It was a good thing I was sitting down. My knees were vibrating. My stomach was in knots. I was hoping my voice wouldn’t shake too. I wasn’t the focus, although it did not feel like that to me. It was supposed to be a “pre-hearing”, whatever that was. Nothing to worry about, the lawyer said. But it was in a law office. There were lots of people in suits. It was scary.
The two parents were sitting tight-faced on one side of the table, flanked by their lawyers. We were on the other side, myself, the school principal, a school board official, and school board lawyer. We were there because the parents were contesting the school’s decision to not offer their son weekly speech therapy in school.
I was a public school speech-language pathologist. I was assigned ten schools, eight elementary schools and two high schools. Most of my schools had at least one dedicated special education class, in those days before integration. I traveled around to my schools weekly. The caseload was impossible. In this particular school, in this particular class, I was helping the classroom teacher to incorporate the students’ various language goals into the daily curriculum. A couple of students were receiving some very limited, short, individual therapy sessions. The parents of the student in question wanted individual therapy for their son. Their son had a diagnosed speech and language disorder. He was “coded” to receive special education services. Didn’t that mean all required services, the parents reasoned?
The parents’ lawyer asked me whether, in my professional opinion, wasn’t it a better use of my time to provide services to his clients’ son, who was “less handicapped” than a more severely impaired classmate , who might not benefit as much? There were a lot of questions about test scores, percentiles and age levels, as if these indicators were the only and absolute factors to decide who was helped, and who wasn’t. I was horrified. I tried to explain the complexities of clinical decision-making. The lawyer persisted in asking for “yes” or “no”. I remember the school-board lawyer taking over the discussion. There was a lot of talk about individual education plans, classroom support and consultation. At the end, no one went away happy.
Were the parents justified in their legal challenge? I understood why they felt compelled to do it. It wasn’t personal. For me it underlined the urgency in our profession for research in treatment efficacy, outcome measurements and the need for research to reflect more clearly the complexities of making functional changes for clients with communication challenges. Research had to reflect that clinically, “normal” is not just a number. It also made an indelible impression on my professional life. It is sometimes hard, faced with clinical realities, to think of research as having anything to do with the real world of daily practice. The need to continue to read, study, and struggle to apply research to practice was thrown into sharp focus that day. Fast forward twenty five years.
We know a lot more about communication, development, the brain. Educational practices evolve. Evidence-based best-practice principles are pervasive as we train the next generation of health care and educational professionals. Creativity is key. With delight, I see changing service delivery models, development of “ecologically valid” rubrics for assessment and outcome data, use of standardized assessment tempered with client input, real world possibilities factored in. We know more about what works, what is ideal for certain communication challenges. But life is rarely ideal.
In recent years at A.S.H.A convention, I attended a seminar on language sample analysis. I usually attend anything the Wisconsin group do, though I realize S.A.L.T. database research is not to everyone’s taste. Usually the small room is not over full. This time the room was packed. Afterwards there was a line of people wanting to ask the presenters questions. One young woman had a fistful of papers, obviously a language sample, she wanted help with. She began by saying that her student had increased his MLU and some of the other measures had improved, but how was she going to make him perform within one standard deviation of the mean? The room echoed with others asking the same question. The presenter said the group will always look at anyone’s transcript, but really just to check the coding and make sure the programme was able to do the analysis accurately. The purpose of the database project was not meant to be such a definitive indicator of all “normal” in expressive language. The young woman turned to leave and we walked out of the room together. She was almost in tears. I observed that her student seemed to have improved. She said yes, but the parents were challenging her “numbers” on the transcript analysis, and saying she wasn’t doing her job, because their son’s “numbers” weren’t “normal” yet. A formal complaint to her employer had been made. I asked whether her employer was supporting her in presenting the whole clinical picture, not just a number? She laughed and said it was all about the number, the score, the percentage.
When I hear stories like this I wonder, what have we done in twenty five years? What this young clinician was obligated to do was not evidence-based best-practice. If we want to attract young clinicians to school based work and retain them, there’s still work to be done. I’m just saying….
No comments:
Post a Comment