ability
  predicted on the basis of intelligence (ability)
  and the actual level of reading achievement (p.
  146).
• Also used in defining mental retardation, but
  challenged in the courts and in the research on
  the language/dialect factor in IQ tests. IQ
  tests are never strictly nonverbal.

24
Faulty Logic of the Discrepancy Approach

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

25
Measurement Concerns

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

26
Other Measurement Concerns

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

27
Evidence Based Practice

• Influence of EBP in Evaluation Eligibility
  Practices

28
Evidence Based Practice

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

29
Relevance of EBP

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

30
Workgroup considered EBP in light of

• Evaluation components for all evaluations of
  speech and language
• Assessment considerations for children from
  culturally linguistically diverse backgrounds
  (CLD populations)
• Determination of eligibility
• Application of scientifically-based research

31
Evaluation Determination of Eligibility Basis
in EBP (contd)

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

32
Evaluation Determination of Eligibility Based
on EBP (contd)

• Assessment considerations for children from
  culturally linguistically diverse (CLD)
  populations
• Consider cultural and linguistic biases inherent
  in many standardized assessment tools (Hedge
  Maul, 2006 Roseberry-McKibbin, 2002).
• Consider advantages of dynamic assessment (ASHA,
  2000) and child-specific procedures such as
  observations and language sampling (Hegde Maul,
  2006).

33
Evaluation Determination of Eligibility Based
on EBP (contd)

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

34
Scientifically based research

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

35
Scientifically based research

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

36
References

• Aram, D. M., Morris, R., Hall, N. E. (1992).
  The validity of discrepancy criteria for
  identifying children with developmental language
  disorders. Journal of Learning Disabilities, 25,
  549-554.
• American Speech-Language-Hearing Association.
  Committee on Language Learning Disorders. (1989,
  March). Issues in determining eligibility for
  language intervention. Asha, 31, 113118.
• American Speech-Language-Hearing Association.
  (1999). IDEA and your caseload A template for
  eligibility and dismissal criteria for students
  321. Rockville, MD Author.
• American Speech-Language-Hearing Association.
  (2000). Special Interest Division 1 Language
  Learning and Education Newsletter, 7(1), 329.
• American Speech-Language-Hearing Association.
  (2004). Admission/Discharge Criteria in
  Speech-Language Pathology Guidelines. Available
  from www.asha.org/policy.
• Casby, M. W. (1992). The cognitive hypothesis and
  its influence on speech-language services in
  schools. Language, Speech, and Hearing Services
  in Schools, 23, 198202.
• Casby, M. W. (1996, April). Cognition and
  language Basis, policy, practice, and
  recommendations. In P. A. Prelock (Ed.), Special
  interest divisions, language learning and
  education (Vol. 3, Issue 1, p. 5).

37
References

• Cole, K. (1996, April). What is the evidence from
  research with young children with language
  disorders? In P. A. Prelock (Ed.), Special
  interest divisions, language learning and
  education (Vol. 3, Issue 1, pp. 67).
• Cole, K.N., Coggins, T.E., Vanderstoep, C.
  (1999). The influence of language/cognitive
  profile on discourse intervention outcome.
  Language, Speech, and Hearing Services in
  Schools, 30, 61-67.
• Cole, K. N., Dale, P. S., Mills, P. E. (1990).
  Defining language delay in young children by
  cognitive referencing Are we saying more than
  we know? Applied Psycholinguistics, 11, 291302.
  
• Cole, K. N., Dale, P. S., Mills, P. E. (1992).
  Stability of the intelligence quotient-language
  quotient relation Is discrepancy modeling based
  on myth? American Journal of Mental Retardation,
  97(2), 131145.
• Cole, K. N., Fey, M. E. (1996). Cognitive
  referencing in language assessment. In K. N.
  Cole, P. S. Dale, D. J. Thal (Eds.),
  Assessment of communication and language (pp.
  143159). Baltimore Brookes.

38
References

• Cole, K.N., Mills, P.E., Kelley, D. (1994).
  Agreement of assessment profiles used in
  cognitive referencing. Language, Speech, and
  Hearing Services in Schools, 25, 25-31.
• Cole, K., Schwartz, I., Notari, A., Dale, P.,
  Mills, P. (1995). Examination of the stability of
  two methods of defining specific language
  impairment. Applied Psycholinguistics, 16,
  103123.
• Dale, P.S., Cole, K.N. (1991). Whats normal?
  Specific language impairment in an individual
  differences perspective. Language, Speech, and
  Hearing Services in Schools, 22, 80-83.
• Fey, M. E., Long, S. H., Cleave, P. L. (1994).
  Reconsideration of IQ criteria in the definition
  of specific language impairment. In R. V.
  Watkins M. L. Rice (Eds.), Specific language
  impairments in children (pp. 161178).
  Baltimore, MD Paul Brookes.
• Fletcher, J. M., Francis, D. J., Rourke, B. P.,
  Shaywitz, S. E., Shaywitz, B. A. (1992). The
  validity of discrepancy-based definitions of
  reading disabilities. Journal of Learning
  Disabilities, 25, 555561.
• Francis, D.J., Fletcher, J.M., Shaywitz, B.A.,
  Shaywitz, S.E., Rourke, B.P. (1996). Defining
  learning and language disabilities Conceptual
  and psychometric issues with the use of IQ tests.
  Language, Speech, and Hearing Services in
  Schools, 27, 132-143.

39
References

• Hall-Mills, S., Apel, K. (2007). A hybrid model
  for teaching and practicing evidence based
  practice. Perspectives on Language Learning and
  Education, 14, 1, 20-22.
• Hegde, M. N., Maul, C. A. (2006). Language
  disorders in children An evidence-based
  approach to assessment and treatment. Boston
  Allyn Bacon.
• Justice, L. (2006). Evidence-based practice,
  response-to-intervention, and the prevention of
  reading difficulties. Language, Speech, and
  Hearing Services in Schools, 37, 284-297.
• Kamhi, A.G. (1998). Trying to make sense of
  developmental language disorders. Language,
  Speech, and Hearing Services in Schools, 29,
  35-44.
• Krassowski, E., Plante, E. (1997). IQ
  variability of children with SLI Implications
  for use of cognitive referencing in determining
  SLI. Journal of Communication Disorders, 30,
  1 9.
• Lahey, M. (1996, April). Who shall be called
  language disordered? An update. In P. A. Prelock
  (Ed.), Special interest divisions, language
  learning and education (Vol. 3, Issue 1, pp.
  56).
• Lahey, P. (1990). Who shall be called language
  impaired? Some reflections and one perspective.
  Journal of Speech and Hearing Disorders, 55,
  612620.
• Nelson, N. W. (1996, April). Discrepancy models
  and the discrepancy between policy and evidence.
  Opening remarks Are we asking the wrong
  questions? In P. A. Prelock (Ed.), Special
  interest divisions, language learning and
  education (Vol. 3, Issue 1, pp. 35).

40
References

• Nelson, N. W. (2000, July). Basing eligibility on
  discrepancy criteria A bad idea whose time has
  passed. Perspectives on Language Learning and
  Education, 8-12.
• Notari, A. R., Cole, K. N., Mills, P. W.
  (1992). Cognitive referencing The (non)
  relationship between theory and application.
  Topics in Early Childhood Special Education,
  11(4), 2238.
• Sattler, J.M. (1988). Assessment of Children
  (3rd edition). San Diego Jerome M. Sattler.
• Shaywitz, S., Escobar, M., Shaywitz, B.,
  Fletcher, J., Makuch, R. (1992). Evidence that
  dyslexia may represent the lower tail of a
  normal distribution of reading ability. The New
  England Journal of Medicine, 326(3), 145150.
• Smith, M. W., DickinsonSpaulding, T.J., Plante,
  E., Farinella, K.A. (2006). Eligibility
  criteria for language impairment Is the low end
  of normal always appropriate? Language, Speech,
  and Hearing Services in Schools, 37, 61-72.
• Whitmire, K. A. (2000, July). Cognitive
  referencing and discrepancy formulae Comments
  from ASHA resources. Perspectives on Language
  Learning and Education, 13-16.

41
Resources

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