Speech

Pathology
in Schools
A resource to support engagement and participation
of students with speech, language and
communication needs in schools.

Speech Pathology Australia: Speech Pathology in Schools Project 1

Acknowledgements
Acknowledgment is given to the members of the profession who contributed their knowledge and current literature
to this project.

Speech Pathology Australia Reference Group

Gaenor Dixon, National President, Speech Pathology Australia/ Eleanor McMillan, Speech Pathologist in Private Practice/
Principal Advisor, Therapies School Leader in the ACT Education Direcorate
Tim Kittel, Director, Speech Pathology Australia Dr Natalie Munro, Course Director BAppSc(SpPath) and Senior
Lecturer Speech Pathology, Faculty of Health Sciences, The
Alison Smith, Queensland Branch Chair/ Director Strategy and
University of Sydney, and University Associate, Curtin University
Performance, Metropolitan Region, Department of Education
and Training (Queensland) Dr Tanya Serry, Senior Lecturer, Discipline of Speech Pathology;
Chair, Human Research Ethics Sub-Committee; Honorary
Gail Mulcair, Chief Executive Officer, Speech Pathology
Research Fellow, Murdoch Childrens Research Institute, Policy
Australia
Equity and Transition Group
Candice Brady, Speech Pathologist at Children’s Hospital
Dr Julia Starling, Certified Practicing Speech-Language
at Westmead (SCHN), Leader for Advocacy and Influence –
Pathologist Adjunct Lecturer, The University of Sydney;
Speech Pathology Australia (NSW Branch)
President, Learning Difficulties Coalition of NSW
Felicity Burke, Practice Leader Speech Pathology, Clinical
Kathryn Thorburn, Speech Pathologist/Teacher Language and
Innovation and Governance, Ageing Disability and Home Care,
Learning: K-12 Speech Pathology and Learning Support
Department of Family and Community Services
Pamela Thuan, Speech Pathologist and Speech and Language
Associate Professor Patricia Eadie, Melbourne Graduate
Specialist Consultant
School of Education
Sue Wilks, Speech Pathologists/Managing Director One Stop:
Dr Charlotte Forwood, Leader of Advanced Learning –
Allied Health & Medical Centre
Strathcona Girls Grammar School
Christine Lyons, Senior Advisor – Professional Practice, Speech
Associate Professor Suze Leitao, Life Member SPA, School of
Pathology Australia
Psychology and Speech Pathology, Faculty of Health Sciences,
Curtin University Cathy Olsson, National Advisor – Disability, Speech Pathology
Australia.
Professor Sharynne McLeod, Life Member SPA, ASHA Fellow,
Professor of Speech and Language Acquisition, School of
Teacher Education, Charles Sturt University

The reference group was supported by Mary Gornik, SPA National Advisor - Education, Early Childhood and Projects.
A special thanks to Hayley Tancredi for her contribution to the section on inclusive education.
www.speechpathologyaustralia.org.au >What’s On > Schools Project Resource

For more information on the Speech Pathology Australia: Speech Pathology

in Schools Project contact Speech Pathology Australia National Advisor –
Education, Early Childhood and Projects, Mary Gornik at
mgornik@speechpathologyaustralia.org.au

Copyright: © (2017) The Speech Pathology Association of Australia Limited. Speech Pathology Australia
All rights reserved. Level 1 / 114 William Street
Disclaimer: To the best of The Speech Pathology of Australia Limited’s (‘the Melbourne Victoria 3000
Association’) knowledge, this information is valid at the time of publication. Australia
The Association makes no warranty or representation in relation to the content
or accuracy of the material in this publication. The Association expressly 1300 368 835
disclaims any and all liability (including liability for negligence) in respect of use P: +61 3 9642 4899
of information provided. The Association recommends you seek independent office@speechpathologyaustralia.org.au
professional advice prior to making any decision involving matters outlined in
this publication.

2 Speech Pathology Australia: Speech Pathology in Schools Project

 Introduction

Speech Pathology Australia has produced this resource to promote a whole school
approach to support engagement and participation of students with speech,
language and communication needs in schools. We acknowledge collaboration
with the NSW Department of Education and its stakeholders to produce the
components for principals, teachers and families which will be available on their
website.
Sections of this resource may be useful to you when you are presenting
professional development forums and advocating for your role in schools, and to
educate school staff on the benefits of a whole school approach and what speech
pathologists can offer schools.

A link to the principal, teacher and parent

components will be available once they are
adapted on the NSW DoE website

Speech Pathology Australia: Speech Pathology in Schools Project 3

Contents

Context 6
The United Nations Convention on the Rights of Persons with Disabilities
The Salamanca Statement and Framework for Action on Special Needs Education
Disability Discrimination Act
Disability Standards for Education, 2005
Overview of the National Disability Strategy 2010–2020
Melbourne Declaration on Educational Goals for Young Australians (December 2008)

Prevalence of speech, language and communication needs 9

Aboriginal and Torres Strait Islanders
References

Typical speech, language and communication development 12

Common speech, language and communication needs (SLCN) 13
Markers of potential concern
Other speech, language and communication markers of needs

Complex communication needs and augmentative and alternative communication 14

References
The impact of speech, language and communication needs 18
Identifying students with speech, language and communication needs 19
Best practice models and support for students with speech, language and 20
communication needs
Why we are promoting inclusive education?
The features of inclusive education
References
Response to intervention 22
The RtI approach
Response to intervention and literacy difficulties 25
Useful references
The positive impact of providing best practice support to students 27
with speech, language and communication needs
Ensuring communication is embedded at a universal level
Skilled and confident staff can make a positive impact
Links with the curriculum
A functional approach
A strategy-focused approach
Support at transition times
Involving young people
Opportunities for specialist intervention where difficulties are severe and complex

4 Speech Pathology Australia: Speech Pathology in Schools Project

 Contents

Role of teachers and speech pathologists in the educational setting 29

Collaborative partnerships
Reference
What you need to consider when working in schools 31
Workload management
Service delivery options
Employment arrangements
Employee vs. independent contractor
Clinical supervision and mentoring
Resource requirements
Ownership of files and student information
Administrative and program delivery support
Children from culturally and linguistically diverse backgrounds 34
Free resources for speech pathologists
References
The different needs of rural and regional schools 37
Telepractice considerations
Working with other speech pathologists (dual servicing)
Terminology 39
Resources 40
References 42
Prevalence and background information
Whole school approach/ response to intervention
Speech pathology evidence-based practice
Speech Pathology Australia documents
Appendix 47

Speech Pathology Australia: Speech Pathology in Schools Project 5

Context
There are several international and national
imperatives that provide context to this resource.
The most relevant ones are: The United Nations
Convention on the Rights of Persons with
Disabilities, The Salamanca Statement and
Framework for Action on Special Needs Education,
the Disability Discrimination Act, Disability
Standards for Education, 2005, National Disability
Strategy 2010–2020, Melbourne Declaration on
Educational Goals for Young Australians (December
2008).
The United Nations Convention on the Rights of
Persons with Disabilities
Declaration:
“Australia recognizes that persons with disability
enjoy legal capacity on an equal basis with
others in all aspects of life. Australia declares its
understanding that the Convention allows for
fully supported or substituted decision-making
arrangements, which provide for decisions to be
made on behalf of a person, only where such
arrangements are necessary, as a last resort and
subject to safeguards;
Australia recognizes that every person with
disability has a right to respect for his or her
physical and mental integrity on an equal basis with
others. Australia further declares its understanding
that the Convention allows for compulsory
assistance or treatment of persons, including
measures taken for the treatment of mental
disability, where such treatment is necessary, as a
last resort and subject to safeguards;
Australia recognizes the rights of persons with
disability to liberty of movement, to freedom to
choose their residence and to a nationality, on an
equal basis with others. Australia further declares its
understanding that the Convention does not create
a right for a person to enter or remain in a country
of which he or she is not a national, nor impact on
Australia’s health requirements for non-nationals
seeking to enter or remain in Australia, where these
requirements are based on legitimate, objective and
reasonable criteria.”
The United Nations Convention on the
Rights of Persons with Disabilities
6 Speech Pathology Australia: Speech Pathology in Schools Project
The convention is international legislation and
Australia reports on its actions towards meeting the
requirements regularly to the UN.
For you as a speech pathologist working in schools,
this legislation frames your work around ensuring
equal access to education for students with
disability to support schools to use appropriate
materials, techniques and forms of communication
for the students you support, and to provide
support measures for students with speech,
language and communication needs.
The Salamanca Statement and Framework for
Action on Special Needs Education
These documents are informed by the principle
of inclusion, by recognition of the need to work
towards “schools for all” – institutions which include
everybody, celebrate differences, support learning,
and respond to individual needs. As such, they
constitute an important contribution to the agenda
for achieving education for all and for making
schools educationally more effective.
The guiding principle that informs this framework
is that schools should accommodate all children
regardless of their physical, intellectual, social,
emotional, linguistic or other conditions. These
conditions create a range of different challenges
to school systems. Schools have to find ways of
successfully educating all children, including those
who have serious disadvantages and disabilities.
There is an emerging consensus that children and
youth with special educational needs should be
included in the educational arrangements made for
the majority of children. This has led to the concept
of the inclusive school. The challenge confronting
the inclusive school is that of developing a
child-centred pedagogy capable of successfully
educating all children, including those who have
serious disadvantages and disabilities. The merit
of such schools is not only that they are capable
of providing quality education to all children; their
establishment is a crucial step in helping to change
discriminatory attitudes, in creating welcoming
communities and in developing an inclusive society.
Salamanca Statement 1994
This statement calls on schools to ensure that
they respond to the needs of all students through
the use of adjusted curriculum, organisational

strategies, good teaching and partnerships. The
statement calls for schools to provide a continuum
of support to meet the needs of students.
This provides the context in which we describe the
Response to Intervention Strategy – the provision of
a continuum of increasing frequency and intensity of
support to meet the needs of students.
Disability Discrimination Act
Disability is broadly defined within the Disability
Discrimination Act (DDA) to include physical,
intellectual, sensory, neurological and psychiatric
disabilities as well as including people who may
have a disease and people with an imputed
disability, (i.e. being treated as if you have a
disability). People like relatives, friends, and carers
are also protected if they are discriminated against
because of their association with a person with
disability.
Overview Disability Discrimination
Act
The definition of disability in the DDA is very broad
and covers a wide range of cognitive, physical,
sensory and social/emotional disabilities. This
includes speech language and communication
needs.
Disability Standards for Education, 2005
The Disability Standards for Education
are subordinate legislation to the Disability
Discrimination Act. In effect, it sets out the
standards that schools and education facilities must
adhere to in order to meet their obligations under
the Disability Discrimination Act, 1996.
Children and young people in Australian education
settings have differing needs, abilities and interests.
Learning happens when teaching responds to these
individual qualities. As there is no single method of
Speech Pathology Australia: Speech Pathology in Schools Project
Context
teaching that supports the learning of all students,
education providers make adjustments to enable
every student to participate in learning.
Many students, including students with disability,
need adjustments to support their learning.
Under the Disability Standards for Education 2005,
students with disability are entitled to reasonable
adjustments to enable them to participate in
education on the same basis as other students.
The Education Institute > disability our
rights
Overview of the National Disability Strategy
2010–2020
The National Disability Strategy 2010-2020 is
Australia’s whole of government plan for the
progressive implementation of the United Nations
Convention on the Rights of Persons with
Disabilities. The Australian Government undertook
significant consultation with people with disability,
their families and carers to inform the strategy. This
process reflected the fact that people with disability
are their own experts and are best-placed to provide
input on issues that affect them. Most importantly, it
ensured that the strategy was truly reflective of the
priorities of people with disability across Australia.
The final strategy includes six core outcome areas.
Each of these outcome areas then includes a
number of policy directives to help guide the work
of governments in meeting that particular outcome.
Outcome area 5 focuses on learning and skills.
Outcome area 5 – learning and skills
• Strengthen the capability of all education
providers to deliver inclusive high quality
educational programs for people with all abilities
from early childhood through adulthood.
7
Context
• Focus on reducing the disparity in educational
outcomes for people with a disability and
others.
• Ensure that government reforms and initiatives
for early childhood, education, training and skill
development are responsive to the needs of
people with disability.
• Improve pathways for students with disability
from school to further education, employment
and lifelong learning.
Human Rights National Disability
Strategy
Each state or territory will have its own disability
plan that guides the work that each government
agency needs to complete to meet the strategy
goals. Education departments will have contributed
to the development of the state or territory disability
plan, and will have their own actions arising out
of that plan. Being aware of the priorities for
the department and schools can assist you in
discussing how your work contributes to the bigger
picture.
Melbourne Declaration on Educational Goals for
Young Australians (December 2008)
As signatories to the Melbourne Declaration,
Australian education ministers seek to achieve
the highest possible level of collaboration with the
government, Catholic and independent school
sectors and across and between all levels of
government. Australian education ministers also
seek to achieve new levels of engagement with all
stakeholders in the education of young Australians.
The Melbourne Declaration acknowledges major
changes in the world that are placing new demands
on Australian education:
• global integration and international mobility
• globalisation and technological change
• complex environmental, social and economic
pressures
• rapid and continuing advances in information
and communication technologies.
8 Speech Pathology Australia: Speech Pathology in Schools Project
Educational goals
Goal 1
Australian schooling promotes equity and
excellence
Goal 2
All young Australians become:
• successful learners;
• confident and creative individuals; and
• active and informed citizens.
Melbourne Declaration on Educational
Goals for Young Australians
The Melbourne Declaration provided the basis for
the development of the Australian Curriculum. The
Australian Curriculum, Assessment and Reporting
Authority (ACARA) was set up to be responsible
for the development of a high-quality curriculum
for all Australian students, one that promotes
excellence and equity in education. All students are
entitled to rigorous, relevant and engaging learning
programs drawn from a challenging curriculum that
addresses their individual learning needs. The F-10
Australian Curriculum sets out the core knowledge,
understanding, skills and general capabilities
important for all Australian students. It describes
the learning entitlement of students as a foundation
for successful, lifelong learning and participation in
the Australian community. It acknowledges that the
needs and interests of students will vary, and that
schools and teachers will plan from the curriculum
in ways that respond to those needs and interests.
Prevalence of speech, language and
communication needs1

The following evidence will be valuable to speech
pathologists when performing an advocacy
role in schools to highlight the need for speech
pathology in the education sector.
• Australian estimates (from the Longitudinal
Study of Australian Children) indicate that
between 22.3 and 24.5 per cent of children
have a speech, language or communication
disorder at school entry McLeod & Harrison,
2009).
• One large study based on NSW students
estimated that 11 per cent of students in
secondary school have a communication
disorder (McLeod & McKinnon, 2010). There
is no evidence to indicate that the prevalence
of communication disorders in secondary
school students would be significantly
different from this in other states and
territories.
general knowledge as measured by the
Australian Early Development Census at
school entry.
• Children living in the most socioeconomically
disadvantaged locations were four times as
likely to be developmentally vulnerable (falling
below the 10th percentile) than those from
the least disadvantaged areas in the language
and cognitive skills domain (AECD, 2015).
• Children living in very remote Australia
were nearly five times more likely to be
developmentally vulnerable in the language
and cognitive skills domain than children
living in major cities (AECD, 2015).
• Boys were 1.7 times more likely to be
developmentally vulnerable than girls in the
language and cognitive skills domain (AECD,
2015).

• Forty six percent of young offenders have a
language impairment (Snow, 2014).
• There is very good evidence to indicate a
negative trajectory for these young people
with increased incidence of disengagement
from school, poor educational outcomes,
mental ill-health, problematic behaviour,
anti-social problems and interaction
with the juvenile justice system (Conti-
Ramsden,Durking, Simkin, & Knox, 2009).
• Over 17 per cent of children start school
with scores of “developmentally at risk” or
“vulnerable” in the language and cognitive
domain (which includes pre-literacy skills),
and over 25 per cent are at risk or vulnerable
in relation to their communication skills and
• Speech, language and communication
difficulties are closely linked to behaviour
(Lindsay & Dockrell, 2012), social skills, self-
esteem, health and well-being, family and
social relationships.
• Adolescents with speech, language and
communication difficulties have been
shown to be at a greater risk of developing
emotional, social and behavioural difficulties,
mental health issues (anxiety and depression),
emotional difficulties2, early school leaving
and poor school engagement.
• There is strong evidence that many students
with language and learning difficulties
struggle enormously with the transition to
secondary school and may develop mental
health problems.3

1
Speech, language and communication needs (SLCN) is the umbrella term most commonly used to describe these
difficulties.
2
There is now substantial research evidence that children and young people with speech, language and
communication needs (SLCN) are more likely to develop behavioural, emotional and social difficulties (BESD) than
typically developing young people (Beitchman et al., 1996 Fujiki, Brinton, & Clarke, 2003; Tomblin et al., 2000.
Studies have shown prevalence rates as high as 35–50 per cent.
3
Communication disorders frequently co-occur with mental health issues. Bryan and Roach (2001) reported the
incidence of speech and language problems in individuals receiving mental health services to be higher than that
in the general population. Longitudinal studies have indicated an increased likelihood of mental health problems in
those who initially presented with significant speech/language impairments as a child. Developmental Language
Disorders have been found to contribute to the development pf personality disorders in adulthood.

Speech Pathology Australia: Speech Pathology in Schools Project 9

 Prevalence of speech, language and
communication needs

• Students with communication problems are and 20 years compared to non-indigenous

at greater risk of bullying4 and report less children who experience 3 months of otitis
school enjoyment than their peers. media within the same period.

• Young people with communication needs
are overrepresented in juvenile justice5
settings.
Aboriginal and Torres Strait Islanders
• Among Aboriginal and Torres Strait Islander
children (Williams & Jacobs, 2009), rates of
otitis media are high, the disease manifests
early in life, and it may continue to occur in
adolescence and beyond. Australian data
indicates that Indigenous Australian children
experience otitis media for a cumulative
total of 32 months between the ages of 2
• Indigenous children in 2015 were nearly
four times more likely to be developmentally
vulnerable than non-indigenous children in
the language and cognitive skills domain
(AECD, 2015).
• Indigenous children in 2015 were 2.4
times more likely to be developmentally
vulnerable than non-Indigenous children
on the communication skills and general
knowledge domain (19.3 and 7.9 per cent
respectively) (AECD, 2015).

A general pattern seen in the literature is that children with SLCN are reported to be particularly vulnerable to
4

bullying (McLaughlin et al., 2012). Given the negative links between bullying and children’s mental health (Gini
and Pozzoli, 2009), there is clearly a particular need to establish mechanisms for children with SLCN to voice their
perspectives and concerns.
5
In a 2011 study in Victoria (Snow & Powell, 2014), approximately 50 per cent of young offenders were found to
have an oral language impairment. Those with more severe types of offences performed more poorly on language
assessments.

References
Beitchman, J. H., Wilson, B., Brownlie, E. B., Walters, H., Inglis, A., Lancee, W. (1996)

Long-term consistency in speech/language profiles: 11. Behavioral, emotional and social outcomes.
Journal of the American Academy of Child & Adolescent Psychiatry, 35 (6), 815-825.

Bryan K, & Roach J. (2001) Assessment of speech and language in mental health. In: J. France &
S.Kramer (eds). Communication and mental illness. Jessica Kingsley Publishers: London. pp 110-
122.

Conti-Ramsden, G., Durkin, K., Simkin, Z. & Knoz, E., (2009). Specific language impairment and
school outcomes. 1. Identifying and explaining variability at the end of compulsory education.
International Journal of Language and Communication Disorders, 44, 15–35.

Fujiki, M., Brinton, B., and Clarke, D. (2002) Emotional regulation in children with specific language
impairment. Language, Speech, and Hearing Services in Schools. (33) 102-111.

Gini, G. and Pozzoli, T. (2009). Association between bullying and psychosomatic problems: a meta-
analysis. American Academy of Pediatrics. 123 (3).

Law, J., Rush, R., Schoon, I., & and Parsons, S. (2009). Modeling developmental language
difficulties from school entry into adulthood: literacy, mental health and employment outcomes.
Journal of Speech, Language and Hearing Research, 52, 1401–-1416.

10 Speech Pathology Australia: Speech Pathology in Schools Project

Lindsay, Geoff, and Julie E. Dockrell. (2012).The relationship between speech, language and
communication needs and behavioural, emotional and social difficulties. London, UK: Department for
Education. (Better Communication Research Programme).

McLaughlin, C., Byers, R., Oliver, C. (Eds.) (2012). Perspectives on bullying and difference:
supporting young people with special educational needs and/or disabilities in schools. (1st Ed.)
London, National Children’s Bureau.

McLeod, S., & Harrison, L. J. (2009). Epidemiology of speech and language impairment in a
nationally representative sample of 4- to 5-year-old children. Journal of Speech, Language, and
Hearing Research, 52(5), 1213–1229.

McLeod, S., and & McKinnon (2010) Support required for primary and secondary students with
communication disorders and/or other learning needs. Child Language Teacher and Therapy, 26(2),
123–143.

Snow, P. (2014). Submission to the Senate Committee Report, Community Affairs References
Committee: Prevalence of different types of speech, language and communication disorders and
speech pathology services in Australia. September, 24–25.

Snowling, M., Adams, J., Bishop, D., and & Stothard, S., (2001). Educational attainments of school
leavers with a preschool history of speech-language impairments. International Journal of Language
and Communication Disorders, 36, 173-–183.

Tomblin, J. B., Zhang, X., Buckwalter, P. and Catts, H. (2000). The association of reading disability,
behavioural disorders, and language impairment among second-grade children. The Journal of Child
Psychology and Psychiatry and Allied Disciplines, 41 (4), 473-482.

Williams, C. J. & Jacobs, M. A. (2009). The impact of otitis media on cognitive and educational
outcomes. Medical Journal of Australia, 2 Nov, 191(9 Suppl), S69–72. Retrieved October 2017, from
mja.com.au

Speech Pathology Australia: Speech Pathology in Schools Project 11

 Typical speech, language and
communication development
This section is provided as a resource for
speech pathologists to use when you are
required to present information to principals,
teachers and parents. Links to websites outlining
developmental milestones are included below.
Level of educational attainment is one of the
strongest single determinants of health on
a population basis and is heavily reliant on
language and literacy skills.
All children and young people need to have
acquired well-developed speech, language
and communication skills to reach their full
potential; academically, socially, vocationally,
and economically. As well as being vital for
learning, speech, language and communication
skills are essential across the school day – for
students to make friends, sort out problems
and share experiences. Speech, language and
communication underpin literacy and numeracy
– skills which are necessary for students to
understand and achieve in all key learning areas.
In turn, having adequate literacy skills also
contributes to children’s language skills. Speech,
language and communication are closely linked
to behaviour, educational outcomes, social skills
and self-esteem.
Language skills are innate and do not directly
need to be taught when children are developing
typically. However, literacy skills, in particular
reading, must be explicitly taught. Children
must master the basics of decoding and
comprehension in the first three years of school
in order to progress from “learning to read”, to
“reading to learn”.
Speech, language and communication needs
that are evident in a child during early to mid-
primary school do not resolve on transition
to secondary school without appropriate
intervention. Many young people with speech,
language and communication needs struggle
enormously with the transition to secondary
school and it has been shown that many
develop mental health problems such as anxiety
and depression as a result. More sophisticated
aspects of language develop during secondary
school years: complex verbal reasoning,
understanding and using figurative language,
telling more involved stories, and using
12 Speech Pathology Australia: Speech Pathology in Schools Project
increasingly sophisticated social communication
skills.
All of these skills are needed to access both
the academic and social curriculum of school,
to cope with the demands of adolescence and
to ensure a successful onward transition to the
workplace.
As learning becomes more reliant on
independent study, language enables students
to make contact with others; to organise,
manage and evaluate experiences; and to
influence and inform. Adolescents spend more
time than younger children talking to others, so
becoming adept at switching between styles of
language. Socially, interactions become more
complex and sophisticated and interaction
becomes increasingly reliant on competent
communication skills; being able to hold a
conversation and to put together sentences into
a story or report (narrative) is integral to creating
and maintaining social relationships.
A focus on speech, language, and
communication is seen by some as the key for
young people to fit into society, and language
difficulties are identified as a significant risk
factor in adult outcomes (e.g., participation in
education and training, and employment). Many
employers place communication skills above
qualifications and value young people with
good communication, literacy and interaction
skills, which is why we need to support those
with SLCN. Some schools have an increasing
emphasis on the development of functional skills
for life and work and on personal learning and
thinking skills. None of these can be achieved
without effective communication skills.
For information on milestones of primary and
secondary school-aged students, see:
www.raisingchildren.net.au > language
development
www.talkingpoint.org.uk > ages and
stages
I CAN, the children’s communication
charity (UK Registered charity 21003)
www.icancharity.org.uk
 Common speech, language and
communication needs (SLCN)
The following information is included to provide
speech pathologists with the latest advice regarding
“red flags”.
A useful resource: Visser-Bochane, Margot I.,
Gerrits, E., Van der Schans, C. P., Reijneveld,
S. A. and Luinge, M. R. (2016). Atypical speech
and language development: a consensus study
on clinical signs in the Netherlands. International
Journal of Language & Communication Disorders,
52 (1), 10–20.
Markers of potential concern
The following features are markers of potential
concern (red flags) for language development of
children.
4–5 years of age:
• At most, three-word sentences
• No simple sentences
• Not intelligible for strangers
• Not 50–75% intelligible for parents
• Disturbed interaction
• Does not understand spoken language/cannot
process spoken language quickly enough
5–6 years of age:
• Poorly intelligible for teacher/grandparents
• No adequate reaction to questions or
commands
• Does not understand composite commands
• At most, simple sentences
• Poor intelligibility
• Does not ask questions
6–7 years of age:
• Does not understand composite commands
• Disturbed communication
• Incomplete sentences
• No adequate reaction to questions or
commands
• Poor understanding of language
• Poor intelligibility
• Poor vocabulary
• Does not produce compound sentences
• Poor story telling
• Cluster reduction
Speech Pathology Australia: Speech Pathology in Schools Project
Children who start school with oral language
difficulties are at risk of experiencing challenges
when learning to read and spell.
Some children have problems with language
development that creates significant barriers
within everyday life or educational progress.
Developmental language disorder (DLD) has
recently emerged in the literature as the preferred
term for language problems that are severe enough
to interfere with daily life.
Speech, language and communication needs
can also include the following:
• limited eye contact;
• poor turn taking and difficulty with starting and
ending conversations;
• problems getting the conversation back on
track after two people have talked at once, or
if there has been a misunderstanding between
them;
• difficulty understanding or responding to
feedback from the listener, (e.g., not noticing
when someone is bored or doesn’t understand
something);
• difficulty staying on topic in conversation;
• difficulty using language to negotiate in
discussions or arguments;
• word finding difficulties and basic use of
vocabulary;
• difficulty understanding and/or using meta
linguistic skills such as interpreting abstract
information, inferring meaning from non-literal
language, understanding and using linguistic
devices such as cohesive devices, ellipsis and
humour.
13
 Complex communication needs and
augmentative and alternative communication

Complex communication needs (CCN) is the

term used to describe SLCN in association
with cognitive, physical, perceptual, or sensory
impairments. Students with CCN may have
difficulties with understanding or using speech
and language for communication, and may use
different modes to add to, or as an alternative
to their speech. Examples include using signs
and gestures, a communication book or board
with symbols, or a speech output device.
These are called augmentative and alternative
communication (AAC).
CCN may lead to communication partners,
including teachers, having reduced expectations,
and providing reduced opportunities for
communication participation and learning for
students with CCN (Pennington & McConchie,
1999). Attempts to communicate may not be
recognised or acknowledged. They may have
fewer interactions and these may be shorter.
Their needs may be anticipated and they may
not be asked or expected to take their turn in
interactions or within learning activities (Harris,
1982; Light, Collier, & Parnes, 1985). These
reduced expectations and opportunities impact
on opportunities for learning and using language.
There is a broad scope of the desired outcomes
of AAC interventions. The focus is not on
teaching students to use symbols or devices,
but to support them to share meaning and
involvement in everyday life activities. Teachers
may have trouble understanding how to
integrate use of AAC - Augmentative and
Alternative Communication into the learning
environment. As well as working directly with the
student to develop their communication skills,
the speech pathologist plays an important role
in supporting communication partners, both
educators and other students, to understand
how the student communicates, and the
strategies to ensure that the student can
participate in all activities at school, in the same
way as other students.
The Participation Model (Beukelman & Mirenda,
2014) provides a great framework to help identify
goals for classroom participation, as well as the
opportunity and skills based barriers which may
need to be addressed to achieve these. Speech
pathologists typically play an important role in
“The focus is not on
teaching students
to use symbols
or devices, but
to support them
to share meaning
and involvement
in everyday life
activities.”
Definition of AAC
An area of clinical and educational
practice that provides communication
strategies, techniques, and
interventions for people with a range
of communication limitations. The
term “augmentative” in this context
means supplemental or additional to
speech. Augmentative techniques (e.g.,
gestures, facial expressions, and items
of reference) are commonly used when
communicating and interacting with
others. The use of the term “alternative”
acknowledges that there are some
individuals whose speech is sufficiently
impaired that they must rely completely
on strategies, systems, and techniques
which do not augment speech but are
alternatives to speech (SPA, 2013).
Purpose of AAC
To enable the person to meet all of his/
her varied communication requirements
as intelligibly, specifically, efficiently,
independently and in as socially valued a
manner as possible; and to understand
others and to be understood (Porter,
2004).

14 Speech Pathology Australia: Speech Pathology in Schools Project

supporting those who are in the educational
as well as care environment of children to
understand and use AAC modelling, including
using aided AAC as they are speaking with the
student, as part of naturalistic communication
interactions (ASHA).
Along with all the skills that typically developing
children are acquiring, students with CCN
need to learn different and additional skills. For
example, they may need to learn to recognise
symbols and understand what they represent,
or how to “repair” interactions when the person
they are talking with misinterprets their meaning,
or how and when to increase and decrease the
volume of their communication device, or when
to use gesture to greet someone, rather than
taking the time to generate speech output on a
device. Light’s Communication competencies
provide a useful framework to identify goals for
intervention to support children to participate
using AAC in the educational context. (Light &
McNaughton, 2014.)
If there is a language disorder, it is likely that the
development of literacy will also be affected.
Language and literacy skills do not develop
in isolation but over time and are dependent
on students’ skills as well as environmental
exposure and demands. Students with CCN
will often need or benefit from the same
interventions as children with speech sound
disorders or developmental language disorder,
as well as requiring specific and additional
supports due to the specific and additional
barriers they face to developing literacy. For
example, children who have limited or no speech
do not have the same ability to “sound out”
words, or even to match a letter with the motor
pattern associated with that sound. (Hetzroni,
2004: Millar, Light, & McNaughton, 2004).
Research focusing on students with CCN
who use AAC has highlighted the discrepancy
between their cognitive abilities and predicted
literacy skills (Sandberg, 2006). Therefore,
it is critical that professionals who work
with students with CCN identify appropriate
AAC to promote literacy and to develop
effective strategies that foster acquisition of
skills necessary for literacy development. As
professionals with expertise in communication
and AAC, you as speech pathologists can play
an important and unique role in working with
teachers and other educational staff (as well
as the student and their family) to help embed
the use of AAC to support a student’s literacy
development (Sturm & Clendon, 2004; Hetzroni,
2004; Erickson, Koppenhaver, & Cunningham,
2006; Porter, 1997).
AAC users, who may not have the ability to
produce speech, face unique challenges in
the development of phonological awareness
skills. The development of literacy skills for
students who are AAC users can be even
more important, not only because it supports
their ability to generate novel and spontaneous
utterances using text, but also because it can
provide for access to new experiences, and may
be a critical skill to enable them to enter the job
market (Smith & Blischak, 1997).

Children with CCN may also have changed and

reduced experiences of shared book reading,
which can impact on their opportunities to
develop literacy. For example, it may be difficult
for them to request that a favourite book is read
repeatedly. They may not have been able to ask
questions, or make comments, or “pretend” to
read a book that they have memorised, have
limited opportunities to ask questions or practice
with books (Light & Kelford-Smith, 1993).

Speech Pathology Australia: Speech Pathology in Schools Project 15

 Complex communication needs and
augmentative and alternative communication

References
Beukelman, D. R., & Mirenda, P. (2013). Augmentative and alternative communication: Supporting
children and adults with complex communication needs. Baltimore, MD: Brookes
Erickson, K. A., Koppenhaver, D. A., & Cunningham, J. W. (2006). Balanced reading intervention
and assessment in augmentative communication. In R. J. McCauley, M. E. Fey, & R. Gillam (Eds.),
Treatment of language disorders in children (pp. 309–346). Baltimore, MD: Brookes).
Harris, D. (1982). Communicative interaction processes involving non-vocal physically handicapped
children, Topics in Language Disorders, 2 (2), 21-38.
Hetzroni, O. E. (2004). AAC and literacy. Disability and Rehabilitation, 26, 1305–1312.
Lund, S. K., & Light, J. (2007). Long-term outcomes for individuals who use augmentative
and alternative communication: Part III – Contributing factors. Augmentative and Alternative
Communication, 23, 323–335.
Light, J., Collier, B., & Parnes, P. (1985). Communicative interaction between young nonspeaking
physically disabled children and their primary caregivers: Part I: Discourse patterns. Augmentative
and Alternative Communication, 1(3),98-107
Light, J., & Kelford Smith, A. (1993). Home literacy experiences of pre-schoolers who use AAC
systems and of their nondisabled peers. Augmentative and Alternative Communication, 9(1), 10–25.
doi:10.1080/07434619312331276371
Light, J. C., &, McNaughton, D. (2014). Communicative competence for individuals who require
augmentative and alternative communication: A new definition for a new era of communication?
Augmentative and Alternative Communication, 30, 1–18.
Millar, D. C., Light, J. C., & McNaughton, D. B. (2004). The effect of direct instruction and
writer’s workshop on the early writing skills of children who use augmentative and alternative
communication. Augmentative and Alternative Communication, 20, 164–178.
Pennington, L. & McConachie, H. (1999). Mother–child interaction revisited: Communication with
non-speaking physically disabled children. International Journal of Language and Communication
Disorders, 34(4), 391–416.
Porter, G. (1997). Integrating AAC into programmes applying the principles of conductive education.
Conductive Education News, 12(3), 2–8.
Porter, G. (2004). AGOSCI National Tour, Adelaide.
Sandberg, A. (2006). Reading and spelling abilities in children with severe speech impairments and
cerebral palsy at 6, 9, and 12 years of age in relation to cognitive development: A longitudinal study.
Developmental Medicine & Child Neurology, 48(8), 629-634. doi:10.1017/S0012162206001344
Sennott, S.C., Light, J.C. and McNaughton, D. 2016) Research and practice for persons with severe
disabilities. Sage Journals, AAC Modeling Inervention Research Review 41, (2), 101-115.
Smith, M. M., & Blischak, D. M. (1997). Literacy. In L. L. Lloyd, D. R., Fuller, & H. H. Arvedson (Eds.),
Augmentative and alternative communication: Handbook of principles and practices (pp. 414–444).
Needham Heights, MA: Allyn and Bacon.
Speech Pathology Australia (SPA). (2012). Augmentative and alternative clinical guideline. 2012
Sturm, J. M., & Clendon, S. A. (2004). Augmentative and alternative communication, language, and
literacy: Fostering the relationship. Topics in Language Disorders, 24(1), 76–91.

16 Speech Pathology Australia: Speech Pathology in Schools Project

AAC resources
ADHC Augmentative and Alternative Communication (AAC): Guidelines for speech pathologists
who support people with disability http://www.adhc.nsw.gov.au/__data/assets/file/0011/302402/
Augmentative_and_Alternative_Communication_Practice_Guide.pdf
American Speech and Hearing Association AAC Resources https://www.asha.org/PRPSpecificTopic.
aspx?folderid=8589942773&section=Resources
Augmentative and Alternative Communication Newsletter: Archived copies are available at http://
www.augcominc.com/newsletters/?fuseaction=newsletters&C=ACN
The focus on outcomes of communication under six (FOCUS) is a freely available resource
developed by the Bloorview McMillan Center, which can be used to measure changes in
communicative participation of pre-school children. http://www.research.hollandbloorview.ca/
outcomemeasures/focus
PrAACtical AAC School and Education related posts http://www.praacticalaac.org
The WA Independent Living Centre has a number of resources focused on supporting students
using AAC in education settings. http://www.ilc.com.au/ilc-tech-resources-communication

Commercially available AAC assessment tools

AAC Evaluation Genie App https://www.itunes.apple.com/au/app/aac-evaluation-genie/
id541418407
Augmentative and Alternative Communication Profile http://www.linguisystems.com/products/
product/display-itemid=10547
Communication Matrix http://www.communicationmatrix.org
The Pragmatics Profile of Everyday Communication Skills (Adults/Children) http://www.edit.wmin.
ac.uk/psychology/pp/children.htm
Social Networks Tool http://www.spectronicsinoz.com/product/social?networks
The Source for Augmentative Alternative Communication http://www.linguisystems.com/products/
product/display-itemid=10184
Triple C Checklist of Communication Competencies http://www.spectronicsinoz.com/product/
thetriple-c-checklist-of-communication-competencies

AAC and literacy resources

Centre for Literacy and Disability Studies https://www.med.unc.edu/ahs/clds
Caroline Musselwhite: Literacy for All http://www.engagingalllearners.ca/ip/conversation-with-
caroline-musselwhite/index.php
David Koppenhaver’s Literacy and Disability site http://www.litdis.com
Everyone Communicates - Literacy and AAC http://www.everyonecommunicates.org/resources/
literacy.html
Literacy Instruction for individuals with Autism, Cerebral Palsy, Down Syndrome and other disabilities
http://www.aacliteracy.psu.edu
PrAACtical AAC Literacy related posts http://www.praacticalaac.org
Tar Heel Reader – provides access to a wide range of books at different levels and on a range of
topics https://www.tarheelreader.org

Speech Pathology Australia: Speech Pathology in Schools Project 17

 The impact of speech, language and
communication needs (SLCN)
Speech, language and communication skills
such as knowledge of the sounds of language,
phonological awareness, vocabulary, and
the ability to understand sentence and story
structure underpin learning. Communication is
the means by which learning is facilitated and
assessed. The curriculum is heavily reliant on
oral language skills; without strong foundational
communication skills children are at risk of falling
behind in many areas. When children have
ongoing difficulties in language-learning the
gap is compounded between typical language
learners and those with speech language and
communication needs.
Children’s communication abilities strongly
predict their later reading skills, with a sixfold
increased chance of reading problems for
children with poor language skills. Children
with developmental language disorders have
demonstrably weaker skills in areas (such as
their ability to remember, discriminate and
identify sounds in words, or to understand the
structure of stories) that are crucial for reading
development. In addition, their speech, language
and communication needs may impact on their
vocabulary, verbal reasoning skills, and their
ability to analyse the structure or meaning of
words and sentences, so that even if they can
decode words while reading, they may not
understand.
18 Speech Pathology Australia: Speech Pathology in Schools Project
Children’s social communication skills may
also be compromised, so that they have
difficulty interacting appropriately to make
friends, participate in conversations, and to
negotiate and make choices, all of which are
an important part of school life. Their problems
include use of inappropriate strategies for
negotiation and conflict resolution and difficulty
in understanding non-verbal social cues such as
facial expressions and gestures. These problems
impact on their ability to interact socially and
problems increase as children grow.
Children with speech, language and
communication needs are at greater risk of
bullying and report less school enjoyment than
peers. Over half of children with poor speech,
language and communication skills also have a
behavioural disorder, further reducing learning
opportunities, options and effectiveness, and
leading to disengagement from school.
Research into the outcomes for children with
language impairment in early childhood identified
that these children were twice as likely to show
internalising and externalising behavioural
problems in later childhood and adolescence.
Further, children with a history of language
impairment were over 1.5 times more likely to
meet the criteria for ADHD in later childhood
or adolescence than their typically developing
peers.
Identifying students with speech, language
and communication needs (SLCN)
It is often the impact of the SLCN that is most
evident at school – poor literacy, behaviour
problems, difficulties with peer–peer interaction,
withdrawal from activities – rather than the
underlying needs, which can remain “hidden”.
The first step in the identification of a student
who has SLCN is noticing that they are
struggling with their communication. Teachers
have a crucial role observing these difficulties.
Some students may already have been picked
up by allied health practitioners, preschool
teachers, or their parents may have raised
concerns. However, there are many children
and young people whose needs have not been
identified.
If a student has a speech sound disorder or
difficulty with their spoken language, teachers
may be able to identify it as soon they meet
them. Conversely, the issue that is hardest
to detect will be difficulty in understanding
language. Children with comprehension
Speech Pathology Australia: Speech Pathology in Schools Project
difficulties might outwardly appear to understand
as they will often learn the daily classroom
routine by watching and copying their peers, and
readily respond to any non-verbal cues when
available. These children will tend to be very
good at “making themselves invisible” and can
easily slip under the radar.
It is common for the language basis of academic
problems to go unrecognised in mid-primary and
secondary school students. Identification by you
as the speech pathologist should include:
• a review of achievement tests to find
students scoring poorly in the areas
requiring the most complex language
demands;
• requesting referrals from classroom
teachers;
• a review of school reports and assessments
for students experiencing academic failure.
19
 Best practice models and support for SLCN
in schools
Inclusive education is a principle that:
• values the well-being and unique
contribution of every student;
• acknowledges individual requirements
to access and participate in an equitable
education;
• recognises the ability of every person to
be included both at school and in society
more generally (UN CRPD, 2016); and
is central to the achievement of high-
quality education, equity and excellence
for all (Ministerial Council on Education,
Employment, Training and Youth Affairs,
2008).
The international evidence indicates that
evidence-based practice in inclusive education
involves consideration support for the individual
student as well as external/environmental
modifications.
Inclusive education is an ongoing process and
proactive commitment to responding to the
needs of all students by eliminating barriers
to a students’ presence, access to and
achievement in education (UN CRPD, 2016;
UNESCO, 2017). Inclusion is not integration,
nor mainstreaming, where groups of diverse
students (including students with disability)
are simply present in “regular” classrooms
(Carrington & Elkins, 2002). Furthermore, it is
not segregation, where students with diverse
needs (including students with disability) are
educated in separate environments designed or
used to respond to their impairments. Effective
inclusion for all students requires a cultural,
policy and practice shift for both school systems
and school communities. Inclusion is a process
of responding to diversity, where educators and
school communities strive to identify and remove
all barriers to access, and optimise learning
opportunities for all (Ainscow, 2004; Ballard,
1999).
Why we are promoting inclusive education?
Inclusive education is a fundamental human
right, as has been described in Article 24 of
The Convention on the Rights of Persons
with Disabilities (United Nations, 2006), and
20 Speech Pathology Australia: Speech Pathology in Schools Project
recently clarified in General Comment No. 4
(UN CRPD, 2016). In Australia, these rights are
operationalised within the Disability Standards
for Education (Australian Government, 2005).
Each person’s unique characteristics, interests,
strengths and needs in learning give rise to the
need for education systems and schools to
respond to diversity in such a way that enable
access and opportunities for all students. A
commitment to inclusive education supports the
development of inclusive societies.
The features of inclusive education
General Comment No. 4 (UN CRPD, 2016, p. 3)
outlines nine core features of inclusive education:
1. A “whole systems” approach to changes in
institutional culture, policies and practices.
2. A “whole educational environment”
commitment where educational leaders
introduce and embed inclusive culture,
policies and practices that will facilitate
inclusive education within all areas of the
school and school community.
3. A “whole person” approach, where high
expectations are the norm for all students
and flexibility within pedagogy and
curriculum is responsive to student needs.
4. Teacher and all other staff are supported
in receiving the education and training they
need to support the core values of inclusive
education and to work collaboratively with
others.
5. Valuing and respect for diversity, as well as
listening to and responding to the needs of
students.
6. Building positive school communities and
inclusive school environments.
7. Implementing reasonable adjustments to
learning and assessment to ensure equity.
Also, facilitating effective transitions beyond
school into work or further study
8. Recognition of partnerships external
organisations, parents/caregivers and the
broader community.
9. A constant process of monitoring and
evaluation to reflect on and continue to
ensure that inclusive education is being
upheld.
A best practice approach to supporting students
with speech, language and communication needs
is through a whole school collaborative approach
which is multi-tiered. This approach is defined as
cohesive, collective and collaborative action in and
by a school community that has been strategically
constructed to improve student learning,
behaviour and well-being, and the conditions that
support these.
Key features:
• Professionals work together with parents,
sharing knowledge and skills to effectively
support all students with an integrated
approach.
• Professionals know about speech, language
and communication, learning, curriculum and
the interaction between all of these elements,
with an appreciation of the wider social
context for students and their families.
• Professionals work together to create an
environment that facilitates communication
and learning and is adaptable to the needs of
students in that environment.
• A range of specialist, well evidenced
interventions (tiered interventions) to be
planned and delivered by experienced
professionals.
• Explicit monitoring by teachers of student
learning so that they can be making regular
judgements about student movement
between the whole school approach tiers.
Response to intervention (RTI) is an example
of this approach that has substantial empirical
evidence. This model provides evidence-based
classroom instruction for all children and by using
a dynamic and ongoing monitoring approach,
the RTI model supports the identification of
students who are not responding to this “tier”.
These students will need increasingly personalised
and intensive instruction, while measuring and
monitoring progress in order to make decisions
about the need for further intervention.
The focus for a response to intervention approach
is enhancing the performance of all students,
including those with communication needs in the
school.

References
Ainscow, M. (2004). Developing inclusive education systems: what are the levers for change? Journal
of Educational Change, 6(2), 109–124. doi:10.1007/s10833-005-1298-4
Australian Government. (2005). Disability Standards for Education 2005. Plus Guidance Notes. Barton,
ACT: Australian Government Publishing Service. Retrieved from October 2017, from https://www.docs.
education.gov.au/system/files/doc/other/disability_standards_for_education_2005_plus_guidance_
notes.pdf
Ballard, K. (1999). International voices: An introduction. In K. Ballard (Ed.). Inclusive education:
International voices on disability and justice. London: Falmer Press.
Carrington, C., & Elkins, J. (2002). Bridging the gap between inclusive policy and inclusive culture in
secondary schools. Support for Learning, 17(2), 51-57. doi:10.1111/1467-9604.00236
Ministerial Council on Education, Employment, Training and Youth Affairs. (2008). Melbourne
declaration on educational goals for young Australians. Canberra: Author. Retrieved October 2017,
from http://www.apo.org.au/node/29859
UN Committee on the Rights of Persons with Disabilities (CRPD). (2016). General comment No. 4
(2016), Article 24: Right to inclusive education, 2 September 2016, CRPD/C/GC/4. Retrieved October
2017, from http://www.ohchr.org/EN/HRBodies/CRPD/Pages/GC.aspx
United Nations Educational, Scientific and Cultural Organisation (UNESCO). (2017). A guide for
ensuring inclusion and equity in education. Paris: Author. Retrieved October 2017, from http://www.
allmeansall.org.au/unesco-guide-inclusion-education-including-special-school-resources-general-
system

Speech Pathology Australia: Speech Pathology in Schools Project 21

 Response to Intervention (RtI)

Response (RtI) to intervention integrates • decreases the number of students

assessment and intervention within a multi- inappropriately referred for specialised
level prevention system to maximise student assessment and intervention.
achievement and to reduce behavioural
The general RtI model begins with a tiered
problems. With RtI, schools use data to identify
approach to quality evidence-based instruction
students at risk for poor learning outcomes,
that is effective for the majority of students.
monitor student progress, provide evidence-
General education and intervention specialists
based interventions and adjust the intensity and
provide evidence-based interventions and
nature of those interventions depending on a
differentiated instruction to those students
student’s responsiveness, and identify students
who are performing below expected levels of
with speech, language and communication
achievement. The RtI approach to intervention
needs.
requires teachers and specialists to work
Successful RtI programs rely on the integration together as a team to analyse data and design
of systems, data and practices. There needs a customised plan for each student who is
to be clear systems for collection of data, struggling to learn. It provides opportunities for
identification and implementation of support different professionals to learn from one another
needs; there needs to be clear data-based and to take that learning into the whole class,
decisions so data collection occurs that is small group, and individualised instruction.
purposeful and that practices are evidence
The RtI approach
based and have fidelity.
An RTI service delivery approach focuses on:
Leadership of a principal is required and the
• identifying and supporting the educational
ability to bring all educators to the same table
support requirements of all students;
to share professional development, time, space,
money, curriculum and human resources. • regular monitoring and evaluation of
processes;
RtI offers other benefits as well. It:
• matching evidence-based teaching
• helps identify the contributing factors to a
practices/interventions to student
student’s poor performance;
educational support requirements.
• promotes improved instruction through the
Tier 1
use of multiple assessments and progress
Support and train teaching staff to deliver high-
monitoring;
quality inclusive teaching that helps all students
• provides instructionally relevant data and access and participate in the curriculum. It is
emphasises effective teaching approaches; supported by effective whole-school policies and
frameworks. Speech pathologists work across
• reduces the likelihood of students
a range of proactive supports. These supports
incorrectly classified as having specific
may take the form of collaboration, capability
learning disabilities because of difficulties
development, problem-solving, interpretation
arising from various types of social
of data and curriculum support. An example of
disadvantage such as social, cultural and/or
this could include the speech pathologist team
language differences;
teaching with the classroom teacher.
CH

Intensive Individual Intervention

OA

3
Tier
R
PP
IA

Targeted Small Group Instruction

RT

2
Tier
E
TH

Core Classroom Instruction

1
Tier

Source: Retrieved 2017 from https://www.rcps.info/departments/instruction-

al_department/virginia_tiered_systems_of_supports__rti_

22 Speech Pathology Australia: Speech Pathology in Schools Project

Tier 2
Some students may require additional targeted
instruction in aspects of their learning program.
This usually takes the form of a time-limited,
evidence-based and structured intervention
programs in small groups.
Tier 3
Tier 3 is the provision of intensive, individualised
supports for students. This level of support
may be for only aspects of, or the whole of one
learning area, or may be required across many
curriculum areas.
To support the provision of effective supports
for students, the speech pathologist may
assess the students’ speech language
and communication needs, to develop an
understanding of the impacts of those needs
on the students’ educational program, and
support the school to develop and implement
appropriate individualised adjustments. The
speech pathologist may, where appropriate,
provide direct intervention and/or support the
provision of programs through a trained proxy
agent (teacher, education support staff).
It is important to understand that each tier builds
on the previous one so that all students access
universal good teaching. Some students access
targeted supports and some of those students
receive intensive supports. They are not mutually
exclusive and nor are they set in stone as
students may move between tiers.

Table 1
RTI tier Speech pathology roles
Tier 1 Professional development and coaching for teaching staff to increase
All students in the knowledge of the links between oral language, literacy and learning.
school access and Collaborating with teachers to develop and implement whole of class
participate in an or whole-of-school resources and activities that promote oral language
inclusive curriculum. competence. Working with teachers to implement and evaluate these.
For children with CCN; ensuring that there are whole-school approaches
in place for continuity of communication systems; that universal teaching
strategies are accessible; that skilled communication partners are available
throughout the school.
Collaborating with teachers to develop and implement pedagogical
strategies that support students with weak communication skills,
such as adapting lessons to reduce language complexity, marking
important information, or providing elaborations to enhance students’
comprehension; visual support, adjustments and accommodations to
access and participate in the curriculum.
Input into whole-of-school approaches to screening/identification of
children who are struggling and require Tier 2 support.
For children with CCN, collaborating with teachers and other school staff to
support access and participation for children, such as providing more time
for children to process and respond in class, ensuring that the child and
others know of and are able to access vocabulary to support participation
in their learning activity, understanding and providing aided language
stimulation6.

6
Aided language stimulation (ALS) is a communication strategy, where a communication partner teaches symbol
meaning and models language by combining his or her own verbal input with selection of vocabulary on the
augmentative and alternative communication (AAC) system. This is done by simultaneously selecting vocabulary on
the AAC system and speaking.
Comprehension and communication on the AAC system are promoted through modeled use of visual icons/graphic
symbol and providing the corresponding verbal label. Learners are prompted to use symbols to communicate within
context of motivating, frequently occurring routines by incorporation of time delays, sabotage of routines, and/or the
use of verbal cues. Prompts are faded as the AAC user gains proficiency.

Speech Pathology Australia: Speech Pathology in Schools Project 23

 Response to Intervention (RtI)

RTI tier Speech pathology roles

Tier 2 Collaborative development of programs for classes or small groups
Focused support for of students to enhance skill development in specific areas, such as
students who need phonological awareness or narrative skills.
additional supports Support for evaluating the outcomes of the above, including monitoring
to access general students to determine if they are responding to this level of support and
instruction identifying students who need to move to Tier 3.
Tier 3 Comprehensive assessment, diagnosis, applications for funding (where
Individual intervention appropriate) to support educational programing for individual students.
and support Working with teachers and parents to individually plan and implement
programs to develop specific communication skills and competencies.
Delivery may be by the speech pathologist or through an aide, teacher, or
trained assistant.
Individual programing to support children to access curriculum in the
classroom. For example, developing activities that target specific skills or
allow children to use existing skills within age-appropriate curriculum.
Targeted feedback and training for teachers regarding strategies that will
support learning for an identified child.
Monitoring student outcomes to determine if more or less intensive
support is needed by using objective information to determine if students
are meeting goals.

24 Speech Pathology Australia: Speech Pathology in Schools Project

Response-to-Intervention and literacy difficulties

The RtI model offers an alternative to the
discrepancy7 model and takes an evidence-
based approach to determining who should
qualify for intervention and when. It is also
predicated on the fact that any intervention
provided must be of the highest quality/based
on the best available evidence. For the RtI to
be successfully implemented, a whole-school
adoption is required.

Table 2
RTI tier Speech pathology roles
Tier 1 Evidence-based classroom instruction in conventional literacy is provided
All students in the to all students. For students who are commencing formal reading
school access and instruction, systematic synthetic phonics instruction has consistently
participate in an been shown to be more effective compared to alternate methods
inclusive curriculum of teaching such as analytic phonics or the three cueing system. As
speech pathologists, it may be possible for you to engage in observation
of students, discussions with classroom teachers, implementation of
systematic synthetic phonics instruction with a teacher in a class, and
possibly screening, to identify children who are not responding adequately
at Tier 1. It is these students who would then be provided with Tier 2
intervention in the area or areas of need identified.

Tier 2 Involves additional targeted intervention, for example a focus on phonemic

Focused support for awareness, phonics, oral language competencies and/or speech
students who need sound errors which usually lasts for about 10-20 weeks, in addition
additional supports to mainstream classroom instruction for those students who have not
to access general responded adequately or completely to Tier 1. Tier 2 intervention is
instruction provided in small groups and may be delivered by classroom teachers,
specialists and even by well-trained volunteers (with substantial
coaching and support provided). The intervention should target specific
skill areas as needed, such as phonemic awareness, decoding, and
grapheme-phoneme correspondences. Intervention can also target oral
language competencies and comprehension-related reading skills. Tier 2
intervention is typically delivered in either the classroom or as a withdrawal
group.
As a speech pathologist, you are well-equipped to deliver this level of
intervention directly or using indirect consultative methods whereby
classroom teachers or others become the agents of the intervention. It is
critically important to collaborate with the classroom teacher rather than
working in isolation as the more co-constructed the intervention goals
are, the better for the student. Given the overwhelming evidence that
children who present with reading difficulty at an early age will not meet
year-level expectations without additional support, it is important that
Tier 2 intervention commences in a timely manner in order to maximise a
student’s literacy growth.

7
The IQ-achievement discrepancy model assesses whether there is a significant difference between a student’s
scores on a test of general intelligence and scores on an achievement test. If a student’s score on the IQ test is
at least two standard deviations higher than his or her scores on an achievement test, the student is described as
having a significant discrepancy between IQ and achievement and, therefore, as having a learning disability.

Speech Pathology Australia: Speech Pathology in Schools Project 25

 Response-to-Intervention and literacy difficulties

RTI tier Speech pathology roles

Tier 3 A small proportion of students will inevitably have more severe difficulties
Individual intervention learning to read and spell. These students require Tier 3 intervention
and support which is more individualised and typically lasts for extended periods of
time. These students should receive evidence-based Tier 3 intervention
in order for optimal language and literacy gains to be realised. Tier 3
intervention is more individualised to the student’s needs and is delivered
one-to-one or perhaps in a smaller group with other students who have
similar intervention goals and importantly, should be provided with greater
intensity. For many students, the activities and strategies are similar to Tier
2 however there is:
• increased frequency of sessions per week,
• increased length of sessions,
• increased duration of the intervention from start to finish, and
• increased instructor expertise.

Useful references
Hempenstall, K. (2011). Sounding off about teaching children to read. Retrieved October 2017, from
https://www.theconversation.com/sounding-off-about-teaching-children-to-read-1012
Konza, D. (2014). Responding to the Evidence: Synthetic Phonics in Action. Retrieved October
2017, from https://www.ecu.edu.au/__data/assets/pdf_file/0006/647628/RESPONDING_TO_THE_
EVIDENCE.PDF
Moats[CT9], L. C. (1999). Teaching reading is rocket science: What expert teachers of reading
should know and be able to do.
Nation, K. (2017) Nurturing a lexical legacy: reading experience is critical for the development of
word reading skill. npj Science of Learning 2(3), 3.
Snow, P. C. (2016) Elizabeth Usher Memorial Lecture: Language is literacy is language – Positioning
speech-language pathology in education policy, practice, paradigms and polemics. International
Journal of Speech-Language Pathology 18(3), 216–228. http://www.tandfonline.com/doi/full/10.310
9/17549507.2015.1112837
Torgesen, J. K. (1998). Catch them before they fall. American Educator, 22, 32–41.
https://www.aft.org/sites/default/files/periodicals/torgesen.pdf

26 Speech Pathology Australia: Speech Pathology in Schools Project

The positive impact of providing best practice
support to students with SLCN
The features of effective practice in primary and
secondary schools, for all students, including
those with SLCN are numerous. The key ones
are discussed below.
Ensuring communication is embedded
at a universal level
For all students, there is increasing evidence
to show that a focus on students’ spoken
(including the use of additional or alternative
expressive modes, such as symbols, books
or boards) language in primary and secondary
schools can have an impact on achievement.
Using speaking and listening activities to
help students think for themselves has been
highlighted as indicative of an effective school.
The introduction of whole school level activities
such as a consistent approach to reinforcing
good listening in class leads to improved results
in English. Support to develop communication-
friendly environments in primary and secondary
schools is essential.
Skilled and confident staff can make a
positive impact
For all students, including those with SLCN,
what adults do can have a huge impact on their
communication and educational outcomes.
Simple strategies such as allowing more
processing time or directing positive feedback
towards social as well as academic behaviours
have been shown to increase engagement and
performance. Initiatives using guided learning
through portfolio work and concept maps have
been successful in supporting the transfer of
learning into practice.
Links with the curriculum
For all students, building speech, language
and communication skills teaching into
the curriculum has been shown to have
an impact both on the quality of teaching
and on social and academic outcomes for
students. The curriculum used in Australian
schools is the Australian Curriculum (www.
theaustraliancurriculum.edu.au). It is highly
recommended that speech pathologists have a
look at the year level curriculum and analyse the
language skills needed to access it. Consider
student language strengths and needs, and
work with teachers to address the gaps.
This represents a significant shift in approach
Speech Pathology Australia: Speech Pathology in Schools Project
for speech pathologists away from remediation
to supporting access and participation in the
curriculum thereby making language intervention
more meaningful for students. An approach
where specialists work closely together on
aspects of the curriculum has reported benefits
for both teachers and students. Working through
narratives is an example, through scaffolding
story or report writing, but also through creating
a communication-based curriculum or through
focused discipline specific vocabulary teaching.
A functional approach
All students can continue to need support with
aspects of language such as vocabulary and
grammar and the academic requirements of
language. However, it is also important to focus
on associated emotional and social aspects
such as friendship or independence. A focus on
these functional aspects of communication is
useful for the development of all students.
A strategy-focused approach
Successful learning occurs when students
reflect on their strengths and difficulties and
know what they are aiming for. The same
applies to language – being able to reflect on
and analyse language is central to developing
language. Students need to know “how”, rather
than just “what” to learn; strategies rather than
skills. Strategies such as listening to parents as
models, practising words and asking for help
have been identified as useful by young people.
Teaching strategies such as the use of visual
organisers, pause time for planning, and ways of
recognising feedback to support self-monitoring
can result in positive outcomes in both written
and spoken language.
Support at transition times
The transition from preschool to primary school,
from one year level to the next, from primary to
secondary school and from secondary school to
beyond school can be potentially difficult times
for all students academically, organisationally
and socially. The amount of support given by the
secondary school in skills such as note taking,
learning how to read a timetable, understanding
what a subject area is, how to manage a diary/
student planner, managing assessments/
assignments and ‘how to write an essay’ are
crucial to ensuring a successful experience. Not
27
 The positive impact of providing best practice
support to students with SLCN
surprisingly, because of their difficulties in all
of these areas, students with SLCN and their
families can find this a particularly stressful time.
Involving young people
Listening to the voices of students has been
shown to have an impact on policy and
practice, on learning, confidence – and also on
communication skills.
Students value a focus on communication in
school and are very able to say what adults
can do to support this. Students with SLCN
can reflect on their language strengths and
difficulties and develop good insight and
awareness of the outcomes they want. Involving
young people in assessment or activities shows
that they very often have different perspectives
and priorities than adults, which can be valuable
in planning support. While some young people
may feel support is unnecessary, others give
insight into what is most helpful, such as
collaborative goal setting, explicit teaching of
vocabulary and visual support or use of colour
coding. Without this involvement, there is a risk
of getting the focus of an intervention wrong.
With it, there is evidence that it can contribute to
improved engagement and behaviour.
8
Tier 2 vocabulary: high frequency words used in a variety of content domains that usually require explicit
instruction. Some examples include: complex, reasoned, contrast, hypothesise etc.
28 Speech Pathology Australia: Speech Pathology in Schools Project
Opportunities for specialist intervention
where difficulties are severe and
complex
For students with significant and often specific
SLCN there is a growing body of evidence
to show the benefit of focused, specialist
intervention. Students with significant SLCN
continue to need to be taught language skills
explicitly, but this needs to be planned within
the context of a school environment, which can
be challenging. The involvement of you as the
speech pathologist is crucial – either through
direct intervention or by training others. Groups
run by trained teaching assistants, focusing on
developing narrative or Tier 2 vocabulary8 and
planned into a mainstream timetable schedule,
showed improved language skills. Likewise,
specialised and differentiated speech and
language therapy programs, such as support
for the use of aided AAC systems within the
learning environment or visual support for
learning grammar, integrated into the curriculum
can support young people to achieve a full
range of academic and social outcomes.
Role of teachers and speech pathologists
in the educational setting
Speech pathologists can play many roles
supporting the development of speech,
language, communication, literacy and
numeracy skills of primary and secondary
students. Their roles include screening,
assessing, advocating, and designing
augmentative communication equipment in
addition to providing direct intervention with
students and indirect roles of consulting,
coaching, collaborating, team teaching and
training teachers and families. In some areas,
speech pathologists also function as case
managers, team leaders, and supervisors of
speech pathology assistants.
Speech Pathology Australia:
• endorses the critical role of speech
pathologists in prevention, identification,
and management of speech, language,
fluency and literacy difficulties from infancy
to adolescents;
• advocates that speech pathologists work
collaboratively with the education team to
provide language and literacy services;
• asserts speech pathologists should use
evidence-based approaches.
Those who have developed successful speech
pathology models in secondary schools and
have experience in using them emphasise the
need for flexibility using a mixture of approaches.
It is essential that there are shared beliefs
between you as the speech pathologist and
the school’s education team that Response-
to-Intervention services support a prevention
model, provide systematic, intense, and
evidence-based prevention/intervention, and
that all students can benefit from RTI.
Collaborative partnerships
The key components (McKean et al., 2016 for
establishing collaborative partnerships with a
school in the delivery of services to students with
speech, language and communication needs
are:
• establishing an interdisciplinary approach to
working with teachers;
• demonstrating that a collaborative working
relationship between yourself and the
school will be of value to student outcomes;
• ensuring that the service delivery model is
supported by teacher engagement;
Speech Pathology Australia: Speech Pathology in Schools Project
• providing collaborative in-service training
and coaching; and
• collaboration when planning and
implementing lessons.
• It is important to note the speech
pathologist and teacher can co-teach the
students in a classroom. Lessons can be
divided into teachable segments or the
class can be divided into groups with each
group receiving exposure to similar content
or one group led by the speech pathologist
receiving more support in the language
area.
Teacher-speech pathologist partnerships
are strengthened when both individuals
have attended professional development
integrating communication knowledge, with
knowledge about educational pedagogies and
the curriculum, and have the opportunities to
discuss and apply this information in their own
professional settings.
This approach requires collaboration at many
levels, including assessment, goal-setting,
planning, and implementation of intervention for
students with communication needs as well as
for students who are at risk for language and
learning problems.
Importantly, no one person or profession
has sufficient expertise to execute all of the
functions associated with providing educational
services to students with SLCN in the
classroom. By working together, an effective
speech pathologist–teacher collaboration has
the potential to support more students more
effectively in the classroom and lead to better
student outcomes.
The teacher–speech pathologist team identifies
concerns regarding student performance for
both identified students and total classroom
needs. By establishing collaborative concerns,
the team can determine relevant curricular and
speech-language goals for the whole class or
with individual students and their families. It
is imperative that a collaborative team avoid
planning activities before establishing the goals
they wish to achieve.
There are challenges to establishing speech
pathology–teacher collaborations as well.
Ideally we need to assist teachers to achieve a
shared understanding of your respective roles
and expertise as a necessary and first step to
building a collaborative relationship. Teachers
29
 Role of teachers and speech pathologists
in the educational setting

need to be assisted to acknowledge the added
value you as a speech pathologist can bring to
their educational context, and you as a speech
pathologist must be able to maintain your
intervention focus. A mutual acknowledgement
of each professions skills and knowledge base
and a shared language is also really important.
Teachers can take the opportunity to observe
and reinforce strategies being taught, and you
as a speech pathologist will gain a greater
understanding of the skills the student needs to
succeed in the classroom, curriculum and social
context. For students receiving intervention
services, in class intervention means that
valuable instructional time from their teacher is
not missed and promotes greater opportunities
for generalisation. As well, “at-risk” children who
would not otherwise receive speech pathology
services directly, may benefit from the enhanced
language environment achieved through your
collaboration with their teacher.
Communication regarding the whole service
with the principal of the school is also essential.
After a plan has been developed with a specific
teacher, you may need to inform the principal
about the plans you have put in place together.
Then check-in frequently and measure your
impact. Plans need to be well detailed and
include the consent of the teacher(s). When
you speak with the principal, it is essential you
use current terminology to describe how your
new approach fits into the way in which the
school provides their educational programs.
You and your teaching colleagues might also
invite the principal to visit during your time in the
classroom.
Your roles as the speech pathologist in schools
may include one or more of the following:
• Practitioner: undertaking assessment and
management of students’ learning needs;
• Consultant: providing information,
resources and advice on supporting the
learning of students with speech, language
and communication needs, to other
educators and families;
• Advocate and capacity builder: advocate
for changes to address policy or practice
barriers to involvement in activities
and participation, faced by children in
educational settings;
• Educational team member: working
collaboratively with a range of personnel;
• Coach/mentor: supporting educational
staff to develop their ability to provide
appropriate supports for students;\
• Educator: providing theoretical and
practical information about how SLCN and
language communication needs impact on
education outcomes across all curriculum
areas;
• Clinical supervisor of tertiary level
students: disseminating expertise regarding
the impact of communication, mealtime
support needs on educational outcomes
and the student’s well-being;
• Researcher: addressing professional and
service issues.

View videos of interviews

with principals, teachers,
speech pathologists and
parents.

Reference
McKean, C., Law, J., Laing, K., Cockerill, M., Allon-Smith, J., McCartney, E., & Forbes, J. (2016). A
qualitative case study in the social capital of co-professional collaborative co-practice for children
with speech, language and communication needs. International Journal of Language Communication
Disorders, 52(4), 389–539. doi:10.1111/1460-6984.12296

30 Speech Pathology Australia: Speech Pathology in Schools Project

What you need to consider when working
in schools
Before you begin work and while you are
working in schools, you need to consider a
number of issues. Some of the key ones include
workload management, service delivery options,
employment arrangements, clinical supervisions
and mentoring, resource requirements,
ownership of files and student information, and
andministrative and program delivery support.
Workload management
Your workload in your school needs to be
carefully managed, especially in the situation
where you are the only or first speech
pathologist the school has had. The following
issues need to be addressed.
• How you schedule workload responsibilities
which include direct and indirect services
(and administrative tasks) across your time
in a school is vital. It is recommended that
you negotiate your service and include
regular points of review.
• Determine whether there is a match or
mismatch between your time and workload.
If there is a mismatch it is essential to
document your concerns and to raise these
with the school.
• Determine what activities you think are
necessary to provide appropriate support
services for each student on the caseload.
Consideration must be given to best
practice interventions, (e.g. RtI).
• Start filling available slots and supportable
time estimates (additional time for all of the
support activities must be accounted for).
• Strive for a balance among the three tiers
of the RTI model and include a fourth
component, administrative/management
tasks.
• When all the timeslots are filled, your
caseload maximum has been reached.
When the workload responsibilities do not fit
into the time slots available, you may need
to discuss with the principal (or whomever
you are reporting to in the management of
the school) to explore possible options for
change. Flexibility becomes an important
consideration at this step.
Speech Pathology Australia: Speech Pathology in Schools Project
Service delivery options
Changing the way service is delivered to
students may result in a varied workload even
though the caseload number remains the same.
Consider “Who is your client?” Is the client the
school, the parent, the student, the teacher, the
class? This helps to frame expectations and
negotiations with the Principal and teaching staff
as well as workload management. Being clear
on what your role is within the school and what
you and the school hope to achieve through the
speech pathology service is critical to help you
manage your workload. The potential priorities
of a speech pathologist in any school are literally
endless so it is important you keep a clear line of
sight on your role and goals.
Employment arrangements
Speech Pathology Australia recommends to
all schools who are employing or contracting
a speech pathologist that they meet minimum
requirements for regulation of their practice. You,
the speech pathologist must:
• be a current financial practising member
of SPA with Certified Practising Speech
Pathologist CPSP status;
• have current (and an adequate level of)
professional indemnity insurance; and
• have a current working with children check.
Members of Speech Pathology Australia are
strongly encouraged to make a commitment
to read, understand and then apply SPA’s
Code of Ethics (2010) within all professional
interactions. It can be useful for you to explain
to a potential employer (school principal) how
CPSP membership ensures that you are meeting
the code. You can explain that it is similar to a
teacher being registered with a teaching board.
More information is available about Professional
Self-Regulation (PSR) on the SPA website.
Employee vs. independent contractor
Principals have been advised in this resource
that they will need to consider if they wish
to employ a speech pathologist directly (as
a school employee) or as an independent
contractor.
31
 What you need to consider when working
in schools
There may be several options such as:
• sharing a speech pathologist between
schools (e.g., same speech pathologist for
primary schools who feed students to the
secondary school); or
• the school employing their own speech
pathologist; or
• contracting a private practitioner to work in
their school as an independent contractor.
You as a speech pathologist may be employed
as a private practitioner to work with a school
as an independent contractor. You may be
engaged on a contractor’s agreement, engaged
to perform a specific task or you may be
engaged to provide a service under a contract of
indefinite duration.
In the latter case, it is important that you have
a well-planned written contract with the school.
This allows you and the school to identify the
working relationship, rights and responsibilities,
and expected outcomes before commencing
work at the school.
Alternatively, you may be engaged as an
employee. In this instance, like any other
employee, it is important that you receive a
position description with key selection criteria
(KSC). It has been recommended to school
principals that another speech pathologist
be a part of the interview panel and that your
references are substantiated.
If you are employed as a school employee,
then your employment conditions will need to
abide by the industrial agreement that covers
your employment. The Health Professional
and Support Services Award (2010) covers
employees (including speech pathologists)
working in employment arrangements whether
it be private practice, private health industry
and the public health sector. Awards and/
or terms can vary between states so you will
need to check the appropriate one. Some
organisations or individuals negotiate above
this award or provide additional benefits or
alternative working arrangements. This award
is seen as the basic entitlement. Search for
32 Speech Pathology Australia: Speech Pathology in Schools Project
the health professionals and Support Services
Award (2010) at FairWork Ombudsman: Award
Finder. FairWork have produced a pay calculator
to determine base pay rates, allowances and
penalty rates for the Health Professionals and
Support Services Award 2010. They also
provide information about pay obligations, pay
slips and superannuation. For advice about the
award, contracts and other employment issues,
Speech Pathology Australia members can
contact Anna Pannuzzo at Workplace Plus or on
0419 533 433 for free initial advice. Other useful
SPA documents which address awards, wages
and employment conditions; and employment/
contractor contracts for private practice are all
available under Professional Resources on the
SPA website:
SPA Professional Resources
Clinical supervision and mentoring
It is common practice in health professions for
practitioners to have formal requirements for
clinical supervision and mentoring to ensure their
practice is contemporary and evidence based.
Speech Pathology Australia advocates minimum
standards of professional support and clinical
supervision for speech pathologists including
newly graduated speech pathologists.
It is reasonable for the principal to ask you
what arrangements you have in place regarding
clinical supervision and mentoring. In an
employment situation, it is expected that you
would negotiate a need for supervision with the
principal as part of your employment conditions.
Speech Pathology Australia has information on
the role of professional support and supervision
standards for members.
Resource requirements
The cost of speech pathology services in
a school includes more than your salary or
contract costs. Consideration must be given
to the nature of the service, the number of
students requiring support, the wide range of
support needs within the local area, the number
of schools receiving service and any specialist
materials required. Speech pathology services
within a school require a budget including the
following:
• salaries and on-costs;
• administrative costs, (e.g. travel, postage,
telephone);
• professional development;
• educational materials for students, (e.g.
photocopying);
• purchasing and maintaining specialist
materials, (e.g. original assessments and
forms, software/ on-line resources); and
• operational costs, (e.g. utilities, cleaning).
Some of these resources will need to be
provided directly by a school and some by
yourself (if you are sub-contracting into the
school) or they may all be provided by the
school if you are employed directly. This will
need to be discussed before you begin work.
In each school where speech pathology services
are provided, you will require an appropriate
quiet, private room for some specific speech
pathology activities. Access to up to date
specialised assessments and intervention
equipment and tests is essential for evidence-
based practice. Principals have been advised to
consider how these resources will be provided
in situations where they directly employ you or if
they have chosen to use you as an independent
contractor. This should be discussed at the
interview stage (either for an employee or
contractor) to ensure that you and the principal
have a shared understanding of what is needed
and who will provide it.
Contracting a speech pathologist
Speech Pathology Australia: Speech Pathology in Schools Project
Ownership of files and student
information
It is recommended that you formally clarify the
situation regarding ownership and responsibility
of files in every school that you work in (either
as an employee or as a contractor) and have
this written into the contract. Generally, when
you as a health service provider creates a file,
you are the owner of that record. However, the
ownership of records can also be affected by the
contractual arrangements between you and the
school. Parents need to know where their child’s
information is being stored and who has access
to it.
Retention of Files
Administrative and program delivery
support
Like other educational staff, you will require
support for administrative duties including
answering phone calls, taking messages,
recordkeeping, data collection and the
preparation of materials for programs and in-
service provided by the school. The organisation
of parent meetings and obtaining consent
to work with students is another duty to be
negotiated when you are negotiating your
contract.
Depending on the purpose of your speech
pathology service in the school, it is likely that
you will need to ensure that processes for
collaborative program planning with teachers
is established. This may include negotiation
of teacher release time so that you and the
teachers can work together.
33
 Children from Culturally and Linguistically
Diverse Backgrounds (CALD)9)

According to the Australian Bureau of Statistics
(2017), many Australians do not speak English
at home; indeed in 2016, 72.7% of Australians
spoke only English at home. The most
frequently spoken other languages included
Mandarin 2.5%, Arabic 1.4%, Cantonese
1.2%, Vietnamese 1.2% and Italian 1.2%. In
2016, 66.7% of people were born in Australia,
whereas 34.4% of people had both parents born
overseas. To remain relevant and effective in the
changing landscape of the Australian population,
it is essential that your speech pathology
services are informed with sound knowledge
and equipped with the appropriate resources to
support students from culturally and linguistically
diverse (CALD) backgrounds.
It is also important to undertake culturally
sensitive services when working with Indigenous
Australian students. This will include awareness
of local (vs. individual students’) Indigenous
knowledge, customs, and approaches to
learning, education and health care. Speech
pathologists need to be aware of the features
of Aboriginal English compared with standard
Australian English and acknowledge that for
some children English (or Aboriginal English)
may not be a student’s first language, but may
be one of eight languages spoken (McLeod,
Verdon, & Bennetts Kneebone, 2014).
Verdon (2015) outlines six key principles for
speech pathologists to undertake culturally
competent practice. These are:
1) getting to know yourself; 2) knowing
and forming relationships with families and
communities; 3) setting mutually motivating
goals; 4) using appropriate tools and resources;
5) collaborating with other key people, and 6)
being flexible: one size does not fit all.
Speech Pathology Australia (2016 a, b) has
published clinical guidelines and a position paper
titled Working in a Culturally and Linguistically
Diverse Society that provides resources, and
additional resources are found below.
Prior to planning assessment and intervention,
you will need to undertake a comprehensive
case history with individuals and/or their
family. Additional information is required from
individuals from CALD backgrounds including a
comprehensive language profile and information
about their beliefs, concerns and reasons for
seeking help as these may differ from dominant
western perspectives on health and disability.
Case history information should be obtained in a
culturally respectful and ethical way. Often family
members are asked to complete a case history
form. However, this may not be appropriate as
families may not read or speak English fluently
or understand western medical questions and
concepts. The use of an interpreter, multicultural
worker, or cultural broker from the family’s
cultural background may be required in order
to make families feel more comfortable in the
clinical setting, to explain concepts and to
accurately collect case history information during
an interview.
Once you are aware of a student’s specific
language and culture from the information
collected in the case history interview, you
should obtain information about the features of
significant cultural and linguistic influences, as
well as the typical developmental characteristics
of the language(s)/dialect(s) that are spoken or
signed. When explaining the assessment and
intervention process to the family, you should be
sensitive to their reactions. In certain cultures it
may be offensive or cause “shame” to challenge
a person’s abilities or to use a label to diagnose
difficulties. Therefore, cultural knowledge and
understanding on your part is essential for
engaging in culturally competent practice with
diverse families.
When assessing multilingual speakers it is
important to distinguish between an underlying
speech and/or language disorder (which can
be expected to affect learning in the home
language(s) as well as English) and language
differences which arise from learning a second
language. Determining whether speech and
language learning difficulties are evident in
each language is most appropriate for the
identification of speech and/or language disorder
in people from CALD backgrounds. Practical
considerations may, however, make this difficult.

9
It takes up to 5–7 years of exposure to a second language in order to be able to adequately complete standardised
testing; hence, there is a need to use other forms of assessment (criterion referenced procedures, observation,
language sampling, dynamic assessment) for children who are learning English as an additional language
(Roseberry-McKibbin, 2007).

34 Speech Pathology Australia: Speech Pathology in Schools Project

It is important that assessment take place in individual’s contexts. Factors to be taken into
the dominant language, as assessment in the account include:
non-dominant language may falsely suggest
• family preferences and attitudes;
language disorder due to a lack of exposure or
proficiency in this language. • the range of linguistic and cultural contexts
in which a person participates;
Assessment of multilingual speakers with
acquired speech and/or language disorders • current/past proficiency in both languages;
must consider patterns of use in both
• levels of English proficiency within the
languages. It is important to assess the
home;
communicative contexts in which each language
is needed. Assessment in all the multilingual • the availability of resources to support
student’s languages is recommended. intervention in the home language; and
The provision of intervention for speech, • the speech pathologist’s skills in languages
language and communication difficulties in all other than English.
of the languages spoken by an individual is the
Additionally, many factors need to be taken
current recommendation for best practice. Much
into account when selecting and implementing
research has shown that often intervention is
an alternative or augmentative communication
only provided in the language of the speech
system for use in families from CALD
pathologist (usually English) and not in the
backgrounds.
languages spoken by the person receiving
intervention. However, intervention in the home Finally, students, families, schools and
language has been found to have positive effects communities are excellent resources for
on the development of additional languages. understanding students’ cultures and languages.
Participate in cultural activities and events in
Decision-making around the choice of
order to learn and make partnerships that will
language(s) for intervention must be done
benefit your students.
in collaboration with the family and teacher
to facilitate optimal participation in all of an

Speech Pathology Australia: Speech Pathology in Schools Project 35

 Children from Culturally and Linguistically
Diverse Backgrounds (CALD)9)

Free resources for speech pathologists

McLeod, S. (2017). Multilingual children’s speech [website]. Retrieved October 2017, from http://
www.csu.edu.au/research/multilingual-speech/home
McLeod, S., Verdon, S., & International Expert Panel on Multilingual Children’s Speech. (2017).
Tutorial: Speech assessment for multilingual children who do not speak the same language(s) as the
speech-language pathologist. American Journal of Speech-Language Pathology, 26(3), 691–708.
http://www.dx.doi.org/10.1044/2017_AJSLP-15-0161
Speech Pathology Australia (Verdon, S., Armstrong, H., Basso, R., Blake, H., Crowe, K., Heine,
C., Hopf, S., Huang, A., McLeod, S., Ph-m, B., Walker-Smith, K., & Webster, K.). (2016). Clinical
guideline: Working in a culturally and linguistically diverse society. Melbourne, Australia: Speech
Pathology Association of Australia.
Speech Pathology Australia (Verdon, S., Armstrong, H., Basso, R., Blake, H., Crowe, K., Heine, C.,
Hopf, S., Huang, A., McLeod, S., Ph-m, B., Walker-Smith, K., & Webster, K.) (2016). Working in a
culturally and linguistically diverse society. Position paper. Melbourne, Australia: Speech Pathology
Association of Australia.
Paradis, J., Emmerzael, K., Sorensen Duncan, T. (2010). Assessment of English language learners:
Using parent report on first language development. Journal of Communication Disorders, 43, 474-
497. www.ualberta.ca/linguistics/cheslcentre/questionnaires

References
Australian Bureau of Statistics (2017). 2016 Census QuickStats. Retrieved October 2017, from www.
censusdata.abs.gov.au/census_services/getproduct/census/2016/quickstat/036
Genesee, Fred, Johanne Paradis, and Martha B. Crago. Dual language development & disorders: A
handbook on bilingualism & second language learning, Vol. 11. Paul H Brookes Publishing, 2004.
Roseberry-McKibbin, C. (2007). Language disorders in children: A multicultural and case
perspective. Boston, Pearson.
McLeod, S., Verdon, S., & Bennetts Kneebone, L. (2014). Celebrating young Indigenous Australian
children’s speech and language competence. Early Childhood Research Quarterly, 29(2), 118-131.
doi:10.1016/j.ecresq.2013.11.003
Verdon, S. (2015). Enhancing practice with culturally and linguistically diverse families: Six key
principles from the field. Journal of Clinical Practice in Speech-Language Pathology, 17(1), 2–6.

36 Speech Pathology Australia: Speech Pathology in Schools Project

The different needs of rural and regional schools
Service delivery within remote, rural and regional
areas of Australia places specific demands on
the speech pathology profession. At present,
there is an increased obligation on you, the
speech pathologist to provide the most effective
service possible, in the most efficient and
cost-effective manner in order to achieve a
greater throughput of clients. If you run a private
practice, you may have a considerable waiting
list and already be unable to see as many clients
as you wish.
An increased focus on evidence-based practice
challenges the profession to use intervention
methods which have been shown to be both
effective and efficacious.
Telepractice considerations
Telepractice has the same delivery but there
are technical and privacy considerations. Think
about bandwidth and the platform used as
schools will have specific requirements and
are not likely to be able to use all platforms.
Consider collaborating with staff, and staff
requirements for provision of support through
telepractice.
Telepractice in Speech Pathology
Position Statement
Working with other speech pathologists
(dual servicing)
Dual Servicing in Speech Pathology
Position Statement
Dual servicing in speech pathology occurs
when a client accesses speech pathology
services from two or more speech pathologists,
frequently from different organisations or
services, at the same time.
Speech Pathology Australia has determined
that there may be some occasions where
dual servicing in speech pathology would not
achieve positive outcomes for a child or young
Speech Pathology Australia: Speech Pathology in Schools Project
person and thus would not be recommended.
All speech pathologists involved in the dual
servicing arrangement must be cognisant of the
fact that they are equally ethically responsible
for ensuring that they work cooperatively and
collaboratively and that the service they provide
is appropriate, evidence based and consistent
with the client’s need.
When dual servicing occurs it will require careful
planning and coordination in order to maximise
outcomes and not compromise the benefit to
the client. In particular, if a client requests that an
external speech pathologist provide a service in
a school, you, the speech pathologist must:
• gain permission to see the client from the
person responsible (for example, the parent
and school principal);
• familiarise yourself with any policies and
procedures that the school may have about
external providers coming into that facility;
and
• negotiate the service agreement in
consultation with the principal and any other
professionals involved.
Each of the speech pathologists involved in the
dual servicing arrangement must contribute
to the development of the client’s speech
pathology service plan. From the outset,
clear lines of communication will need to be
established between all those involved in the
dual servicing arrangement.
The two, or more, speech pathologists in
consultation with the client, caregiver (if
applicable), and any other professionals involved
will need to develop a speech pathology service
plan which includes:
• the overall goals to be worked on;
• a breakdown of the goals to be worked on
by each speech pathologist;
• specific roles and responsibilities for each
speech pathologist;
37
 The different needs of rural and regional schools
• how often the therapy will occur;
• how home practice will be managed;
• how often the team will communicate and
how that communication will occur.
• how issues will be dealt with;
• when and how the team is going to review
and evaluate the delivery of the dual
services so that they ensure it continues to
meet the needs of the client.
38 Speech Pathology Australia: Speech Pathology in Schools Project
A client who is accessing a speech pathology
service should not be excluded from accessing
another speech pathology service on the basis
of already receiving a service. Speech Pathology
Australia is aware that some speech pathologists
work in organisations with a policy/policies
that prohibit or discourage dual servicing. SPA
believes that all clients should have equal access
to services. Simply having access to one speech
pathologist should not be the reason why the
client is prohibited from accessing another
service.
Terminology
Terminology

Developmental language disorder is used to refer to conditions with no known differentiating

condition. However, this does not include any nonverbal criteria – children with low normal-range
nonverbal ability can be included as cases of DLD. Generally children with intellectual disability will be
identified as having a language disorder with an identifiable genetic or neurological cause.
It is anticipated that the word “developmental” would be dropped in adulthood, leaving the diagnosis
“language disorder” – there is not a specific agreed age at which the change is made, and may
depend on the individual’s choice.
Language disorder is the adopted term for children who are likely to have language problems
enduring into middle childhood and beyond, with a significant impact on everyday social interactions
or educational progress.
Where language disorders occur as part of a more complex pattern of impairments it is suggested
that the term “language disorder associated with X” is used, where X is the differentiating condition.
Differentiating conditions may include ASD, genetic conditions such as Down syndrome and sensori-
neural hearing loss.

References
Bishop, D. V. M. Snowling, M. J., Thompson, P. A., & Greenhalgh, T. (2016). CATALISE: A
multinational and multidisciplinary Delphi consensus study. Identifying language impairments in
children. PLoS One 11(7), e0158753[CT26].
Dorothy Bishop gave a lecture for RCSLT about the project. You can view the YouTube clip here and
the summary in the RCSLT Bulletin.
Susan Ebbels also summarised the project here.
This summary has a good diagram of the questions to consider in reaching a diagnosis of DLD, and
also provides links to good research papers including Ebbels’ article in the International Journal of
Language and Communication Disorders.

Team teaching
The classroom teacher and the speech pathologist each teach from their respective areas of
expertise. Prior planning must take place for a team teaching model to be successful. The speech
pathologist and the classroom teacher must decide how they will divide the workload responsibilities
related to the classroom organisation, the type of lesson design, the materials, the behaviour
management or conflict resolution approach, time management, the materials, modifications and/
or adaptations needed, the assessment activities, and accountability exercises, (e.g. who conducts
the parent–teacher conferences). Team teaching may prove to be very time-consuming in the early
stages. Once the groundwork has been established, however, all parties benefit from providing
services to students.

Speech Pathology Australia: Speech Pathology in Schools Project 39

Resources

Other resources
Developmental language disorder
RALLI (Raising Awareness of Language Learning Impairment) now RADLD
Raising Awareness of Developmental Language Disorder Youtube clip

The Communication Trust: www.thecommunicationtrust.org.uk

LINK–S: www.linksresources.com.au

Learning Difficulties Australia: www.ldaustralia.org

Learning Difficulties Coalition of NSW: www.ldc.org.au/factsheets.html

Motif – Macquarie Online Test Interface: www.motif.org.au/home

Snowling, Maggie – Dyslexia and developmental language disorder: same or different?

Blog post

Talking Point: www.talkingpoint.org.uk

 References

Prevalence and background information

Bercow, J. (2008). The Bercow Report: A review of services for children and young people (0–19)
with speech, language and communication needs.
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multinational and multidisciplinary Delphi consensus study. Identifying language impairments in
children. PLoS One, 11(7), e0158753.
Clegg, J., et al. [CT29](2005). Developmental language disorders – a follow-up in later adult life:
Cognitive, language and psychosocial outcomes. Journal of Child Psychology and Psychiatry, 46(2),
128–149.
The Communication Trust (2017) Communication Commitment. UK. www.thecommunicationtrust.
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nationally representative sample of 4-to 5-year-old children. Journal of Speech, Language, and
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McLeod, S., et al. (2015). NAPLAN outcomes for children identified with speech and language
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McLeod, S., et al.(2016). Multilingualism and speech-language competence in early childhood:
Impact on academic and social-emotional outcomes at school. Early Childhood Research Quarterly
34, 53–66.
Snow, P. C., & Powell, M. B. (2011). Oral language competence in incarcerated young offenders:
Links with offending severity. International Journal of Speech-Language Pathology, 13(6), 480–489.
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What are juvenile offenders trying to tell us? Children and Society 22(1), 16–28.
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(March 2017).

42 Speech Pathology Australia: Speech Pathology in Schools Project

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46 Speech Pathology Australia: Speech Pathology in Schools Project

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government schools in New South Wales. Melbourne: Speech Pathology Australia.

Appendix

Australian Capital Territory – Education Directorate www.education.act.gov.au

New South Wales – Department of Education www.education.nsw.gov.au
Northern Territory – Department of Education www.education.nt.gov.au
Queensland - Department of Education and Training www.education.qld.gov.au
South Australia – Department for Education and Child development www.decd.sa.gov.au/department
Tasmania – The Department of Education www.education.tas.gov.au
Victoria – Department of Education and training www.education.vic.gov.au
Victoria – Inclusive education www.education.vic.gov.au
Western Australia – The Department of Education www.education.wa.edu.au

Speech Pathology Australia: Speech Pathology in Schools Project 47