Speech therapy is an invaluable asset that can assist those struggling with speech and language disorders, but its success depends heavily on several individual factors that vary depending on who it’s applied to.
This scope of practice document draws on current knowledge and developments in communication sciences and disorders.
Frequency
ASHA defines its scope of practice as: an approach to clinical work where current, high-quality research evidence is integrated with practitioner expertise and client values and preferences.”
Speech therapy must be offered at an appropriate frequency in order to produce successful outcomes for children living with cerebral palsy (CAS). They often need frequent and intensive treatments in order to make progress towards their communication goals, though how much therapy a particular child requires depends upon his/her individual circumstances and needs.
Recent reviews of literature indicate that 60 minutes per week of direct intervention for most children with CAS is necessary in order to achieve meaningful progress. This estimate is derived from several studies which demonstrate the need for frequent and intensive treatment programs for these kids.
Review of research includes an examination of evidence pertaining to the current recommended intervention strategies for children with CAS. These strategies utilize multiple teaching methods and techniques such as articulation drills, cued repetition, echolalia modeling and naturalistic modeling as part of multiple activities designed to maximize learning opportunities for the individual child.
SLPs can use this data to advocate for their services and the need for at least 60 minutes of speech therapy per week in order to meet best practice. They can also share this information with their clients and families so that they understand its advantages asha the importance of participating regularly in their treatment plan.
Duration
Speech-language pathologists utilize various strategies to teach communication skills in school-based settings. Deciding the amount of therapy time to recommend at an IEP meeting can often be one of the more complex decisions for school-based SLPs to make, but hopefully this blog post by an SLP can broaden your choices beyond 30 minute, twice weekly sessions in the speech room!
Nickola Wolf Nelson served as chairperson of this ad hoc committee to create this position statement, assisted by Hugh Catts, Barbara J Ehren, Froma P Roth and Cheryl M Scott from ASHA staff from Special Interest Divisions and Professional Practices and Multicultural Affairs units.
This position statement was approved by the ASHA Board of Directors in May 2010, replacing 2000 ASHA document Guidelines for Roles and Responsibilities of School-Based Speech-Language Pathologists. ASHA is dedicated to helping those living with communication disorders receive services they require; our Identify the Signs campaign raises awareness about early indicators of communication disorders while Talking On the Go app offers everyday activities designed to build both expressive and receptive language abilities. For additional resources check out ASHA Practice Portal which is our go-to source of evidence-based decision making on clinical and professional issues!
Intensity
Increased speech therapy intensity is one way to accelerate progress. This can be accomplished by scheduling fewer, shorter sessions with higher doses of activity – this approach allows for more individualized service, less travel time to and from therapy room visits, and greater scheduling flexibility; plus it may even be more cost-effective than treating multiple times every week with smaller sessions with lower activity doses.
Though SLPs possess a wealth of evidence-based expertise, many encounter difficulty providing high-intensity services within their professional roles and settings. This challenge is compounded in health care environments where financial pressures may prioritize time on task over clinical outcomes.
To address these challenges, the ASHA Practice Portal offers SLPs easy access to resources that facilitate clinical decision-making in communication sciences and disorders. These resources include professional literature citations as well as expert opinions regarding dosage and frequency for treatments.
Practice Portal provides a searchable online tool with access to the most up-to-date summarised evidence on screening, assessment and intervention for articulation disorders, including screening/assessment/intervention approaches to childhood apraxia of speech. Furthermore, there is a collection of clinical resources designed for evaluation/management/treatment of childhood apraxia of speech.
This page presents research related to speech sound disorders caused by non-motor/neurological conditions (historically known as articulation and phonological disorders) among preschool and school-age children ages 3-21, which includes dysarthria. A separate Practice Portal page on dysarthria in children is currently under development.
This page links to ASHA’s Education and Practice Portal pages on childhood apraxia of speech and cleft lip and palate, and offers information about a new model for providing articulation/phonological disorder services in schools. In addition, ASHA’s Education and Practice Portals feature a searchable online tool with summarized evidence regarding various interventions for specific disorders; this allows comparison across studies while making results available both to professionals as well as consumers – a critical resource in ASHA’s ongoing efforts to support evidence-based practices in communication sciences and disorders.
Coordination
Timing of treatment initiation is key for optimizing progress. Research has demonstrated that children diagnosed with Childhood Autism Spectrum Disorder (CAS) benefit from early intervention, and those provisionally diagnosed should continue receiving therapy until an etiological cause has been determined.
Intervention type is also essential. Motor programming approaches concentrate on teaching physical components of speech sound production while linguistic approaches treat CAS as a language learning disorder and teach children how to produce sounds within contexts that conform with correct grammar sentences. Furthermore, combination approaches combine both motor programming and linguistic strategies.
Setting is also a key factor. Home-based interventions may prove particularly effective for enabling carryover and generalization of skills learned during therapy sessions, while including family members or other support people can further boost positive results.
As part of their services, clinicians should tailor the setting where they offer services to clients according to their specific needs and goals. Children with CAS often benefit from naturalistic treatment environments that mirror how they speak normally in daily life; adolescents needing speech services should work alongside a team including occupational therapists and physical therapists who can offer input regarding posture and movement needed to produce specific sounds in speech therapy sessions.
School system clinicians may find the scope of practice document and related resources helpful when making clinical decisions. Particularly, Individualized Education Plan (IEP) processes require participation by all team members in order to assess eligibility for services.
Clinicians should regularly review research literature, consult ASHA resources such as Practice Portal and participate in continuing education opportunities to keep abreast of advances in their profession. Perspectives (the online peer-reviewed journal of ASHA Special Interest Groups – SIGs) offers new self-study CE activities each year, while many SIGs host Master Classes at ASHA Convention or other events designed to expand clinician knowledge on specific topics.
