School-Based vs. Medically-Based Speech/Language Therapy

The primary goal of school-based speech therapy/language therapy is to improve communication skills that adversely affect students' ability to participate and learn during the school day.

A student can have a speech delay and not qualify for school-based speech therapy if the teachers do not notice it, and there is no other negative impact on education.

If a student gets all As, she can qualify for speech services if she avoids answering questions because she is embarrassed about how she talks.

Eligibility is a team decision.

Core Facts About School-Based Speech and Language Therapy

1. Governed by IDEA

⭐Services are provided under the Individuals with Disabilities Education Act (IDEA).

⭐Services must be provided in the Least Restrictive Environment. (LRE)

⭐Therapy is offered as a special education program/related service (depending on the state) to help students access and benefit from their education.

2. Eligibility is Based on Educational Impact

⭐A student must have a speech or language impairment that adversely affects educational performance.

⭐This differs from a clinical or medical diagnosis, where therapy can be provided without academic impact.

3. Common Areas Addressed

⭐Articulation/Phonology: Correct production of speech sounds.

⭐Language Disorders: Includes receptive, expressive, and pragmatic (social) language.

⭐Fluency: Addressing stuttering

⭐Voice/Resonance Disorders: Abnormal vocal quality, pitch, or loudness.

⭐Augmentative and Alternative Communication (AAC): For students with limited verbal output.

4. Services Are Individualized

⭐Each student receives services through an Individualized Education Program (IEP).

5. There are Several Models of Services

⭐Pull-out sessions

⭐Push-in/classroom-based services

⭐Consultation with teachers

⭐Group or individual sessions

6.  Collaboration Is Key

SLPs collaborate with: ⭐Teachers

⭐Parents

⭐Special educators

⭐Occupational and physical therapists

⭐School psychologists

7. Emphasis is on Educational Relevance

⭐Therapy targets communication skills that impact academic success, such as:

⭐Following directions

⭐Participating in discussions

⭐Understanding figurative language

8. SLPs Play a Role in RTI/MTSS

⭐SLPs may be involved in Response to Intervention (RTI) or Multi-Tiered Systems of Support (MTSS), providing early intervention and supporting general education students.

SLPs must adhere to:

⭐State Education Codes

⭐ASHA Code of Ethics

⭐IDEA Regulations

Speech-language pathologists (SLPs) serve separate roles depending on their setting. Understanding these differences helps SLPs, educators, families, and administrators collaborate more effectively to support communication development.

School-Based vs. Medically Based Speech/Language Therapy

Topic	School-Based	Medical Model
1. Setting and Goals	School-Based Therapy: Driven by educational impact. Services must support access to and progress in the general curriculum.	Medical Model: Services are provided in a medical setting.
2. Eligibility and Service Delivery	School-Based: Eligibility is determined through the IEP process; services are provided only if the disorder adversely affects educational performance.	Medical Model: Focuses on diagnosis and remediation of communication disorders, regardless of educational impact.
3. Documentation and Goals	School-Based: Goals are aligned with IEP standards, often tied to academic content.	Medical Model: Goals are based on developmental norms or functional communication milestones.
4. Collaboration	School-Based: Frequent collaboration with teachers, special educators, and other related service providers.	Medical Model: Collaboration may include other healthcare professionals (e.g., occupational therapists, physical therapists, physicians).
5. Family Involvement	School-Based: Parents are part of the IEP team and may attend annual meetings, but day-to-day interaction is limited. Quarterly progress is reported.	Medical Model: Parents often participate directly in sessions and receive regular updates.

Examples of Ineligibility for School-Based Speech/Language Therapy

1. No Adverse Educational Impact

⭐A student has a mild articulation error (e.g., lisp, /r/ distortion), but it does not interfere with academic performance, peer interactions, or classroom participation.

2. Age-Appropriate Errors

⭐A young student presents with speech sound errors that are developmentally appropriate for their age.

⭐Example: A 4-year-old substituting “w” for “r” (saying “wabbit” for “rabbit”).

3. Dialect or Accent Differences

⭐A student speaks with a regional dialect or foreign accent that differs from mainstream English but is not considered a disorder.

⭐Example: African American Vernacular English (AAVE), Spanish-influenced English.

4. English Language Learner (ELL) Without Disorder

⭐A student learning English as a second language shows language differences, but no true language disorder is present in their native language or English.

5. Clinical Diagnosis Without School Impact

⭐A student receives a diagnosis from a private SLP or medical provider (e.g., expressive language disorder), but in school, they are meeting academic expectations and functioning well socially.

6. Behavioral Concerns Only

⭐A student has behavioral or attention issues (e.g., impulsivity, poor listening) without a speech/language impairment. These would typically be addressed through behavioral interventions, not SLP services.

7. Resolved Issues

⭐ A student was previously in speech therapy but now demonstrates age-appropriate communication skills, and testing and teacher input confirm no current needs.

8. Parent/Private Request Alone

⭐A parent requests school speech services based on a private evaluation or preference, but the school evaluation finds no qualifying disability under IDEA criteria.

9. Not Meeting Criteria in State Guidelines

⭐A student’s skills fall in a "gray area"—not quite typical, but also not meeting the cutoff scores or observational criteria set by state eligibility guidelines.

Questions? Email BSpeechieTherapy@gmail.com