collaborating with teachers to improve referrals and interventions with bilingual students

Collaborating with Teachers to Improve Referrals and Interventions with Bilingual StudentsAlyson Hendry, M.A., CCC-SLPKatherine Marting, M.A., CCC-SLPTSHA Convention March 7, 2013Dallas, Texas

Disclosure Statement

No relevant financial relationship(s) or nonfinancial relationship(s)•I have no relevant financial or

nonfinancial relationships in the products or services described, reviewed, evaluated or compared in this presentation.

Why can’t I understand

him?

Identification

Intervention

Referrals

Objectives

•Describe the acquisition of sounds and when teachers should be concerned.

•Explain red flags for expressive and receptive language impairment to teachers.

•Identify variables that can complicate the process of identifying a child with speech and language needs.

•List ways in which to help teachers carry over therapeutic strategies into the classroom.

Speech and Language Referrals

DNQs? DNQ due to second language influence?

Teachers who need more support and understanding?

Overwhelmed with number of evaluations? Work with

children who come from CLD backgrounds?

What can Complicate Identifying a Child with Needs

My gut feeling or experience tells me that this student is not communicating well.Is he communicating normally for his age or should he be referred to speech?

SecondLanguageIssues

Low

SES

Issues

Atypica

l Fam

ily

Dynam

ics

Parents

with lo

w

litera

cy abilit

ies,

reduce

d support

and

involve

ment

Reduced experience

with, and exposure to,

vocabulary and

academic topics

Frequent movement between schools

Cultural Differences

Taking Everything into Account

Account for developmental differences resulting from second language influence.

SecondLanguageIssues • Similar amount of

vocab • Code switching• BICS vs. CALP


Account for possible limited

book and vocabulary exposure, reduced

community access, etc.

Low SES Issues


Account for possible low

literacy skills, home

involvement, reduced

communication between parent

and teacher.

Atypical Family Dynamics Parents with low literacy abilities, reduced support and involvement


Academic measurement is heavily weighted by vocabulary.

Reduced experience with, and exposure to academic topics


Account for disruptions in an academic career.

Frequent movements between schools


Account for cultural

importance on communication and differences

in communication

style.

Cultural Differences

Summary• A proper Speech-language referral

and diagnosis will take into account:▫Second language▫Socio-economic Status▫Family Dynamics▫Academic Experience and Exposure▫Culture

• Go to www.speechpathologyceus.net for more resources on these issues

http://www.speechpathologyceus.net/

What are the greatest difficulties we face?

Speech Language Pathologists:

•My caseload is too large• I have too many campuses• I have too much paperwork• I don’t have time to complete the

evaluations given to me

•Can you think of any others?


Principals and Assistant Principals:

• I can’t get this student into special education

•There are too many annual meetings• I can’t believe this child didn’t qualify•The evaluation process is too long

•Any others that you have heard?


Speech Department Leads:

•My staff is stretched too thin•There are not enough bilingual SLPs•There is no money in the budget•We are over-identifying certain minority

groups

•Any others that you have heard?


Teachers:

• I can’t understand my student• I want to help in the classroom but I don’t

know what to do• I have 19 other students•The referral process:

▫Is complicated▫Takes too much time▫Involves a lot of paperwork▫Doesn’t result in students getting help.

Distribution of time over a student’s week

Gather Student

Information

Analyze Student

Difficulties

Develop Strategies

Implement Strategies

Evaluate Student Success 2

Are Teachers Referring the Right Students?

Research on agreement between teachers and SLPs

• Numerous studies have explored the rate of agreement between teachers and SLPs about who should receive speech services (Friberg, 2008).

Diehl & Sinnet (1959) – 60% James & Cooper (1966) – 40% Clauson & Kopatic (1975) – 18% Davis and Harris (1992) – 81% Cartwright-Gard, Harmon & Bryne (2002) – 58%

• On average, teachers- SLP agreement is 60%.• Research indicates that 40% of students who

should be referred are not (Mosheim, 2009)

Gather Student

Information

Analyze Student

Difficulties

Develop Strategies



Teacher confidence•Cartwright-Gard, Harmon & Bryne (2002)

surveyed teachers and found:▫75% of teachers reported low confidence in

making referrals▫80% of teachers indicated a desire for more

training to improve their referrals•Many teachers report very low confidence

when making referrals for bilingual children

Are Teachers Referring the Right Students?

Gather Student

Information

Analyze Student

Difficulties

Develop Strategies



Helping Teachers understand

•Documents for support:▫What is Speech and Language?▫Apples to Apples▫Developmental Articulation Norms▫Red Flags for Speech/Language

impairment

Defining how a child is having difficulty facilitates success in improving their communication

When you say a child “can’t communicate.”

• Can’t follow directions

• Doesn’t remember

• Repetitions• Stuttering

• Doesn’t speak much

• Grammar is wrong

• Can’t understand

• Can’t say sounds

Articulation

Expressive

Language

Receptive LanguageFluency

What is Speech and Language?

Developmental Articulation Norms

Red Flags For Speech or Language Impairment in Bilinguals

• Family history of language/learning disabilities

• Slower development than siblings • Speech and Language performance unlike

others with similar cultural/linguistic experiences

Red Flags For Language Impairment in Bilinguals

• Difficulty learning both languages, even with adult assistance

• Difficulty interacting with peers• Difficulty with language in many routines• High use of non-specific vocabulary (e.g. stuff, thing,

that)• Disorganized sentences and narratives• Limited sentence length and complexity• Does not understand what the teacher says• Difficulty understanding and following directions• Difficulty understanding classroom concepts that are

part of their daily routine that all other students with the same exposure have picked up on.

Red Flags For SpeechImpairment in Bilinguals

• Deletion of sounds or syllables• Lateral /s/- air coming out of the sides of the

mouth• Teacher and/or peers have a hard time

understanding the child• A school-age child should be 100%

intelligible

Red Flags For Pragmatic LanguageImpairment in Bilinguals

• Isolation from peers during play• Difficulty making and keeping friends• Perseveration on certain activities or topics• Difficulty transitioning from one activity to another or from

room to room (tantruming) • “In their own world” • Difficulty turn-taking• Poor topic maintenance• Inappropriate non-verbal communication (body language, eye

contact)

Normal disfluenciesAbnormal disfluency (should be referred)

• Whole word repetition▫ I-I-I went to the

playground • Phrase repetition

▫ I went, I went, I went there

• Normal rate of speech• No tension

• Prolongation▫ mmmmom

• Syllable repetition▫ te-te-te-teacher

• Sound repetition▫ b-b-b-ball

• Blocks▫ I want the b---ball

• Raise in pitch• Facial/body tension• Abnormal blinking • Poor eye contact• Frustration• Social anxiety• Family history

Red Flags For Fluency Disorders in Bilinguals

Response to Intervention (RTI)

• “RTI is not something that happens in special education. Rather, it is a method for teaching all students that needs to be driven by general education teachers in the general education classroom.”

What is RTI?

•A regular education initiative to deal with the problems of the discrepancy model (discrepancy between IQ and achievement).

•A way to determine how students respond to intervention (in the classroom with the teacher)

•A screening to identify children with learning disabilities.

•A way of determining whether children who receive “intensive” intervention in the classroom respond.

•“RTI was first proposed by Gresham (2002 ) as a viable alternative to the discrepancy model.”

• Provide children from culturally and linguistically diverse populations with the assistance they need to succeed.

• To better identify children with reading disabilities.

• To better identify children with learning disabilities.

• How does RTI serve SLPs in it’s intended mission of correctly identifying populations?

*Fasko, 2006

Why was RTI implemented?

Response to Intervention (RTI)

•RTI has 3 basic phases called Tiers▫Tier 1 – Identify a child that has difficulties ▫Tier 2 – Attempt to remediate the problem

in the classroom▫Tier 3 – Continue working with the child in

the classroom and have outside support (SLP) begin working with the student

▫“Why can’t an SLP just do an observation or start working with a child?”

What is our role?

Why are we involved?

•Over identification •Reduce number of DNQs and workload•Help general education teachers increase

effectiveness •Improve the quality of referrals

How can we be involved in RTI without being overwhelmed by it?

•Helping with the referral process (See attached packet –Speech and Language Concerns)

•Referral Portfolio - Decision Tree with Teacher Letters and 35 Speech & Language Probes found at http://speechpathologyceus.net/cld-resource-library/

•How do we make time to collaborate with the teacher during the referral process?

http://speechpathologyceus.net/cld-resource-library/

http://speechpathologyceus.net/cld-resource-library/

RTI Problem Solving Method*

*Adapted from NASDSE, 2006

Gather Student

Information

Analyze student’s

difficulties

Develop strategies

Implement the

strategies

Evaluate student’s success

Who is concerne

d?Is there a problem?

What shall we do about

it?

Here are the steps.

Did our plan

work?

Gather Student Information

1. Name2. Date of Birth3. Grade4. Teacher5. Vision and Hearing6. Parent Concern and History7. Teacher Concern

1. I can’t understand my student2. My student doesn’t speak enough, is

confusing, or can’t understand me

Gather Student

Information

Analyze Student

Difficulties

Develop Strategies



Initial Data

• Hearing Concern• Parent Concern• Teacher Concern

• I can’t understand the words that my student uses.

• My student doesn’t speak enough, is confusing, or can’t understand me.

Part A - Everyone

Part B – Which best describes your student

Speech and Language ConcernsGather Student

Information

Analyze Student

Difficulties

Develop Strategies



Speech and Language Concerns

The Language Information generates data about each area of possible concern.

Teachers read it from top to bottom

SLPs read it from left to right

Gather Student

Information

Analyze Student

Difficulties

Develop Strategies



Why referrals might be daunting to teachers

•There are 7 pieces of data from three sources

•Multiple Causes▫There are 27 common speech outcomes▫There are 7 common language outcomes

•There are 12 steps across 3 tiers

•Referral Manuals can be 12-58 pages•Teachers on average receive less than 2

hours of training per year

Gather Student

Information

Analyze Student

Difficulties

Develop Strategies



Analyze Student Difficulties

1. I can’t understand my student.2. 27 common outcomes (not

including multiple issues, 2nd language, or age).

Gather Student

Information

Analyze Student

Difficulties

Develop Strategies



Analyze Student Difficulties

1. My student doesn’t speak enough, is confusing, or can’t understand me

2. 7 common outcomes across expressive and receptive domains

Gather Student

Information

Analyze Student

Difficulties

Develop Strategies



Develop Strategies

1. What problem is a child having?2. Example: Answering questions

Gather Student

Information

Analyze Student

Difficulties

Develop Strategies



Implement Strategies1. Example: Answering questions2. Tell the student this story and ask him these

questions

Gather Student

Information

Analyze Student

Difficulties

Develop Strategies



Who wanted to go to the ball?

What did Cinderella lose?

When did she have to leave?

Where did the prince live?

Evaluate Student Success

1. Example: Answering questions2. How did he do?

Gather Student

Information

Analyze Student

Difficulties

Develop Strategies



Who wanted to go to the ball?

What did Cinderella lose?

When did she have to leave?

Where did the prince live?

Repeat if unsuccessful

Develop Strategi

es

Gather Student

Information

Analyze Student

Difficulties

Develop Strategies



Gather Student

Information

Analyze Student

Difficulties

Develop Strategies



Gather Student

Information

Analyze Student

Difficulties

Develop Strategies



Implement

Strategies

Evaluate Success

Case Study

•One of our colleagues put this plan into play from start to finish

•Only there 2 days/week!•Started the year with a teacher training on

speech and language•Over 23 referrals came in, 6 for eval, 4

qualified•Used the steps in this packet, tracked number

of students who went on for evaluation and number who resulted in qualifying

•Approx 1 hour or less/week

Collaboration after Identification

“Education takes place through the process of communication. The ability to participate

in active and interactive communication with peers and adults in the educational

setting is essential for a student to access education”

– Michigan Speech-Language-Hearing Association (1995)

Why do we need collaboration?

•Generalization of skills in the academic setting▫IDEA requires that intervention be relevant▫Focus on speech/language in the context of

academics•Continued teacher education of

speech/language▫How teachers can continue to support the

student in the classroom

Language and Speech in the Context of Academics

•Focus on what is most functional for excelling in the classroom: ▫Follow the curriculum ▫Use classroom materials

•Therapy programs that support curriculum:▫Lit Kits▫PPCD Plans▫FLS Plans

Literacy Based Intervention• Using books that the student is reading in class • Refer to Using storybooks in speech-language

intervention for templates to create speech and language activities▫ Found on SpeechPathologyCEUs.net in the Resource

Library• Pre-reading activities• Post-reading activities• Category, Attribute, Function Activity Template• Character and Setting Activity Template• WH. Card Template• Sequencing Activities• Articulation Word and Data Collection Template

PPCD Plans

•Small group routine in the classroom•Consistent schedule with themes that

change, according to the curriculum•Identify goals that can be targeted with

each activity

PPCD Plan Activities• Greeting/attendance• Calendar• Introduction of theme• Music• Surprise Bag• Phonological goal• Read book• Centers

▫Auditory bombardment▫Language activity

• Review language goal and phonological target

PPCD Plan Materials

•Book •Song•Surprise bag materials•Phonological/artic cards•Auditory bombardment •Themed coloring page•Language activity •Homework sheet

•Similar to PPCD plans but with modifications for students with different disabilities

•Focus on basic functional skills▫Basic personal information (name, age)▫Social introductions

Life Skills Plans

Strategies for reinforcing academics and carryover•Do a short presentation at the beginning

of the year and provide handouts for reference

•Schedule 30 min every week in your calendar to collaborate with teachers

•Get a copy of the curriculum•Join the weekly planning meeting –

different grade level every week •“Walk and talk”•Weekly emails to teachers

For more great resources visit our resource library at SpeechPathologyCEUs.net

Visit us at bilinguistics.com

References• Farber, J.G., Klein, E.R. (1999). Classroom based assessment of a

collaborative intervention program with kindergarten and first-grade students. Language, Speech, and Hearing Services in Schools, 30, 83-91.

• Loeb, D.F., Gillam, R.B., Hoffman, L., Brandel, J., Mauris, J. (2009). The effects of fast forward language on the phonemic awareness and reading skills of school-age children with language impairments and poor reading skills. American Journal of Speech-Language Pathology, 18, 376-387.

• Nind, M. (2000). Teachers’ understanding of interactive approaches in special education. International Journal of Disability, Development and Education, 47(2), 183-199.

• Cartwright-Gard, Harmon & Bryne (2002) surveyed teachers and found:• Numerous studies have explored the rate of agreement between teachers

and SLPs about who should receive speech services (Friberg, 2008).• Research indicates that 40% of students who should be referred are not

(Mosheim, 2009)

Thank you!

collaborating with teachers to improve referrals and interventions with bilingual students

Technology

account account

student difficulties

surveyed teachers

student success

teachers slp agreement

speech language pathologists

language influence

gather student information