Letting Them Go: Exiting Students From Speech-Language Services

We’re finally at the end of the school year! It’s that time of year when I evaluate and consider who really needs to continue speech-language services. When possible, I try to exit students before middle school. But when IS it time to let them go? 

Throughout my 20 years as an SLP, I’ve provided services covering the lifespan. One of the best (and probably most rewarding) parts of being a school-based SLP is when we “graduate” kids. In my elementary school experience, being the SLP granted me near “celebrity status”. Just last week a student faked an articulation error and told his teacher that, “I wily, wily need to go to speech for my ‘R’. His best friend was on my caseload too; so that was probably a contributing factor. But I’ll take the ego boost! Other times, students have run me down in the hallway and asked, “Do I have speech today?” In contrast, when I worked in middle or high school settings I was the one running students down in the hall reminding them to come to therapy sessions (OK, I was more discrete about it, but you know what I mean!). So, with the end of the school year approaching, it might be time to think about exiting some students. But where to begin?

My first consideration is to think comprehensively about a student’s IEP. Rarely do I have a middle or high school student with “communication only” services on their IEP. If they have other areas of specially designed instruction, can my role be eliminated or reduced to consult or related service? Will classroom accommodations added to their IEP be enough to help them succeed?

Another very important decision-making factor (in my clinical opinion) when discharging students is “educational impact”. Is the student able to meet the demands of the classroom effectively enough that their time might be better spent in the general education setting rather than in the speech room? Can they engage in meaningful discussions in English and Language Arts class? Are they able to use persuasive and expository language skills? Can they tell a cohesive personal narrative?  If the answer to these questions is yes, maybe it’s time to discharge.

Data-informed decisions increase confidence in determining when to exit students. We can be confident in our decision to let them “fly” without us when we have good data to back up our clinical decisions. Of course, I complete standardized testing as required. And then I complete a language sample to further substantiate the “educational impact” or lack thereof. A language sample offers students the opportunity to demonstrate generalization of skills as they’re blending all elements of their language system in the task. I also utilize a language sample (transcribed verbatim) for “articulation only” students to measure generalization of skills. 

Normative language sample analysis data is available for middle and high school-aged students in SALT software. The following elicitation contexts are appropriate for older students.

CASE STUDY:

Anton is a 4^th grader who has received speech-language services since preschool. He’s had excellent attendance and has worked well in therapy groups. His teacher reports that there are no “huge” academic concerns, but Anton receives learning support services for reading and writing and he will continue to receive them as a push-in service. His teacher also states that he occasionally needs extra time to complete longer assignments. Anton participates well in group activities and feels comfortable participating in class discussions.  

 
Clinical Evaluation of Language Fundamentals-5^th Edition:

Language Sample Data from a Narrative Story Retell (matched by age +/- 6 months):

The data from the standardized test revealed Anton’s scores continue to fall in the low range on his recent evaluation. Anton’s score is still significantly low and he could likely meet the criteria for specially designed instruction. The CELF assesses language skills in isolation (e.g., grammar and generating single sentences). The language sample data shows that when integrating those language skills Anton can produce a decent story retell. The measures from his language sample indicate that Anton improved his ability to tell a narrative with increased effectiveness, as his Narrative Scoring Scheme score, which measures the structure and content of his narrative, fell within normal limits. This skill relates to educational impact in that he can more effectively meet the core standard (SL4.4), “tell a story or recount an experience in an organized manner, using appropriate facts, and relevant descriptive details...”. He also increased his Subordination Index score slightly and decreased the number of errors produced in streaming speech. The number of different words (NDW) produced remained in the average range, although Anton still uses shorter utterances than his peers. 

Using language assessment data with documented progress over time as well as classroom performance and history, drives the decision to exit a student from speech-language services based on solid data and facts rather than just a feeling of, “It’s time!” In our case study Anton demonstrated increased ability to effectively retell a story, and he was better able to use the isolated language skills measured by the CELF-5. Another factor to consider is that he will have continued services through learning support. Looking at Anton’s IEP goals in a comprehensive manner helped Anton’s IEP team decide to exit him from speech-language services and add accommodations to his IEP.

The language sample analysis outcomes that complimented Anton’s standardized testing data provided sound evidence and increased confidence for the SLP and IEP team in their decision to exit Anton from S/L services. The language sample analysis showed Anton was able to generalize skills learned in therapy to the classroom and support the notion that Anton will likely succeed without speech-language services! Maybe his SLP will be lucky enough to get a “Hi”, a smile, and wave when she sees Anton in the hall at school!