Preferred Practice Patterns for the Profession of Speech-Language Pathology

Preferred Practice Patterns

About this Document: Approved by the ASHA Legislative Council, November 2004

Preamble to the Preferred Practice Patterns for the Profession of Speech-Language Pathology
- Preamble
- ASHA Policy Documents and Selected References
Fundamental Components and Guiding Principles
- Individuals Who Provide the Service(s)
- Expected Outcome(s)
- Clinical Indications
- Clinical Process
- Setting, Equipment Specifications, Safety and Health Precautions
- Documentation
- ASHA Policy Documents and Selected References
#1. Speech-Language Screening—Children
#2. Speech-Language Screening—Adults
#3. Swallowing Screening
#4. Audiologic Screening
#5. Consultation
#6. Counseling
#7. Follow-Up Procedures
#8. Prevention Services
#9. Elective Communication Modification
#10. Comprehensive Speech-Language Assessment
#11. Communication Assessment—Infants and Toddlers
#12. Communication Intervention—Infants and Toddlers
#13. Preschool Speech-Language and Communication Assessment
#14. Preschool Speech-Language and Communication Intervention
#15. Speech Sound Assessment
#16. Speech Sound Intervention
#17. Spoken and Written Language Assessment—School-Age Children and Adolescents
#18. Spoken and Written Language Intervention—School-Age Children and Adolescents
#19. Speech-Language Assessment for Individuals Who Are Bilingual and/or Learning English as an Additional Language
#20. Spoken and Written Language Assessment—Adults
#21. Spoken and Written Language Intervention—Adults
#22. Cognitive-Communication Assessment
#23. Cognitive-Communication Intervention
#24. Severe Communication Impairment Assessment
#25. Severe Communication Impairment Intervention
#26. Augmentative and Alternative Communication (AAC) Assessment
#27. Augmentative and Alternative Communication (AAC) Intervention
#28. Prosthetic/Adaptive Device Assessment
#29. Prosthetic/Adaptive Device Intervention
#30. Fluency Assessment
#31. Fluency Intervention
#32. Motor Speech Assessment—Adults
#33. Motor Speech Intervention—Adults
#34. Voice Assessment
#35. Voice Intervention
#36. Resonance and Nasal Airflow Assessment
#37. Resonance and Nasal Airflow Intervention
#38. Orofacial Myofunctional Assessment
#39. Orofacial Myofunctional Intervention
#40. Swallowing and Feeding Assessment—Children
#41. Swallowing and Feeding Intervention—Children
#42. Swallowing Function Assessment—Adults
#43. Swallowing Function Intervention—Adults
#44. Assessment of Cognitive-Communication and/or Language Abilities Associated With Auditory Processing Disorders (APD)
#45. Intervention for Cognitive-Communication and/or Language Impairments Associated With Auditory Processing Disorders (APD)
#46. Aural Rehabilitation Assessment
#47. Aural Rehabilitation Intervention

Preamble to the Preferred Practice Patterns for the Profession of Speech-Language Pathology

This revision was completed by the Ad Hoc Committee for the Review and Revision as Needed of the Preferred Practice Patterns for the Profession of Speech-Language Pathology, which was appointed in 2003. Members of the committee include Ron Gillam (chair), Tempii Champion, Leora Cherney, Nickola Nelson, Mark Ylvisaker, and Janet Brown (ex officio). Celia Hooper, 2003–2005 vice president for professional practices in speech-language pathology, served as monitoring vice president. The committee is indebted to many ASHA members who contributed their expertise in the development or review of this document, including John Riski, Larry Shriberg, Teri Bellis, Alina de la Paz, Travis Threats, and the steering committees of the Special Interest Divisions, and to ASHA staff members from the speech-language pathology and audiology professional practices and multicultural affairs units for their careful review.

Preamble

The American Speech-Language-Hearing Association (ASHA) established the Preferred Practice Patterns for the Profession of Speech-Language Pathology to enhance the quality of professional services. These statements were developed as a guide for ASHA-certified speech-language pathologists and as an educational tool for other professionals, members of the general public, consumers, administrators, regulators, and third-party payers. The practice patterns apply across all settings in which the procedure is performed and are to be used with sensitivity to and knowledge of cultural and linguistic differences and the individual preferences and needs of clients/patients and their families. In publishing these statements, ASHA does not intend to exclude members of other professions or related fields from rendering services within their scope of practice for which they are competent by virtue of education and training.

The Preferred Practice Patterns provide an informational base to promote delivery of quality patient/client care. They are sufficiently flexible to permit both innovation and acceptable practice variation, yet sufficiently definitive to guide practitioners in decision making for appropriate clinical outcomes. They further provide a focus for professional preparation, continuing education, and research activities. However, the Preferred Practice Patterns are neither a yardstick to measure acceptable conduct nor a set of aspirational principles. Rather, they reflect the normally anticipated professional response to a particular set of circumstances. There may be legitimate reasons for departing from the practice patterns. The ultimate judgment regarding the appropriateness of any given procedure is made by the speech-language pathologist in light of individual circumstances often based on collaborative decision making with the client/patient, family/caregivers, and other professionals. Practitioners, however, need to be aware of the Preferred Practice Patterns, carefully considering the justifications for alternative practices.

These generic and universally applicable practice patterns were developed to be consistent with the World Health Organization's International Classification of Functioning, Disability and Health (WHO, 2001) as well as the framework of the Scope of Practice for Speech-Language Pathology (ASHA, 2001). For each procedure, the Preferred Practice Patterns for the Profession of Speech-Language Pathology specify the professionals who perform the procedure, expected outcome(s), clinical indications for the procedure, clinical processes, setting and equipment specifications, safety and health precautions, and documentation. Adherence, however, to the Preferred Practice Patterns for the Profession of Speech-Language Pathology does not guarantee a desired outcome.

It is useful to regard these practice patterns within a conceptual framework of ASHA policy statements that range in scope and specificity. Figure 1 illustrates these categories of policy statements for professional practice from broad to narrow in scope, and general to detailed in content, within the context of the ASHA Code of Ethics (2003). These categories are defined as follows:

Scope of Practice Statement: A list of professional activities that define the range of services offered within the profession of speech-language pathology.
Preferred Practice Patterns: Statements that define generally applicable characteristics of activities directed toward individual patients/clients and that address structural requisites of the practice, processes to be carried out, and expected outcomes.
Position Statements: Statements that specify ASHA's policy and stance on a matter that is important not only to the membership but also to other outside agencies or groups.
Practice Guidelines: A recommended set of procedures for a specific area of practice, based on research findings and current practice. These procedures detail the knowledge, skills, and/or competencies needed to perform the procedures effectively.

Figure 1.

In applying the practice patterns, all ASHA members and ASHA-certified professionals are bound by the ASHA Code of Ethics. All professional activity is consistent with the Code of Ethics. Particularly relevant to clinical practice are those provisions for holding paramount the welfare of persons served and providing only those clinical services for which one is competent, considering education, training, and experience.

The original Preferred Practice Patterns (approved by the ASHA Legislative Council in 1992) addressed the professions of speech-language pathology and audiology and were the product of extensive peer review by all segments of the professions of speech-language pathology and audiology. In clinical areas of controversy, working groups were formed to reach consensus on accepted practice patterns. The 1997 version and the current version of the Preferred Practice Patterns for the Profession of Speech-Language Pathology address only the profession of speech-language pathology and were revised by an ad hoc committee of ASHA members in collaboration with expert members as individuals or groups. Each version was circulated for select and widespread peer review by speech-language pathologists and audiologists. As a result, the practice patterns represent the consensus of the members of the professions after they considered available scientific evidence, existing ASHA and related policies, current practice patterns, expert opinions, and the collective judgment and experience of practitioners in the field. Requirements of federal and state governments and accrediting and regulatory agencies also have been considered.

The Preferred Practice Patterns reflect current practice based on available knowledge. Because speech-language pathology is a dynamic and continually developing profession, advances are expected to change current practice patterns. Similarly, advances in educational and health care policy and practices influence professional practices. The practice patterns are updated periodically to reflect new clinical, scientific, and technological developments that occur inside and outside the profession of speech-language pathology.

ASHA Policy Documents and Selected References

American Speech-Language-Hearing Association. (1987). Classification of speech-language pathology and audiology procedures and communication disorders. Asha, 29, 49–53.

American Speech-Language-Hearing Association. (1993). Definitions of communication disorders and variations. Asha, 35(Suppl. 10), 40–41.

American Speech-Language-Hearing Association. (2001). Scope of practice in speech-language pathology. Rockville, MD: Author.

American Speech-Language-Hearing Association. (2002). Knowledge and skills for supervisors of speech-language pathology assistants. ASHA Supplement, 22, 113–118.

American Speech-Language-Hearing Association. (2003). Code of Ethics (revised). ASHA Supplement, 23, 13–15.

American Speech-Language-Hearing Association. (2004). Guidelines for the training, use, and supervision of speech-language pathology assistants. Rockville, MD: Author.

American Speech-Language-Hearing Association. (2004). Knowledge and skills needed by speech-language pathologists and audiologists to provide culturally and linguistically appropriate services. ASHA Supplement 24, 152–158.

American Speech-Language-Hearing Association. (2004). Position statement for the training, use, and supervision of support personnel in speech-language pathology. Rockville, MD: Author.

American Speech-Language-Hearing Association. (2004). Scope of practice in audiology. ASHA Supplement 24, 27–35.

World Health Organization. (2001). International classification of functioning, disability and health. Geneva, Switzerland: Author.

Fundamental Components and Guiding Principles

Individuals Who Provide the Service(s)

Speech-language pathologists providing specific services hold the appropriate credentials, including ASHA certification, and have pertinent training and experience.
Speech-language pathology assistants who provide screening and/or intervention services do so under the supervision of an ASHA-certified speech-language pathologist (in accordance with the current Guidelines for the Training, Credentialing, Use, and Supervision of Speech-Language Pathology Assistants). The speech-language pathologist who supervises speech-language pathology assistants maintains full responsibility for the quality and appropriateness of services provided to the patient/client.
Speech-language pathologists may provide services as part of a collaborative team.

Expected Outcome(s)

Comprehensive assessment, intervention, and support address the following components within the World Health Organization's International Classification of Functioning, Disability, and Health (2001) framework.
- Body structures and functions:
  - Identify and optimize underlying anatomic and physiologic strengths and weaknesses related to communication and swallowing effectiveness. This includes mental functions such as attention as well as components of communication such as articulatory proficiency, fluency, and syntax.
- Activities and participation, including capacity (under ideal circumstances) and performance (in everyday environments):
  - Assess the communication and swallowing-related demands of activities in the individual's life (contextually based assessment);
  - Identify and optimize the individual's ability to perform relevant/desired social, academic, and vocational activities despite possible ongoing communication and related impairments;
  - Identify and optimize ways to facilitate social, academic, and vocational participation associated with the impairment.
- Contextual factors, including personal factors (e.g., age, race, gender, education, lifestyle, and coping skills) and environmental factors (e.g., physical, technological, social, and attitudinal):
  - Identify and optimize personal and environmental factors that are barriers to or facilitators of successful communication (including the communication competencies and support behaviors of everyday people in the environment).
  - Services may result in a diagnosis of a communication disorder, identification of a communication difference, prognosis for change (in the individual or relevant contexts), intervention and support, evaluation of their effectiveness, and referral for other assessments or services as needed.
  - Although the outcomes of speech, language, or hearing services may not be guaranteed, a reasonable statement of prognosis is made to referral sources, clients/patients, and families/caregivers.
  - Outcomes of services are monitored and measured in order to ensure the quality of services provided and to improve the quality of those services.
  - Appropriate follow-up services are provided to determine functional outcomes and the need for further services after discharge.

Clinical Indications

Screening services are used to identify individuals with potential communication or swallowing disorders.
Assessment services are provided as needed, requested, or mandated or to rule in or out a specific disabling condition.
Intervention and consultation services are provided when there is a reasonable expectation of benefit to the patient/client in body structure/function and/or activity/participation.

Clinical Process

Comprehensive assessment, intervention, and support address the components within the World Health Organization's International Classification of Functioning, Disability and Health (2001) framework, as described previously.
Services are consistent with the best available scientific and clinical evidence in conjunction with individual considerations.
Assessment may be static (i.e., using procedures designed to describe structures, functions, and environmental demands and supports in relevant domains at a given point in time) or dynamic (i.e., using hypothesis testing procedures to identify potential for change and elements of successful interventions and supports).
Services address patient/client and family preferences, goals, and special needs to enhance participation and improve functioning in life activities that the patient/client, family, and others deem important. Materials and approaches have ecological validity in that they are appropriate to the patient's/client's chronological and developmental ages; medical status; physical and sensory abilities; education; vocation; cognitive status; and cultural, socioeconomic, and linguistic backgrounds.
Counseling and consultation are essential components that address the nature and impact of the disorder or difference and engage the patient/client, family/caregiver, and others (e.g., teachers, employers, peers) in the clinical process, as appropriate.
Services may include instruction of communication partners (e.g., family/caregivers, peers, educators) in how to facilitate functioning, remove communication barriers, and enhance participation.
A variety of service delivery models and supports may be utilized, including direct service (e.g., pullout, individual, small group, classroom, community settings); indirect service through consultation and collaboration; service by support personnel with appropriate supervision; service by transdisciplinary or interdisciplinary teams; and service mediated by technology (e.g., telepractice).

Setting, Equipment Specifications, Safety and Health Precautions

Settings for assessment, intervention, and support are selected on the basis of intervention goals and in consideration of the World Health Organization (WHO) framework described above. There is a plan to generalize and maintain intervention gains that includes references to relevant settings and activities.
Telepractice (i.e., telehealth) may be used, when appropriate, to overcome barriers to accessing service caused by distance, unavailability of specialists and subspecialists, or impaired mobility.
All services ensure the safety of the patient/client and clinician and adhere to universal health precautions (e.g., prevention of bodily injury and infectious disease transmission).
Equipment is maintained according to manufacturer's specifications and recommendations. Instruments are properly calibrated, and calibration records are maintained.
Decontamination (e.g., cleaning, disinfection, or sterilization) of multiple-use equipment before reuse is carried out according to facility-specific infection control policies and manufacturer's instructions.

Documentation

Speech-language pathologists prepare, sign, and maintain, within an established time frame, documentation that reflects the nature of the professional service.
Results of assessment and treatment are reported to the patient/client and family/caregivers, as appropriate. Reports are distributed to the referral source and other professionals when appropriate and with written consent.
The privacy and security of documentation are maintained in compliance with the regulations of the Health Insurance Portability and Accountability Act (HIPAA), Family Educational Rights and Privacy Act (FERPA), and other state and federal laws.
Except for screenings, documentation addresses the type and severity of the communication or related disorder or difference, associated conditions (e.g., medical or educational diagnoses) and impact on activity and participation (e.g., educational, vocational, social).
Documentation includes summaries of previous services in accordance with all relevant legal and agency guidelines.

ASHA Policy Documents and Selected References

American Speech-Language-Hearing Association. (1985, June). Clinical management of communicatively handicapped minority language populations. Asha, 27(6).

American Speech-Language-Hearing Association. (1987). Classification of speech-language pathology and audiology procedures and communication disorders. Asha, 29, 49–53.

American Speech-Language-Hearing Association. (1993). Definitions of communication disorders and variations. Asha, 35(Suppl. 10), 40–41.

American Speech-Language-Hearing Association. (2001). Scope of practice in speech-language pathology. Rockville, MD: Author.

American Speech-Language-Hearing Association. (2002). Knowledge and skills for supervisors of speech-language pathology assistants. ASHA Supplement 22, 113–118.

American Speech-Language-Hearing Association. (2003). Code of Ethics (revised). ASHA Supplement, 23, 13–15.

American Speech-Language-Hearing Association. (2004). Guidelines for the training, use, and supervision of speech-language pathology assistants. Rockville, MD: Author.

American Speech-Language-Hearing Association. (2004). Position statement for the training, use, and supervision of support personnel in speech-language pathology. Rockville, MD: Author.

American Speech-Language-Hearing Association. (2004). Scope of practice in audiology. ASHA Supplement 24, 27–35.

World Health Organization. (2001). International classification of functioning, disability and health. Geneva, Switzerland: Author.

#1. Speech-Language Screening—Children

Speech-language screening in the pediatric population is a pass/fail procedure to identify infants, toddlers, children, or adolescents who require further speech-language/communication assessment or referral to other professional and/or medical services.

Pediatric speech-language screening is conducted according to the Fundamental Components and Guiding Principles.

Individuals Who Provide the Service(s)

Pediatric speech-language screening is conducted by appropriately credentialed and trained speech-language pathologists, possibly supported by speech-language pathology assistants under appropriate supervision.

Expected Outcome(s)

Pediatric speech-language screening identifies infants, toddlers, children, or adolescents likely to have speech-language and communication impairments that may interfere with body structure/function and/or activity/participation as defined by the World Health Organization (WHO) (see Fundamental Components and Guiding Principles).

Screening services result in pass/fail decisions and may result in —

recommendations for supporting normal development and preventing speech language impairment;
referral for comprehensive speech-language assessment or other assessments or services;
plans to monitor development.

Clinical Indications

Pediatric speech-language screening services are provided to infants, toddlers, children, adolescents, and their families as needed, requested, or mandated, or when other evidence suggests that they have risks for speech-language disorders associated with their body structure/function and/or activities/participation.

Clinical Process

Pediatric speech-language screening services are provided with parental consent as mandated by federal, state, and or local regulations.

Screening services are sensitive to cultural and linguistic diversity. Screening includes a range of age-appropriate, speech-language and other communication functions and activities.

Standardized (e.g., normed screening tests) or nonstandardized methods (e.g., criterion-referenced assessments, parent interviews, classroom observations) are used to screen oral motor function, communication and social interaction skills, speech production skills, comprehension and production of spoken and written language (as age-appropriate), and cognitive aspects of communication.

Screening typically focuses on body structures/functions but may also address activities/participation, and contextual factors affecting communication.

Individuals who fail the screening are referred to a speech-language pathologist for further assessment.

Setting, Equipment Specifications, Safety and Health Precautions

Setting: Pediatric speech-language screening is conducted in a clinical or educational setting or other natural environment conducive to valid screening results. Settings for screening may include hospitals, clinics, schools, or homes.

Equipment Specifications: All equipment used for pediatric speech-language screening is used and maintained in accordance with the manufacturer's specifications.

Safety and Health Precautions: All screening services ensure the safety of the patient/client and clinician and adhere to universal health precautions (e.g., prevention of bodily injury and transmission of infectious disease). Decontamination, cleaning, disinfection, and sterilization of multiple-use equipment before reuse are carried out according to facility-specific infection control policies and services and according to manufacturer's instructions.

Documentation

Documentation includes a statement of identifying information, screening results, and recommendations, indicating the need for rescreening, assessment, or for a referral.

The privacy and security of documentation are maintained in compliance with the regulations of the Health Insurance Portability and Accountability Act (HIPAA), the Family Educational Rights and Privacy Act (FERPA), and other state and federal laws.

Results of screening are reported to child's family/caregivers, as appropriate. Reports are distributed to referral source and other professionals when appropriate and with written consent.

ASHA Policy Documents and Selected References

American Speech-Language-Hearing Association. (1988, March). Prevention of communication disorders: Position statement. Asha, 30, 90.

American Speech-Language-Hearing Association. (1993). Definitions of communication disorders and variations. Asha, 35(Suppl. 10), 40–41.

American Speech-Language-Hearing Association. (2004). Admission/discharge criteria in speech-language pathology. ASHA Supplement 24, 65–70.

World Health Organization. (2001). International classification of functioning, disability and health. Geneva, Switzerland: Author.

#2. Speech-Language Screening—Adults

Speech-language pathology screening in adults is a pass/fail procedure to identify individuals who require further speech, language, and/or cognitive assessment or referral for other professional and/or medical services.

Speech-language pathology screening in adults is conducted according to the Fundamental Components and Guiding Principles.

Individuals Who Provide the Service(s)

Screening is conducted by appropriately credentialed and trained speech-language pathologists, possibly supported by speech-language pathology assistants under appropriate supervision.

Expected Outcome(s)

Speech-language pathology screening identifies persons who are likely to have speech, language, and cognitive impairments that may interfere with body structure/function and /or activity/participation as defined by the World Health Organization (see Fundamental Components and Guiding Principles).

Screening may result in recommendations for rescreening, comprehensive speech, language, or cognitive-communication assessment, or in a referral for other examinations or services.

Clinical Indications

Adults of all ages are screened as needed, requested, or mandated, or when other evidence suggests that they are at risk for speech, language, or cognitive-communication disorders involving body structure/function and/or activities/participation.

Clinical Process

Standardized and nonstandardized methods are used to screen oral motor function, speech production skills, comprehension and production of spoken and written language, and cognitive aspects of communication. Services are sensitive to cultural and linguistic diversity. Screening typically focuses on body structures/functions, but may also address activities/participation, and contextual factors affecting communication.

Individuals who fail screenings are referred to speech-language pathologists for further assessment.

Setting, Equipment Specifications, Safety and Health Precautions

Setting: Screening is conducted in a clinical or natural environment conducive to eliciting a representative sample of the patient's/client's speech, language, and cognitive-communication functions and activities.

Equipment Specifications: All equipment is used and maintained in accordance with manufacturer's specifications.

Safety and Health Precautions: All services ensure the safety of the patient/client and clinician and adhere to universal health precautions (e.g., prevention of bodily injury and transmission of infectious disease). Decontamination, cleaning, disinfection, and sterilization of multiple-use equipment before reuse are carried out according to facility-specific infection control policies and procedures and according to manufacturer's instructions.

Documentation

Documentation includes a statement of identifying information, screening results, and recommendations, indicating the need for rescreening, assessment, or referral.

The privacy and security of documentation are maintained in compliance with the regulations of the Health Insurance Portability and Accountability Act (HIPAA) and other state and federal laws.

Results of screening are reported to the individual and family/caregivers, as appropriate. Reports are distributed to referral source and other professionals when appropriate and with written consent.

ASHA Policy Documents and Selected References

American Speech-Language-Hearing Association. (1988). Position statement: Prevention of communication disorders. Asha, 30(3), 90.

American Speech-Language-Hearing Association. (1993). Definitions of communication disorders and variations. Asha, 35(Suppl. 10), 40–41.

World Health Organization. (2001). International classification of functioning, disability and health. Geneva, Switzerland: Author.

#3. Swallowing Screening

Swallowing screening is a pass/fail procedure to identify individuals who require a comprehensive assessment of swallowing function or a referral for other professional and/or medical services.

Screening is conducted according to the Fundamental Components and Guiding Principles.

Individuals Who Provide the Service(s)

Swallowing screening is conducted by appropriately credentialed and trained speech-language pathologists.

Expected Outcome(s)

Swallowing screening identifies persons who are likely to have swallowing impairments related to function, activity, and/or participation as defined by the World Health Organization (see Fundamental Components and Guiding Principles). Impairments may cause pulmonary aspiration, airway obstruction, or inadequate nutrition and/or hydration

Screening may result in recommendations for rescreening or comprehensive assessment of swallowing function, or in a referral for other examinations or services.

Clinical Indications

Individuals of all ages are screened as needed, requested, or mandated or when other evidence (e.g., neurological or structural deficits) suggests that they are at risk for a swallowing disorder involving body structure/function and/or activities/participation.

Clinical Process

Screening services are sensitive to cultural and linguistic diversity. Screening may include the following:

Interview or questionnaire that addresses swallowing function.
Observation of the signs and symptoms of oropharyngeal swallowing dysfunction.
Observation of routine or planned feeding situation, if indicated.
Formulation of appropriate recommendations, including the need for a full swallow function assessment.
Communication of results and recommendations to the team responsible for the individual's care.

Individuals who fail the screening are referred for a full swallow function assessment by a speech-language pathologist and/or other medical services as appropriate.

Setting, Equipment Specifications, Safety and Health Precautions

Setting: Screening is conducted in a clinical or natural environment conducive to obtaining valid screening results, which may include settings such as bedside, home, or hospice. Patient/client positioning and comfort, functional competencies, and environmental distractors are observed during routine or planned oral intake/feeding.

Equipment Specifications: All equipment is used and maintained in accordance with the manufacturer's specifications.

Safety and Health Precautions: All procedures ensure the safety of the patient/client and clinician and adhere to universal health precautions (e.g., prevention of bodily injury and transmission of infectious disease). Decontamination, cleaning, disinfection, and sterilization of multiple-use equipment before reuse are carried out according to facility-specific infection control policies and procedures and according to the manufacturer's instructions.

Documentation

Documentation includes a statement of identifying information, screening results, and recommendations, indicating the need for rescreening, assessment, or referral.

ASHA Policy Documents and Selected References

American Speech-Language-Hearing Association. (2000). Guidelines for the roles and responsibilities of the school-based speech-language pathologist. Rockville, MD: Author.

American Speech-Language-Hearing Association. (2001). Roles of speech-language pathologists in swallowing and feeding disorders: Technical report. ASHA 2002 Desk Reference, 3, 181–199.

American Speech-Language-Hearing Association. (2002). Knowledge and skills for speech-language pathologists performing endoscopic assessment of swallowing. ASHA Supplement, 22, 107–112.

American Speech-Language-Hearing Association. (2002). Knowledge and skills needed by speech-language pathologists providing services to individuals with swallowing and/or feeding disorders. ASHA Supplement 22, 81–87.

American Speech-Language-Hearing Association. (2002). Roles of speech-language pathologists in swallowing and feeding disorders: Position statement. ASHA Supplement 22, 73.

American Speech-Language-Hearing Association. (2004). Guidelines for speech-language pathologists performing videofluoroscopic swallowing studies. ASHA Supplement 24, 77–92.

American Speech-Language-Hearing Association. (2004). Knowledge and skills for speech-language pathologists performing videofluoroscopic swallowing studies. ASHA Supplement 24, 178–183.

American Speech-Language-Hearing Association. (2004). Role of the speech-language pathologist in the performance and interpretation of endoscopic evaluation of swallowing: Position statement. Available from www.asha.org/policy/.

American Speech-Language-Hearing Association. (2004). Role of the speech-language pathologist in the performance and interpretation of endoscopic evaluation of swallowing: Technical report. Available from www.asha.org/policy/.

American Speech-Language-Hearing Association. (2004). Speech-language pathologists training and supervising other professionals in the delivery of services to individuals with swallowing and feeding disorders: Position statement. ASHA Supplement 24, 62.

World Health Organization. (2001). International classification of functioning, disability and health. Geneva, Switzerland: Author.

#4. Audiologic Screening

Audiologic screening services are limited to pure-tone air conduction screening and screening tympanometry for initial identification and/or referral purposes. These are pass/fail procedures to identify individuals who require referral for further audiologic assessment or other professional and/or medical services.

Audiologic screening is conducted according to the Fundamental Components and Guiding Principles.

Individuals Who Provide the Service(s)

Audiologic screening is conducted by appropriately credentialed and trained speech-language pathologists, possibly supported by speech-language pathology assistants under appropriate supervision.

Expected Outcome(s)

Audiologic screening identifies those persons who are likely to have hearing impairments or disorders that may interfere with body function/structure and/or activity/participation as defined by the World Health Organization (WHO) (see Fundamental Components and Guiding Principles).

Screening may result in recommendations for rescreening, or referral for comprehensive audiologic assessment or other medical examinations or services.

Clinical Indications

Audiologic screening services are provided to children or adults as needed, requested, or mandated or when other evidence suggests risk for hearing impairments affecting body structure/function, activities, or participation.

Clinical Process

Screening for hearing impairment consists of pure tones presented via earphones at 1000, 2000, and 4000 Hz at 20 dB HL for children (ages 3–18) via conventional or conditioned play audiometry, and at 25 dB HL for adults.

Patients/clients who do not respond at any frequency in either ear are rescreened.
Patients/clients who fail the rescreen are referred to an audiologist for an audiologic evaluation.

Screening for outer and middle ear disorders in children (birth-18 years) includes visual inspection, otoscopic examination, and screening tympanometry.

Patients/clients who fail the screening are rescreened.
Patients/clients who fail the rescreening are referred for medical and/or audiologic follow-up.

Screening for hearing disability is conducted by interview, case history, and/or questionnaire.

Patients/clients who fail the screening are referred for audiologic assessment.

Screening services are sensitive to cultural and linguistic diversity.

Setting, Equipment Specifications, Safety and Health Precautions

Setting: Screening is conducted in a clinical or natural environment conducive to obtaining valid screening results. Settings for screening may include hospitals, clinics, schools, homes, or hospice facilities. Ambient noise levels may not always meet ANSI standards for pure-tone threshold testing but are sufficiently low to allow accurate screening.

Equipment Specifications: All equipment is used and maintained in accordance with the manufacturer's specifications. Electroacoustic equipment meets ANSI and manufacturer's specifications.

Safety and Health Precautions: All services ensure the safety of the patient/client and clinician and adhere to universal health precautions (e.g., prevention of bodily injury and transmission of infectious disease). Decontamination, cleaning, disinfection, and sterilization of multiple-use equipment before reuse are carried out according to facility-specific infection control policies and services and according to manufacturer's instructions.

Documentation

Documentation includes a statement of identifying information, screening results, and recommendations, indicating the need for rescreening, assessment, or referral.

ASHA Policy Documents and Selected References

American National Standards Institute. (1987). Specifications for instruments to measure aural acoustic impedance and admittance (aural acoustic immittance). In New York: Acoustical Society of America.

American National Standards Institute. (1991). Maximum permissible ambient noise levels for audiometric test rooms. In New York: Acoustical Society of America.

American National Standards Institute. (1996). Specifications for audiometers. In New York: Acoustical Society of America.

American Speech-Language-Hearing Association. (1988). Position statement: Prevention of communication disorders. Asha, 30(3), 90.

American Speech-Language-Hearing Association. (1991). The prevention of communication disorders tutorial. Asha, 33(Suppl. 6), 15–41.

American Speech-Language-Hearing Association. (1993). Definitions of communication disorders and variations. Asha, 35(Suppl. 10), 40–41.

American Speech-Language-Hearing Association. (1997). Guidelines for audiologic screening. Rockville, MD: Author.

American Speech-Language-Hearing Association. (2001). Scope of practice in speech-language pathology. Rockville, MD: Author.

American Speech-Language-Hearing Association. (2004). Clinical practice by certificate holders in the profession in which they are not certified. ASHA Supplement 24, 39–42.

World Health Organization. (2001). International classification of functioning, disability and health. Geneva, Switzerland: Author.

#5. Consultation

Consultation is a service related to speech-language, communication, and swallowing issues, including collaborating with other professionals, family/caregivers, and patients/clients; working with individuals in business, industry, education, and other public and private agencies; engaging in program development, supervision, or evaluation activities; or providing expert testimony.

Consultation is conducted according to the Fundamental Components and Guiding Principles.

Individuals Who Provide the Service(s)

Consultation is provided by appropriately credentialed and trained speech-language pathologists.

Speech-language pathologists may provide these services individually or as members of collaborative teams that may include the individual, family/caregivers, or other relevant persons (e.g., educators, medical personnel).

Expected Outcomes

Goals and expectations of consultation are variable and are negotiated between the consultant and those seeking consultation. The consultant collaborates in joint problem solving to address mutual goals. Information is sought about the perceptions and priorities of those involved in the consultation process.

Information is shared regarding communication development and processes, speech-language and communication impairments and related disorders, assessment and intervention strategies, and other issues related to the goals of the consultation.

Clinical Indications

Consultation services are provided by arrangement or upon request and address situations such as the following:

Prevention of communication disorders.
Identification of persons at risk for communication disorders.
Assessment and intervention plans and procedures and interpretation of results.
Monolingual English language speakers providing services to clients who speak languages other than English.
Environmental assessment and modification.
Equipment and material needs and/or modifications.
Program evaluation and management.
Quality assessment and improvement.
Education and advocacy.
Second opinion and/or independent educational evaluation.
Expert testimony.

Clinical Process

Consulting activities take many forms. As appropriate to the situation, the consultant —

collaborates with others to develop mutual goals for the consultation activity;
gathers information through observations, interviews, assessments or other direct services, and through review of records and materials;
assesses the type and extent of assistance required;
makes recommendations or provides information;
provides training on communication and swallowing issues;
provides monitoring and follow-up services;
provides information to federal and state government agencies, business, and industry;
provides expert testimony regarding speech-language and communication issues.

Setting, Equipment Specifications, Safety and Health Precautions

Setting: Consultation services are offered to individuals, families, groups, and organizations in home, health care, education, business, industrial, government, and legal settings.

Equipment Specifications: All equipment is used and maintained in accordance with the manufacturer's specifications.

Documentation

The consulting speech-language pathologist provides written plans and/or reports as documentation of services rendered as indicated in the agreement made between the parties.

ASHA Policy Documents and Selected References

American Speech-Language-Hearing Association. (1991). A model for collaborative service delivery for students with language-learning disorders in the public schools. Asha, 33(Suppl. 5), 44–50.

American Speech-Language-Hearing Association. (1994). Professional liability and risk management for the audiology and speech-language pathology professions. Asha, 36(Suppl. 12), 25–38.

American Speech-Language-Hearing Association. (1995). Position statement and guidelines on acoustics in educational settings. Asha, 37(Suppl. 14), 15–19.

American Speech-Language-Hearing Association. (2002). A workload analysis approach for establishing speech-language caseload standards in the schools: Technical report. Rockville, MD: Author.

American Speech-Language-Hearing Association. (2003). Appropriate school facilities for students with speech-language-hearing disorders: Technical report. ASHA Supplement 23, 83–86.

American Speech-Language-Hearing Association. (2003). Knowledge and skills in business practices needed by speech-language pathologists in health care settings. ASHA Supplement, 23, 87–92.

American Speech-Language-Hearing Association. (2004). Knowledge and skills in business practices for speech-language pathologists who are managers and leaders in health care organizations. ASHA Supplement 24, 146–151.

World Health Organization. (2001). International classification of functioning, disability and health. Geneva, Switzerland: Author.

#6. Counseling

Counseling provides individuals, families/caregivers, and other relevant persons with information and support about communication and/or swallowing disorders to develop problem-solving strategies that enhance the (re)habilitation process.

Counseling is conducted according to the Fundamental Components and Guiding Principles.

Individuals Who Provide the Service(s)

Counseling is conducted by appropriately credentialed and trained speech-language pathologists.

Speech-language pathologists may provide these services individually or as members of collaborative teams that may include the individual, family/caregivers, and other relevant persons (e.g., educators, psychologists, social workers, physicians).

Expected Outcome(s)

Consistent with the World Health Organization (WHO) framework, counseling is designed to—

assist individuals to develop appropriate goals related to a communication or swallowing disorder that capitalize on strengths and address weaknesses related to underlying structures and functions that affect communication/swallowing;
facilitate the individual's activities and participation by assisting the person to increase autonomy, self-direction, and responsibility for acquiring and utilizing new skills and strategies that are related to their goals to communicate or swallow more effectively;
assist individuals in understanding how to modify contextual factors to reduce barriers and enhance facilitators of successful communication/swallowing and participation.

Counseling is expected to result in improved abilities, functioning, participation, and contextual facilitators. Counseling also may result in recommendations for speech-language or swallowing reassessment or follow-up, or in a referral for other services.

Clinical Indications

Counseling is prompted by referral and/or by the results of a communication or swallowing assessment. Individuals of all ages may receive counseling as part of intervention and/or consultation services when their ability to communicate or swallow effectively is impaired and when there is a reasonable expectation of benefit to the individual in body structure/function and/or activity/participation. Counseling may be warranted even if the prognosis for improved body structure/function is limited.

Clinical Process

Counseling involves providing timely information and guidance to patients/clients, families/caregivers, and other relevant persons about the nature of communication or swallowing disorders, the course of intervention, ways to enhance outcomes, coping with disorders, and prognosis. Services are sensitive to cultural and linguistic diversity.

Depending on assessment results, counseling addresses the following:

Assessment of counseling needs.
Provision of information.
Use of strategies to modify behavior and/or the individual's environment.
Development of coping mechanisms and systems for emotional support.
Development and coordination of individual and family self-help and support groups.

Speech-language pathologists are responsible for ensuring that individuals, families/caregivers, and other relevant persons receive counseling about communication and swallowing issues. Referrals to and consultation with mental health professionals may be an integral component of counseling.

Counseling extends long enough to accomplish stated objectives/predicted outcomes. The counseling period does not continue past the point at which there is no longer any expectation for further benefit.

Setting, Equipment Specifications, Safety and Health Precautions

Setting: Counseling is conducted in clinical and educational settings and other natural environments that are conducive to individual and family comfort, confidentiality, and uninterrupted privacy. Settings are selected with consideration for the social, academic, and/or vocational activities that are relevant to or desired by the individual. In any setting, counseling addresses the personal and environmental factors that are barriers to or facilitators of the patient's/client's communication or swallowing.

Equipment Specifications: All equipment is used and maintained in accordance with the manufacturer's specifications.

Safety and Health Precautions: All services ensure the safety of the patient/client and clinician and adhere to universal health precautions (e.g., prevention of bodily injury and transmission of infectious disease). Decontamination, cleaning, disinfection, and sterilization of multiple-use equipment before reuse are carried out according to facility-specific infection control policies and services and according to manufacturer's instructions.

Documentation

Documentation includes the following:

Written record of the dates, length, and type of counseling services that were provided.
Progress toward stated goals, updated prognosis, and specific recommendations.
Evaluation of counseling outcomes and effectiveness within the WHO framework of body structures/functions, activities/participation, and contextual factors.

The privacy and security of documentation are maintained in compliance with the regulations of the Health Insurance Portability and Accountability Act (HIPAA), Family Education Rights and Privacy Act (FERPA), and other state and federal laws.

ASHA Policy Documents and Selected References

American Speech-Language-Hearing Association. (2000). Guidelines for the roles and responsibilities of the school-based speech-language pathologist. In Rockville, MD: Author.

American Speech-Language-Hearing Association. (2004). Knowledge and skills needed by speech-language pathologists providing services to infants and families in the NICU environment. ASHA Supplement 24, 159–165.

American Speech-Language-Hearing Association. (2004). Roles of speech-language pathologists in the neonatal intensive care unit: Guidelines. Available from www.asha.org/policy/.

American Speech-Language-Hearing Association. (2004). Roles of speech-language pathologists in the neonatal intensive care unit: Position statement. ASHA Supplement 24, 60–61.

American Speech-Language-Hearing Association. (2004). Roles of speech-language pathologists in the neonatal intensive care unit: Technical report. ASHA Supplement 24, 121–130.

World Health Organization. (2001). International classification of functioning, disability and health. Geneva, Switzerland: Author.

#7. Follow-Up Procedures

Follow-up procedures are used to complete or supplement an assessment, monitor progress during intervention, and/or determine status after screening, assessment, intervention, or discharge.

Follow-up procedures are conducted according to the Fundamental Components and Guiding Principles.

Individuals Who Perform the Procedure(s)

Follow-up procedures are conducted by appropriately credentialed and trained speech-language pathologists, possibly supported by speech-language pathology assistants under appropriate supervision.

Expected Outcome(s)

Follow-up procedures complete an assessment and determine reassessment needs.

Follow-up procedures determine efficacy of intervention, functional outcomes, maintenance of level of function achieved at the end of intervention, and appropriateness of clinical decisions and clinical recommendations.

Follow-up procedures may result in recommendations for continued or repeated assessment and/or intervention, referral for other examinations or services, dismissal from services, or readmission to services.

Clinical Indications

Follow-up services are provided to individuals of all ages at a predetermined time following screening, assessment, or intervention, and as required by federal, state, or local regulations.

Clinical Process

Standardized and nonstandardized methods are used to determine the individual's current status including body structures/functions, activities/participation, contextual factors affecting communication and swallowing, and level of satisfaction with services consistent with the World Health Organization (WHO) framework.

Follow-up procedures are conducted either in person (e.g., interview, reassessment) or indirectly (e.g., phone or mail surveys), and involve the patient/client, family/caregivers, professionals, and/or others associated with the individual. Follow-up procedures are sensitive to cultural and linguistic diversity.

Services include the following:

Supplemental evaluations.
Re-evaluations and rechecks.
Telephone contacts with patients/clients and/or referral agencies.
Verbal or written consultation with other professionals to monitor a patient's/client's functional communication or swallowing status and contextual factors.

Materials and approaches are appropriate to the individual's chronological and developmental ages, medical status, physical and sensory abilities, education, vocation, cognitive status, and cultural, socioeconomic, and linguistic backgrounds.

Setting, Equipment Specifications, Safety and Health Precautions

Setting: Follow-up procedures are conducted in a clinical or educational setting, or other natural environment. Selection of settings for follow-up are based on the goals of assessment with consideration of the WHO framework.

Equipment Specifications: All equipment is used and maintained in accordance with the manufacturer's specifications.

Safety Precautions: All services ensure the safety of the patient/client and clinician and adhere to universal health precautions (e.g., prevention of bodily injury and transmission of infectious disease). Decontamination, cleaning, disinfection, and sterilization of multiple-use equipment before reuse are carried out according to facility-specific infection control policies and procedures and manufacturer's instructions.

Documentation

Documentation includes a statement of pertinent background information, results, progress, and recommendations, indicating the need for reassessment, continued or additional intervention, or referral.

The privacy and security of documentation are maintained in compliance with the regulations of the Health Insurance Portability and Accountability Act (HIPAA), Family Education Right to Privacy Act (FERPA), and other state and federal laws.

Results of the follow-up are reported to the individual and family/caregivers, as appropriate. Reports are distributed to referral source and other professionals when appropriate and with written consent.

ASHA Policy Documents and Selected References

American Speech-Language-Hearing Association. (1988). Position statement: Prevention of communication disorders. Asha, 30(3), 90.

American Speech-Language-Hearing Association. (1993). Definitions of communication disorders and variations. Asha, 35(Suppl. 10), 40–41.

World Health Organization. (2001). International classification of functioning, disability and health. Geneva, Switzerland: Author.

#8. Prevention Services

Prevention services are designed to avoid communication or swallowing disorders, minimize their effects and sequelae, and facilitate normal development.

Prevention is conducted according to the Fundamental Components and Guiding Principles.

Individuals Who Provide the Services

Prevention services are conducted by appropriately credentialed and trained speech-language pathologists, possibly supported by speech-language pathology assistants under appropriate supervision.

Expected Outcome(s)

Consistent with the World Health Organization (WHO) framework, prevention is designed to—

inhibit or delay the onset of a communication or swallowing disorder by capitalizing on strengths, addressing weaknesses related to underlying structures and functions that may interfere with communication/swallowing, and facilitating normal development;
minimize impact of risk factors, associated conditions, and sequelae to facilitate individuals' activities and level of participation;
reduce exposure to contextual factors that may interfere with successful communication/swallowing activities and participation and provide appropriate accommodations and other supports, as well as training in how to use them.

Prevention is expected to result in a reduced risk for communication or swallowing disorders and their sequelae. Prevention also may result in recommendations for speech-language and communication or swallowing reassessment or follow-up, or in a referral for other services.

Clinical Indications

Prevention is prompted by referral, the results of a speech-language assessment, or other indications of need. Individuals of all ages may receive prevention services when they are deemed to be at risk for impaired ability to communicate effectively or swallow safely and when there is a reasonable expectation of benefit to the individual in body structure/function and/or activity/participation. Prevention services that enhance activity and participation through modification of contextual factors may be warranted even if the prognosis for improved body structure/function is limited.

Clinical Process

Prevention involves providing information and guidance to patients/clients, families, other significant persons, or target groups about the risk for or ramifications of a communication or swallowing disorder with sensitivity to cultural and linguistic diversity.

Depending on the nature of the risk, prevention may involve—

identifying and contacting target groups;
establishing professional relationships;
providing consultation and educational strategies:
- Consultation may be provided to natural support systems, such as the family, or to direct service personnel, organizations, or policymaking groups.
- Education may provide general information about communication or swallowing processes, disorders, and intervention; specific information to help target groups identify and/or eliminate risk factors for the onset, development, or maintenance of a communication or swallowing disorder; or may improve target groups' ability to cope with communication disorders.

Prevention services extend long enough to accomplish stated objectives/predicted outcomes.

Setting, Equipment Specifications, Safety and Health Precautions

Setting: Prevention services are conducted in a clinical or educational setting and/or other natural environments that are selected on the basis of prevention goals and in consideration of the social, academic and/or vocational activities that are relevant to or desired by individuals, families, groups, communities, or organizations. In any setting, prevention addresses the personal, cultural, and environmental factors that increase the risk of a communication or swallowing disorder.

Equipment Specifications: All equipment is used and maintained in accordance with the manufacturer's specifications.

Safety Precautions: All prevention services ensure the safety of the patient/client and clinician and adhere to universal health precautions (e.g., prevention of bodily injury and transmission of infectious disease). Decontamination, cleaning, disinfection, and sterilization of multiple-use equipment before reuse are carried out according to facility-specific infection control policies and services and according to manufacturer's instructions.

Documentation

Documentation includes the following:

Written record of the dates, length, and type of prevention services that were provided.
Progress toward stated goals, updated prognosis, and specific recommendations.
Evaluation of prevention outcomes and effectiveness within the WHO framework of body structures/functions, activities/participation, and contextual factors.

The privacy and security of documentation are maintained in compliance with the regulations of the Health Insurance Portability and Accountability Act (HIPAA), Family Educational Rights and Privacy Act (FERPA), and other state and federal laws.

ASHA Policy Documents and Selected References

American Speech-Language-Hearing Association. (1988). Prevention of communication disorders. Asha, 30(3), 90.

American Speech-Language-Hearing Association. (1991). The prevention of communication disorders tutorial. Asha, 33(Suppl. 6), 15–41.

American Speech-Language-Hearing Association. (2000). Guidelines for the roles and responsibility of school-based speech-language pathologists. In Rockville, MD: Author.

World Health Organization. (2001). International classification of functioning, disability and health. Geneva, Switzerland: Author.

#9. Elective Communication Modification

Elective communication modification services are for individuals who do not have a communication disorder but who wish to receive assistance from a speech-language pathologist to enhance their communication effectiveness. Communication modification includes instruction in public speaking, accent modification, and interpersonal communication skills.

Communication modification is conducted according to the Fundamental Components and Guiding Principles.

Individuals Who Provide the Service(s)

Communication modification for adults is conducted by appropriately credentialed and trained speech-language pathologists, possibly supported by speech-language pathology assistants under appropriate supervision.

Speech-language pathologists may provide these services as members of collaborative teams that may include the individual, family/caregivers, and other relevant persons.

Expected Outcome(s)

Consistent with the World Health Organization (WHO) framework, communication modification is designed to—

capitalize on strengths and address weaknesses related to functions that affect communication;
facilitate the individual's activities and participation by assisting the person to acquire new skills and strategies;
modify contextual factors that serve as barriers and enhance facilitators of successful communication and participation.

Communication modification is expected to result in reduced contextual barriers, improved abilities and contextual facilitators, and measurably enhanced functioning and participation. Communication modification services also may result in recommendations for reassessment or follow-up, or in a referral for other services.

Clinical Indications

Communication modification is prompted by referral or upon request, including self-referral. Individuals of all ages may receive intervention and/or consultation services when there is an identified or perceived reduction in the ability to communicate effectively, and when there is a reasonable expectation of benefit to the individual in body structure/function and/or activity/participation.

Interventions that enhance activity and participation through modification of contextual factors may be warranted even if the prognosis for improved body structure/function is limited.

Clinical Process

Communication modification services involve information and guidance to patients/clients, families, and other significant persons about communication, communication effectiveness, and the course of services.

Communication modification services address the complexities of communication effectiveness in a manner that is sensitive to cultural and linguistic diversity.

Depending on assessment results, communication modification may address the following:

Knowledge and use of verbal and nonverbal pragmatic rules of communication in varied communication situations.
Knowledge and application of phonological and prosodic differences.
Use of effective listening skills.
Knowledge of cultural influences on communication.
Increased ability to use speech and language skills within academic, vocational, and social contexts.
Analysis of the cognitive and communication demands of relevant social, academic, and/or vocational tasks and contexts, and subsequent appropriate strategies for modifying communication.
Voice care and techniques for modulating intensity, pitch, and quality without inducing strain.
Development of self-assessment and monitoring techniques.
Development of plans, including referral, for problems such as hearing difficulties and emotional disturbance.

Communication modification services extend long enough to accomplish stated objectives/predicted outcomes and end when there is no longer any expectation for further benefit. Clinicians provide patients/clients and their families/caregivers with an estimate of the duration of communication modification services.

Setting, Equipment Specifications, Safety and Health Precautions

Setting: Communication modification services may be conducted in a variety of settings and are selected on the basis of intervention goals and in consideration of the social, academic, and/or vocational activities that are relevant to or desired by the individual. In any setting, communication modification addresses the personal and environmental factors that are barriers to or facilitators of the patient's/client's communication function. There is a plan to generalize and maintain communication gains and to increase participation in relevant settings and activities.

Equipment Specifications: All equipment will be used and maintained in accordance with the manufacturer's specifications.

Documentation

Documentation includes the following:

Indication that the services were elective.
Written records of the dates, length, and type of services that were provided.
Evaluation of communication modification outcomes and effectiveness as applied to activities, participation, and contextual factors.
Progress toward stated goals.
Specific recommendations.

The privacy and security of documentation are maintained in compliance with the regulations of the Health Insurance Portability and Accountability Act (HIPAA) the Family Education Rights and Privacy Act (FERPA), and other state and federal laws.

ASHA Policy Documents and Selected References

American Speech-Language-Hearing Association. (1983). Social dialects and implications of the position on social dialects. Asha, 25, 23–27.

American Speech-Language-Hearing Association. (1988, March). Prevention of communication disorders: Position Statement. Asha, 30, 90.

American Speech-Language-Hearing Association. (1993). Definitions of communication disorders and variations. Asha, 35(Suppl. 10), 40–41.

American Speech-Language-Hearing Association. (2003). Technical report: American English dialects. ASHA Supplement 23, 45–46.

American Speech-Language-Hearing Association Joint Subcommittee of the Executive Board on English Language Proficiency. (1998). Students and professionals who speak English with accents and nonstandard dialects: Issues and recommendations. Technical report. ASHA, 40(Suppl. 18), 28–31.

World Health Organization. (2001). International classification of functioning, disability and health. Geneva, Switzerland: Author.

#10. Comprehensive Speech-Language Assessment

Comprehensive speech-language assessment addresses speech, language, cognitive-communication and/or swallowing function (strengths and weaknesses) in children and adults, including identification of impairments, associated activity and participation limitations, and context barriers and facilitators.

Comprehensive speech-language assessment is conducted according to the Fundamental Components and Guiding Principles.

Individuals Who Provide the Service(s)

Comprehensive speech-language assessments are conducted by appropriately credentialed and trained speech-language pathologists.

Speech-language pathologists may perform these assessments individually or as members of collaborative teams that may include the individual, family/caregivers, and other relevant persons (e.g., educators and medical personnel).

Expected Outcome(s)

Consistent with the World Health Organization (WHO) framework, assessment is conducted to identify and describe —

underlying strengths and weaknesses related to speech, language, cognitive and/or swallowing factors that affect communication and swallowing performance;
effects of speech, language, cognitive-communication and/or swallowing impairments on the individual's activities (capacity and performance in contexts) and participation;
contextual factors that serve as barriers to or facilitators of successful communication and swallowing and participation for individuals with speech, language, cognitive-communication and/or swallowing impairments.

Assessment may result in the following:

Diagnosis of a speech, language, cognitive-communication and/or swallowing disorder.
Clinical description of the characteristics of speech, language, cognitive-communication and/or swallowing impairments.
Identification of a communication difference, possibly co-occurring with a speech, language, cognitive-communication and/or swallowing disorder.
Prognosis for change (in the individual or relevant contexts).
Recommendations for intervention and support.
Identification of the effectiveness of intervention and supports.
Referral for other assessments or services.

Clinical Indications

Assessment services are provided to individuals of all ages as needed, requested, or mandated or when other evidence suggests that they have speech, language, cognitive-communication and/or swallowing impairments affecting body structure/function and/or activities/participation.

Assessment is prompted by referral, by the individual's medical status, educational performance, or by failing a speech-language or swallowing screening that is sensitive to cultural and linguistic diversity.

Clinical Process

Comprehensive assessment is sensitive to cultural and linguistic diversity and addresses the components within the WHO's International Classification of Functioning, Disability and Health (2001) framework including body structures/functions, activities/participation, and contextual factors.

Assessment may be static (i.e., using procedures designed to describe current levels of functioning within relevant domains) and/or dynamic (i.e., using hypothesis testing procedures to identify potentially successful intervention and support procedures) and includes the following:

Relevant case history, including medical status, education, vocation, and socioeconomic, cultural, and linguistic backgrounds.
Review of auditory, visual, motor, and cognitive status.
Patient/client and family interview.
Standardized and/or nonstandardized measures of specific aspects of speech, spoken and nonspoken language, cognitive-communication, and swallowing function.
Analysis of associated medical, behavioral, environmental, educational, vocational, social, and emotional factors.
Identification of potential for effective intervention strategies and compensations;
Selection of standardized measures for speech, language, cognitive-communication and/or swallowing assessment with consideration for documented ecological validity.
Follow-up services to monitor communication and swallowing status and ensure appropriate intervention and support for individuals with identified speech, language, cognitive-communication and/or swallowing disorders.

Setting, Equipment Specifications, Safety and Health Precautions

Setting: Assessment is conducted in a clinical or educational setting and/or other natural environments conducive to eliciting representative samples of the patient's/client's capacities and performance in communication and swallowing. The goals of the assessment and the WHO framework are considered in selecting assessment settings. Identifying the influence of contextual factors on functioning (activity and participation) requires assessment data from multiple settings.

Equipment Specifications: All equipment will be used and maintained in accordance with the manufacturer's specifications.

Safety and Health Precautions: All services ensure the safety of the patient/client and clinician and adhere to universal health precautions (e.g., prevention of bodily injury and transmission of infectious disease). Decontamination, cleaning, disinfection, and sterilization of multiple-use equipment before reuse are carried out according to facility-specific infection control policies and services and according to the manufacturer's instructions.

Documentation

Documentation includes pertinent background information, results and interpretation, prognosis, and recommendations indicating the need for further assessment, follow-up, or referral. When intervention is recommended, information is provided concerning frequency, estimated duration, and type of service (e.g., individual, group, home program) required.

Documentation addresses the type and severity of the speech, language, cognitive-communication or swallowing disorder and associated conditions (e.g., medical diagnoses).

Documentation includes summaries of previous services in accordance with all relevant legal and agency guidelines.

The privacy and security of documentation are maintained in compliance with the regulations of the Health Insurance Portability and Accountability Act (HIPAA), the Family Education Rights and Privacy Act (FERPA), and other state and federal laws.

Results of the assessment are reported to the individual and family/caregivers, as appropriate. Reports are distributed to the referral source and other professionals when appropriate and with written consent.

ASHA Policy Documents and Selected References

American Speech-Language-Hearing Association. (1990). The roles of speech-language pathologists in service delivery to infants, toddlers, and their families. Asha, 32(Suppl. 2), 4.

American Speech-Language-Hearing Association. (1991). Guidelines for speech-language pathologists serving persons with language, sociocommunication, and/or cognitive-communication impairments. Asha, 33(Suppl. 5), 21–28.

American Speech-Language-Hearing Association. (2000). Guidelines for roles and responsibilities for the school-based speech-language pathologist. Rockville, MD: Author.

American Speech-Language-Hearing Association. (2001). Roles and responsibilities of speech-language pathologists with respect to reading and writing in children and adolescents (position statement, executive summary of guidelines, technical report). In ASHA Supplement 21 (pp. 17–28). Rockville, MD: Author.

American Speech-Language-Hearing Association. (2002). Knowledge and skills needed by speech-language pathologists with respect to reading and writing in children and adolescents. ASHA 2002 Desk Reference, 3, 455–464.

American Speech-Language-Hearing Association. (2002). Roles of speech-language pathologists in swallowing and feeding disorders: Position statement. ASHA Supplement 22, 73.

American Speech-Language-Hearing Association. (2004). Admission/discharge criteria in speech-language pathology. ASHA Supplement 24, 65–70.

American Speech-Language-Hearing Association. (2004). Knowledge and skills needed by speech-language pathologists providing services to individuals with cognitive-communication disorders. Available from www.asha.org/policy/.

American Speech-Language-Hearing Association. (2004). Roles of speech-language pathologists in the identification, diagnosis, and treatment of individuals with cognitive-communication disorders: Position statement. Available from www.asha.org/policy/.

World Health Organization. (2001). International classification of functioning, disability and health. Geneva, Switzerland: Author.

#11. Communication Assessment—Infants and Toddlers

Infant-toddler assessment is provided to evaluate strengths and weaknesses of early communication interactions and prespeech-language functioning in infants and toddlers, including identification of impairments, associated activity and participation limitations, and context barriers and facilitators.

Infant/toddler early communication and prespeech-language assessment is conducted according to the Fundamental Components and Guiding Principles.

Individuals Who Provide the Service(s)

Infant/toddler assessments are conducted by appropriately credentialed and trained speech-language pathologists.

Speech-language pathologists may perform these assessments as members of collaborative teams that may include the individual, family/caregivers, and other relevant persons (e.g., educators, medical personnel).

Expected Outcome(s)

Consistent with the World Health Organization (WHO) framework, assessment is conducted to identify and describe —

underlying strengths and weaknesses related to factors that affect communication performance such as play, prespeech, babbling, jargon, early words and sentences, and communicative intent;
effects of preschool communication impairments on the infant's/toddler's activities (capacity and performance in everyday communication contexts) and participation; such as day care and family/caretaker interaction;
contextual factors that serve as barriers to or facilitators of successful communication and participation for infants/toddlers with communication development risks.

Assessment may result in the following:

Diagnosis of a communication disorder or high risk of developmental difficulties.
Identification of a communication difference.
Clinical description of the characteristics of the current level of communication development and/or impairment.
Prognosis for change (in the infant/toddler and/or relevant contexts).
Recommendations for intervention and support.
Identification of the effectiveness of intervention and supports.
Referral for other assessments (e.g., swallowing and feeding) or services.

Clinical Indications

Assessment services are provided to infants/toddlers and their families as needed, requested, or mandated, or when other evidence suggests that the infant's/toddler's ability to communicate is impaired, or likely to be impaired, because of identified biological or other developmental risks involving their body structure/function and/or activities/participation.

Assessment is prompted by referral, by the infant's/toddler's medical or developmental status, or by failing a speech-language or hearing screening.

Clinical Process

Comprehensive assessments are sensitive to persons from all culturally and linguistically diverse backgrounds and address the components within the WHO's International Classification of Functioning, Disability and Health (2001) framework, including body structures/functions, activities/participation, and contextual factors.

Assessment may be static (i.e., using procedures designed to describe current levels of functioning within relevant domains) or dynamic (i.e., using hypothesis testing procedures to identify potentially successful intervention and support procedures) and includes the following:

Relevant case history, including medical status, and socioeconomic, cultural, and linguistic backgrounds.
Review of auditory, visual, motor, and cognitive status.
Standardized and/or nonstandardized methods selected with consideration for ecological validity, such as —
- parent's response instruments and observational instruments that examine early communication, prespeech-language, and early speech-language behaviors;
- criterion-referenced developmental scales;
- description of samples of play behavior and nonverbal and early speech-language interactions with caregivers and others;
- caregiver interviews;
- contextualized behavioral and functional-communication observations.
Follow-up services to monitor cognitive-communication-motor status and ensure appropriate intervention and support for infants/toddlers with identified communication impairments or high risks of communication developmental difficulties.

Setting, Equipment Specifications, Safety and Health Precautions

Setting: Assessment is conducted in a Neonatal Intensive Care Unit (NICU), clinical, or natural environment conducive to eliciting a representative sample of the infant's/toddler's early communicative development. The goals of the assessment and the WHO framework are considered in selecting assessment settings. Identifying the influence of contextual factors on functioning (activity and participation) requires assessment data from multiple settings and interactions.

Equipment Specifications: All equipment will be used and maintained in accordance with the manufacturer's specifications.

Safety and Health Precautions: All services ensure the safety of the infant/toddler and clinician and adhere to universal health precautions (e.g., prevention of bodily injury and transmission of infectious disease). Decontamination, cleaning, disinfection, and sterilization of multiple-use equipment before reuse are carried out according to facility-specific infection control policies and services and according to manufacturer's instructions.

Documentation

Documentation includes pertinent background information, assessment results and interpretation, prognosis, and recommendations, and indicates the need for further assessment, follow-up, or referral. When intervention services are recommended, information is provided concerning frequency, estimated duration, and type of service (e.g., individual, group, home program).

Documentation addresses the type and severity of the communication impairment, or risks of impaired communication development, and associated conditions (e.g., medical diagnoses).

Documentation includes summaries of previous services in accordance with all relevant legal and agency guidelines.

Results of the assessment are reported to the family/caregivers, as appropriate. Reports are distributed to the referral source and other professionals when appropriate and with written consent.

ASHA Policy Documents and Selected References

American Speech-Language-Hearing Association. (1990). The roles of speech-language pathologists in service delivery to infants, toddlers, and their families. Asha, 32(Suppl. 2), 4.

American Speech-Language-Hearing Association. (2004). Roles of speech-language pathologists in the neonatal intensive care unit: Guidelines. Available from www.asha.org/policy/.

American Speech-Language-Hearing Association. (2004). Roles of speech-language pathologists in the neonatal intensive care unit: Position statement. ASHA Supplement, 24, 60–61.

American Speech-Language-Hearing Association. (2004). Roles of speech-language pathologists in the neonatal intensive care unit: Technical report. ASHA Supplement, 24, 121–130.

World Health Organization. (2001). International classification of functioning, disability and health. Geneva, Switzerland: Author.

#12. Communication Intervention—Infants and Toddlers

Family-centered intervention and developmentally supportive services are provided for infants and toddlers with identified communication disorders or with high risks for delayed development of receptive and expressive language skills.

Intervention is conducted according to the Fundamental Components and Guiding Principles.

Individuals Who Provide the Services

Communication interventions are conducted by appropriately credentialed and trained speech-language pathologists, possibly supported by speech-language pathology assistants under appropriate supervision.

Speech-language pathologists may provide these services as members of collaborative teams that may include the individual, family/caregivers, and other relevant persons (e.g., educators, medical personnel).

Expected Outcome(s)

Consistent with the World Health Organization framework, intervention is designed to —

capitalize on strengths and address weaknesses related to underlying structures and functions that affect communication;
facilitate the infant's or toddler's activities and participation by working with the family to assist the infant or toddler to acquire new communication skills and strategies;
modify contextual factors to reduce barriers and enhance facilitators of successful communication and participation, and to provide appropriate accommodations and other supports, as well as training in how to use them.

Intervention is expected to result in improved abilities, functioning, participation, and contextual facilitators. Intervention also may result in recommendations for reassessment or follow-up, or in a referral for other services. Early intervention strategies may function as prevention for communication problems (e.g., delayed language because of preterm status).

Clinical Indications

Communication intervention for infants and toddlers is prompted by referral and/or by the results of an early communication, and prespeech-language assessment. Infants and toddlers and their families receive intervention and/or consultation services when their ability to communicate effectively is impaired, or likely to be impaired, because of identified biological or other developmental risks, and when there is a reasonable expectation of benefit to the infant/toddler in body structure/function and/or activity/participation. Interventions that enhance activity and participation through modification of contextual factors may be warranted even if the prognosis for improved body structure/function is limited.

Clinical Process

Intervention for infants/toddlers is family-centered and involves providing timely, developmental supportive and culturally appropriate information and guidance to families/caregivers, and other significant persons about the normal development of speech-language-communication and how to foster it, the risks for communication disorder, course of intervention, an estimate of intervention duration, and prognosis for improvement and/or prevention of a communication disorder.

Depending on assessment results and the age of the infant/toddler, intervention addresses the following:

Preverbal communication (e.g., helping the family/caregiver be sensitive to the infant's or toddler's physical states and needs, gestural and other means of conveying them, and helping them learn to foster the development of preverbal expressions of communicative intentions and turn-taking).
Feeding and swallowing skills.
Early receptive language skills (e.g., understanding words, sentences, and communicative intentions with and without nonverbal supports).
Early expressive language skills (e.g., babbling, producing early words and sentences; expressing a variety of communicative functions verbally and nonverbally).
Social interaction, play, and emergent literacy skills (e.g., engaging in joint action routines; interacting with family/caregivers using toys, baby books and other age-appropriate literacy materials).

Intervention extends long enough to accomplish stated objectives/predicted outcomes. The intervention period ends when there is no longer any expectation for further benefit at this particular developmental stage.

Setting, Equipment Specifications, Safety and Health Precautions

Setting: Intervention may be conducted in a variety of settings, including Neonatal Intensive Care Units (NICUs), homes, day care, clinical and community settings that are selected on the basis of intervention goals and in consideration of natural contexts and preferences of the infant's/toddler's family/caregivers. In any setting, intervention addresses the personal and environmental factors that are barriers to or facilitators of the infant/toddler's communication interaction and development. There is a plan to generalize and maintain intervention gains and to increase participation in relevant settings and activities.

Equipment Specifications: All equipment is used and maintained in accordance with the manufacturer's specifications.

Documentation

Documentation includes the following:

Written record of the dates, length, and type of interventions that were provided.
Progress toward stated goals, updated prognosis, and specific recommendations.
Evaluation of intervention outcomes and effectiveness within the WHO framework of body structures/functions, activities/participation, and contextual factors.

ASHA Policy Documents and Selected References

American Speech-Language-Hearing Association. (1990). The roles of speech-language pathologists in service delivery to infants, toddlers, and their families. Asha, 32(Suppl. 2), 4.

American Speech-Language-Hearing Association. (2004). Roles of speech-language pathologists in the neonatal intensive care unit: Guidelines. Available from www.asha.org/policy/.

American Speech-Language-Hearing Association. (2004). Roles of speech-language pathologists in the neonatal intensive care unit: Position statement. ASHA Supplement, 24, 60–61.

American Speech-Language-Hearing Association. (2004). Roles of speech-language pathologists in the neonatal intensive care unit: Technical report. ASHA Supplement, 24, 121–130.

World Health Organization. (2001). International classification of functioning, disability and health. Geneva, Switzerland: Author.

#13. Preschool Speech-Language and Communication Assessment

Preschool speech-language-communication assessment is provided to evaluate strengths and weaknesses of speech, language, communication, social interaction, and emergent literacy functioning in preschool-age children including identification of impairments, associated activity and participation limitations, and context barriers and facilitators.

Preschool communication assessment is conducted according to the Fundamental Components and Guiding Principles.

Individuals Who Provide the Service(s)

Speech, language, communication, social interaction, and emergent literacy assessments are conducted by appropriately credentialed and trained speech-language pathologists.

Speech-language pathologists may perform these assessments as members of collaborative teams that may include family/caregivers, day care providers, preschool teachers, and other relevant persons.

Expected Outcome(s)

Consistent with the World Health Organization (WHO) framework, assessment is conducted to identify and describe—

underlying strengths and deficits related to factors that affect communication performance, such as communicative intent, social interaction skills, play, speech, language, and emergent literacy behaviors;
effects of preschool communication impairments on the individual's activities (capacity and performance in everyday communication contexts) and participation, such as day care, preschool, and caregiver interaction;
contextual factors that serve as barriers to or facilitators of successful communication and participation for individuals with speech-language impairment.

Assessment may result in the following:

Diagnosis of a communication disorder, clinical description of the characteristics of the preschooler's communication development and disorder.
Identification of a communication difference, possibly co-occurring with a communication disorder.
Prognosis for change (in the preschooler or relevant contexts).
Recommendations for intervention and support.
Identification of the effectiveness of intervention and supports.
Referral for other assessments or services.

Clinical Indications

Speech, language, communication, social interaction, and emergent literacy assessments are provided to preschoolers as needed, requested, or mandated, or when other evidence suggests that they have risks for spoken and written language impairments involving their body structure/function and/or activities/participation.

Assessment is prompted by referral (e.g., through Child Find), by the preschooler's medical, developmental, or educational status, or by failing a speech-language screening that is sensitive to cultural and linguistic diversity.

Clinical Process

Review of auditory, visual, motor, and cognitive status.
Collection of relevant case history information and parental/teacher perspectives on the child's development and needs and behavioral observations by family/teachers and clinician.
Standardized and/or nonstandardized methods selected with consideration for ecological validity, such as—
- instruments that examine age-appropriate syntax, semantics, and pragmatics;
- criterion referenced instruments;
- developmental scales (including play scales);
- instruments that examine emergent literacy, including early drawing and writing, phonological processes, print awareness, and book interactions;
- language samples in multiple contexts.
Follow-up services to monitor development and ensure appropriate intervention and support for preschoolers with speech-language and communication disorders and differences.

Setting, Equipment Specifications, Safety and Health Precautions

Setting: Assessment is conducted in a clinical or educational setting and/or other natural environment conducive to eliciting representative samples of the preschooler's speech-language and communication abilities. Selection of settings for assessment is based on the goals of assessment with sensitivity to the child's speech community, and in consideration of the WHO framework. Identifying the influence of contextual factors on functioning (activity and participation) requires assessment data from multiple settings and interactions.

Equipment Specifications: All equipment will be used and maintained in accordance with the manufacturer's specifications.

Safety and Health Precautions: All services ensure the safety of the preschooler and clinician and adhere to universal health precautions (e.g., prevention of bodily injury and transmission of infectious disease). Decontamination, cleaning, disinfection, and sterilization of multiple-use equipment before reuse are carried out according to facility-specific infection control policies and services and according to manufacturer's instructions.

Documentation

Documentation includes pertinent background information, results and interpretation, prognosis, and recommendations. Recommendations may include the need for further assessment, follow-up, or referral. When intervention services are recommended, information is provided concerning frequency, estimated duration, and type of service (e.g., individual, group, home program) required.

Documentation addresses the type and severity of the communication disorder or difference and associated conditions (e.g., medical or special education diagnoses).

Documentation includes summaries of previous services in accordance with all relevant legal and agency guidelines such as Individuals with Disabilities Education Act (IDEA) Parts B and C.

Results of the assessment are reported to the family/caregivers, as appropriate. Reports are distributed to the referral source and other professionals when appropriate and with written consent.

ASHA Policy Documents and Selected References

American Speech-Language-Hearing Association. (2004). Admission/discharge criteria in speech-language pathology. ASHA Supplement 24, 65–70.

World Health Organization. (2001). International classification of functioning, disability and health. Geneva, Switzerland: Author.

#14. Preschool Speech-Language and Communication Intervention

Speech-language and communication intervention services are provided for preschoolers with impaired or delayed speech, language, and/or communication skills and related risks for literacy learning difficulties.

Preschool speech-language-communication interventions are conducted according to the Fundamental Components and Guiding Principles.

Individuals Who Provide the Services

Preschool speech-language and communication interventions are conducted by appropriately credentialed and trained speech-language pathologists, possibly supported by speech language pathology assistants under appropriate supervision.

Expected Outcome(s)

Consistent with the World Health Organization (WHO) framework, intervention is designed to—

capitalize on strengths and address weaknesses related to underlying structures and functions that affect speech-language and communication development and use among preschoolers, and for the particular preschooler;
facilitate the preschooler's activities and participation by assisting the child to acquire new communication skills and strategies;
modify contextual factors to reduce barriers and enhance facilitators of successful communication and participation, and to provide appropriate accommodations and other supports, as well as training in how to use them.

Intervention is expected to result in improved abilities, functioning, participation, and contextual facilitators and reduction of risks for literacy learning difficulties. Intervention also may result in recommendations for speech-language and communication reassessment or follow-up, or in a referral for other services.

Clinical Indications

Speech-language-communication interventions are prompted by referral, mandate, and/or by the results of a speech-language assessment. Children receive intervention and/or consultation services when their ability to communicate effectively is impaired because of a communication disorder and when there is a reasonable expectation of benefit in body structure/function and/or activity/participation. Interventions that enhance activity and participation through modification of contextual factors may be warranted even if the prognosis for improved body structure/function is limited.

Clinical Process

Intervention involves providing information and guidance to patients/clients, families, and other significant persons about normal speech-language and communication development, emergent literacy, the communication disorder, course and type of intervention, an estimate of intervention duration, and prognosis for improvement and reduction of future risks.

Depending on assessment results, intervention addresses the following:

Receptive language skills (e.g., attention and listening skills; vocabulary development; following directions; understanding sentences and stories; responding to communicative intent of peers and adult partners).
Expressive language skills (e.g., using age-appropriate phonology and articulation skills; using a variety of words; formulating simple and complex sentences; expressing a variety of communicative functions; engaging with peers).
Play, social interaction, and emergent literacy skills (e.g., using toys, props, and literacy materials in dramatic play; interacting appropriately with peers and adult partners; interacting with books and demonstrating emergent writing skills).
Oral narrative skills (from sequences to simple stories).
Alternative and augmentative communication (AAC) and/or other assistive technology supports as appropriate.

Intervention extends long enough to accomplish stated objectives/predicted outcomes. The intervention period does not continue when there is no longer any expectation for further benefit.

Setting, Equipment Specifications, Safety and Health Precautions

Setting: Intervention may be conducted in a variety of settings, including homes, day care centers, clinics, and preschools that are selected on the basis of intervention goals and in consideration of natural contexts for the preschool-age child. In any setting, intervention is family-centered, developmentally supportive, culturally appropriate and addresses the personal and environmental factors that are barriers to or facilitators of the preschooler's communication. There is a plan to generalize and maintain intervention gains and to increase participation in relevant activities and settings.

Equipment Specifications: All equipment is used and maintained in accordance with the manufacturer's specifications.

Documentation

Documentation includes the following:

Written record of the dates, length, and type of interventions that were provided.
Progress toward stated goals, updated prognosis, and specific recommendations.
Evaluation of intervention outcomes and effectiveness within the WHO framework of body structures/functions, activities/participation, and contextual factors.

ASHA Policy and Selected References

American Speech-Language-Hearing Association. (1991). Guidelines for speech-language-pathologists serving persons with language, sociocommunication, and/or cognitive-communication impairments. Asha, 33(Suppl. 5), 21–28.

American Speech-Language-Hearing Association. (1996). Inclusive practices for children and youths with communication disorders. Asha, 38(Suppl. 16), 35–44.

American Speech-Language-Hearing Association. (2004). Admission/discharge criteria in speech-language pathology. ASHA Supplement 24, 65–70.

World Health Organization. (2001). International classification of functioning, disability and health. Geneva, Switzerland: Author.

#15. Speech Sound Assessment

Assessment of articulation and phonology is provided to evaluate articulatory and phonological functioning (strengths and weaknesses in speech sound discrimination and production), including identification of impairments, associated activity and participation limitations, and context barriers and facilitators.

Articulation and phonology assessment is conducted according to the Fundamental Components and Guiding Principles.

Individuals Who Provide the Service(s)

Speech sound assessments are conducted by appropriately credentialed and trained speech-language pathologists.

Speech-language pathologists may perform these assessments individually or as members of collaborative teams that may include the individual, family/caregivers, and other relevant persons.

Expected Outcome(s)

Consistent with the World Health Organization (WHO) framework, assessment is conducted to identify and describe —

underlying structural/functional strengths and deficits related to articulatory and phonological factors that affect communication performance;
effects of articulation and phonology impairments on the individual's activities (capacity and performance in everyday communication contexts) and participation;
contextual factors that serve as barriers to or facilitators of successful communication and participation for individuals with speech sound disorders.

Assessment may result in the following:

Diagnosis of a speech sound disorder, including childhood apraxia of speech.
Clinical description of the characteristics of articulation and phonology (e.g., speech sound discrimination, developmental phonological processes, production of phonemes in multiple contexts, intelligibility, phonemic awareness).
Identification of a communication difference, possibly co-occurring with a speech sound disorder.
Prognosis for change (in the individual or relevant environmental contexts).
Recommendations for intervention and support.
Identification of the effectiveness of intervention and supports.
Referral for other assessments or services.

Clinical Indications

Speech sound assessments are provided to individuals as needed, requested, or mandated or when other evidence suggests that individuals have articulation and phonology impairments associated with their body structure/function and/or communication activities/participation.

Assessment is prompted by referral, by the individual's medical status, or by failing a speech-language screening that is sensitive to cultural and linguistic diversity.

Clinical Process

Relevant case history, including medical status, education, vocation and socioeconomic, cultural, and linguistic backgrounds.
Review of auditory, visual, motor, and cognitive status.
Standardized and/or nonstandardized assessments including —
articulation tests;
spontaneous speech samples;
error analysis to determine whether the individual displays primarily speech production deficits and/or deficits associated with phonological constraints;
independent analysis such as a phonetic inventory;
relational analysis such as assessment of simplification processes;
observation of intelligibility in communication environments.
Standardized measures for articulation and/or phonological assessment selected with consideration for documented ecological validity.
Follow-up services to monitor status and ensure appropriate intervention and support for individuals with identified speech sound disorders.

Setting, Equipment Specifications, Safety Precautions

Setting: Assessment is conducted in a clinical or educational setting or other natural environments conducive to eliciting a representative sample of the patient's/client's speech production. The goals of the assessment and the WHO framework are considered in selecting assessment settings. Identifying the influence of contextual factors on functioning (activity and participation) requires assessment data from multiple settings.

Equipment Specifications: All equipment will be used and maintained in accordance with the manufacturer's specifications.

Safety and Health Precautions: All services ensure the safety of the patient/client and clinician and adhere to universal health precautions (e.g., prevention of bodily injury and transmission of infectious disease). Decontamination, cleaning, disinfection, and sterilization of multiple-use equipment before reuse are carried out according to facility-specific infection control policies and services and according to manufacturer's instructions.

Documentation

Documentation includes pertinent background information, results and interpretation, prognosis, and recommendations. Recommendations may include the need for further assessment, follow-up, or referral. When intervention is recommended, information is provided concerning frequency, estimated duration, and type of service delivery.

Documentation addresses the type and severity of the speech sound disorder or difference and associated conditions (e.g., educational or medical diagnoses).

Documentation includes summaries of previous services in accordance with all relevant legal and agency guidelines.

Results of assessment are reported to the individual and family/caregivers, as appropriate. Reports are distributed to referral source and other professionals when appropriate and with written consent.

ASHA Policy Documents and Selected References

American Speech-Language-Hearing Association. (1983). Social dialects and implications of the position on social dialects. Asha, 25, 23–27.

American Speech-Language-Hearing Association. (1989, March). Bilingual speech-language pathologists and audiologists: Definition. Asha, 31, 93.

American Speech-Language-Hearing Association. (1998). Provision of instruction in English as a second language by speech-language pathologists in school settings. Asha, 40(Suppl. 18).

American Speech-Language-Hearing Association. (2002). A workload analysis approach for establishing speech-language caseload standards in schools: Guidelines. In Rockville, MD: Author.

American Speech-Language-Hearing Association. (2002). A workload analysis approach for establishing speech-language caseload standards in schools: Position statement. In Rockville, MD: Author.

American Speech-Language-Hearing Association. (2002). A workload analysis approach for establishing speech-language caseload standards in schools: Technical report. In Rockville, MD: Author.

American Speech-Language-Hearing Association. (2004). Cultural competence. Available from www.asha.org/policy/.

World Health Organization. (2001). International classification of functioning, disability and health. Geneva, Switzerland: Author.

#16. Speech Sound Intervention

Intervention in speech sound disorders addresses articulatory and phonological impairments, associated activity and participation limitations, and context barriers and facilitators by optimizing speech discrimination, speech sound production, and intelligibility in multiple communication contexts.

Intervention is conducted according to the Fundamental Components and Guiding Principles.

Individuals Who Provide the Services

Interventions in speech sound disorders are conducted by appropriately credentialed and trained speech-language pathologists, possibly supported by speech-language pathology assistants under appropriate supervision.

Expected Outcome(s)

Consistent with the World Health Organization (WHO) framework, intervention is designed to—

capitalize on strengths and address weaknesses related to underlying structures and functions that affect articulation and phonology;
facilitate the individual's activities and participation by assisting the person to acquire new speech production skills and strategies;
modify contextual factors to reduce barriers and enhance facilitators of successful communication and participation and to provide appropriate accommodations and other supports, as well as training in how to use them.

Intervention is expected to result in improved abilities, functioning, participation, and contextual factors. Intervention also may result in recommendations for reassessment or follow-up, or in a referral for other services.

Clinical Indications

Intervention for speech sound disorders is prompted by referral, mandates, and/or by the results of an assessment that includes measures of articulation and phonology. Individuals receive treatment and/or consultation services when their ability to communicate effectively is impaired because of a speech sound disorder and when there is a reasonable expectation of benefit to the individual in body structure/function and/or activity/participation. Interventions that enhance activity and participation through modification of contextual factors may be warranted even if the prognosis for improved body structure/function is limited.

Clinical Process

Intervention involves providing information and guidance to patients/clients, families, and other significant persons about articulation and phonology, the course of intervention, an estimate of intervention duration, and prognosis for improvement.

Depending on assessment results and age of the client/patient, intervention addresses the following:

Selection of intervention targets based on the results of an assessment of the client/patient's articulation and phonology.
Improvement of speech sound discrimination and production.
General facilitation of newly acquired articulation and/or phonological abilities to a variety of speaking, listening, and literacy-learning contexts.
Increased phonological awareness of sounds and sound sequences in words and relating them to print orthography (when age-appropriate).

Intervention extends long enough to accomplish stated objectives/predicted outcomes. The intervention period ends when there is no longer any expectation for further benefit.

Setting, Equipment Specifications, Safety and Health Precautions

Setting: Intervention may be conducted in a variety of settings, selected on the basis of intervention goals and in consideration of the social, educational, and/or vocational activities that are relevant to or desired by the individual. In any setting, intervention addresses the personal and environmental factors that are barriers to or facilitators of the patient's/client's articulatory and phonological abilities. There is a plan to generalize and maintain intervention gains and to increase participation in relevant settings and activities.

Equipment Specifications: All equipment is used and maintained in accordance with the manufacturer's specifications.

Safety and Health Precautions: All services ensure the safety of the patient/client and clinician and adhere to universal health precautions (e.g., prevention of bodily injury and transmission of infectious disease). Decontamination, cleaning, disinfection, and sterilization of multiple-use equipment before reuse are carried out according to facility-specific infection control policies and services and according to manufacturer's instructions.

Documentation

Documentation includes the following:

Written record of the dates, length, and type of interventions that were provided.
Progress toward stated goals, updated prognosis, and specific recommendations.
Evaluation of intervention outcomes and effectiveness within the WHO framework of body structures/functions, activities/participation, and contextual factors.

ASHA Policy Documents and Selected References

American Speech-Language-Hearing Association. (1983). Social dialects and implications of the position on social dialects. Asha, 25, 23–27.

American Speech-Language-Hearing Association. (1989, March). Bilingual speech-language pathologists and audiologists: Definition. Asha, 31, 93.

American Speech-Language-Hearing Association. (1993). Definitions of communication disorders and variations. Asha, 35(Suppl. 10), 40–41.

American Speech-Language-Hearing Association. (1998). Provision of instruction in English as a second language by speech-language pathologists in school settings. Asha, 40(Suppl. 18).

American Speech-Language-Hearing Association. (2004). Cultural competence. Available from www.asha.org/policy/.

World Health Organization. (2001). International classification of functioning, disability and health. Geneva, Switzerland: Author.

#17. Spoken and Written Language Assessment—School-Age Children and Adolescents

Spoken and written language assessment for school-age children and adolescents is used to evaluate spoken and written language functioning (strengths and weaknesses) in school-age children and adolescents, including identification of impairments, associated activity and participation limitations, and context barriers and facilitators.

Spoken and written language assessment among school-age children and adolescents is conducted according to the Fundamental Components and Guiding Principles.

Individuals Who Provide the Service(s)

Spoken and written language assessments are conducted by appropriately credentialed and trained speech-language pathologists.

Speech-language pathologists may perform these assessments as members of collaborative teams that include the individual, family/caregivers, educators, and other relevant persons.

Expected Outcomes

Consistent with the World Health Organization (WHO) framework, assessment is conducted to identify and describe—

underlying structural/functional strengths and deficits in language and literacy knowledge and skills that affect communication performance;
effects of spoken and written communication impairments on the individual's activities (capacity and performance in everyday curricular/communication contexts) and participation;
contextual factors that serve as barriers to or facilitators of successful communication and participation.

Assessment may result in the following:

Diagnosis of a language disorder involving spoken and written language, or indication that an individual does not have a disorder.
Clinical description of the spoken and written language disorder.
Identification of a communication difference, possibly co-occurring with a language disorder.
Evaluation of the effectiveness of prior intervention and supports.
Prognosis for change (if a disorder is diagnosed).
Recommendations for intervention and contextual modifications or other follow-up activities.
Referral for other assessments or services.

Clinical Indications

Spoken and written language assessment services are provided to school-age children and adolescents as needed, requested, or mandated or when other evidence suggests that individuals may have spoken and written language impairments associated with their body structure/function and/or activities/participation.

Assessment is prompted by referral, by the individual's educational or medical status, or by failing a speech and language screening that is sensitive to cultural and linguistic diversity backgrounds.

Clinical Process

Comprehensive assessment is sensitive to cultural and linguistic diversity and addresses components within the WHO's International Classification of Functioning, Disability and Health (2001) framework including body structures/functions, activities/participation, and contextual factors.

Review of auditory, visual, motor, and cognitive status.
Collection of relevant case history information, including medical and educational status, and teacher, parent, and client/patient perspectives on the problem.
Administration of standardized assessment tools and/or nonstandardized sampling or observation methods.
Knowledge and use of language for listening, speaking, reading, writing, and thinking, including —
- phonology and print symbols (orthography) for recognizing and producing intelligible spoken and written words;
- syntactic structures and semantic relationships for understanding and formulating complex spoken and written sentences;
- discourse structures for comprehending and organizing spoken and written texts;
- pragmatic conventions (verbal and nonverbal) for communicating appropriately in varied situations;
- metacognitive and self-regulatory strategies for handling complex language, literacy, and academic demands.
Examination of how language strengths and weaknesses affect the individual's activities and participation in specific educational, social, and vocational activities identified as problematic by the assessment team.
Examination of contextual factors that influence the individual's relative success or difficulty in educational, social, and vocational activities.
Selection of standardized measures for spoken and written language assessment with consideration for documented ecological validity (including relevance to the student's sociocultural experiences, educational curriculum, and/or vocational needs).
Follow-up services to monitor cognitive-communication status and ensure appropriate intervention and support for children and adolescents with identified spoken and written language disorders.

Setting, Equipment Specifications, Safety and Health Precautions

Setting: Assessment is conducted in clinical and/or educational environments conducive to eliciting representative samples of the patient's/client's spoken and written language functioning. Selection of settings for assessment is based on the input of others (including the child or adolescent), goals of assessment, and in consideration of the WHO framework. Identifying the influence of contextual factors on functioning (activity and participation) requires the collection of assessment data from multiple language contexts and settings.

Equipment Specifications: Children and adolescents who use AAC devices and techniques are assessed with the devices; those with hearing impairment are assessed using their preferred mode of communication and with optimal amplification.

All equipment and measurement tools are used in accordance with the manufacturer's specifications.

Assessment tools are selected with regard to—

evidence of adequate reliability and validity, including ecological validity (e.g., curriculum-based assessment may conducted with components of a student's actual school curriculum and with reference to educational agency standards);
appropriateness for the cultural and linguistic backgrounds of the individual.

Safety and Health Precautions: All services ensure the safety of the patient/client and clinician and adhere to universal health precautions (e.g., prevention of bodily injury and transmission of infectious disease). Decontamination, cleaning, disinfection, and sterilization of multiple-use equipment before reuse are carried out according to facility-specific infection control policies and services and according to manufacturer's instructions.

Documentation

Documentation includes pertinent background information, results and interpretation of assessments and observations, prognosis, and recommendations. Recommendations may include the need for further assessment, follow-up, or referral. When treatment is recommended, information is provided concerning recommended frequency, estimated duration, and type of service (e.g., individual, group, classroom-based, home program).

Documentation addresses the type and severity of the child or adolescent's spoken and written language disorder or difference and associated conditions (e.g., medical diagnoses or special education category).

Documentation may include a portfolio of the child or adolescent's communication samples (e.g., audiotaped or videotaped interactions, transcripts of spoken conversations or print samples read aloud, descriptions of nonverbal interactions or writing processes, written products).

Documentation includes summaries of previous services in accordance with all relevant legal and agency guidelines.

ASHA Policy Documents and Selected References

American Speech-Language-Hearing Association. (1982). Definitions of language. Asha, 24(6), 44.

American Speech-Language-Hearing Association. (1996). Inclusive practices for children and youths with communication disorders. Asha, 38(Suppl. 16), 35–44.

American Speech-Language-Hearing Association. (2004). Admission/discharge criteria in speech-language pathology. ASHA Supplement 24, 65–70.

World Health Organization. (2001). International classification of functioning, disability and health. Geneva, Switzerland: Author.

#18. Spoken and Written Language Intervention—School-Age Children and Adolescents

Intervention services (including academic instruction) are provided for school-age children and adolescents with spoken and written language.

Intervention is conducted according to the Fundamental Components and Guiding Principles.

Individuals Who Provide the Services

Spoken and written language interventions for school-age children and adolescents are conducted by appropriately credentialed and trained speech-language pathologists, possibly supported by speech-language pathology assistants under appropriate supervision.

Speech-language pathologists may provide these services as members of collaborative teams that include general and special education teachers, the individual, family/caregivers, and other relevant persons.

Expected Outcome(s)

Consistent with the World Health Organization (WHO) framework, intervention is designed to—

capitalize on strengths and address weaknesses related to underlying structures and functions that affect spoken and written language development and use;
facilitate the individual's social, educational, and vocational activities and participation by assisting the person to acquire new spoken and written language skills and communication strategies (verbal and nonverbal);
modify contextual factors to reduce barriers and enhance facilitators of successful spoken and written communication and participation and to provide appropriate accommodations and other supports, as well as training in how to use them.

Intervention is expected to result in improved spoken and written language abilities; improved social, academic, and/or vocational functioning and participation; and improved contextual facilitators. Intervention also may result in recommendations for spoken and written language reassessment or follow-up, or in a referral for other services.

Clinical Indications

Spoken and written language interventions for children and adolescents are prompted by referral, mandate sand/or by the results of a spoken and written language assessment. Children and adolescents receive intervention services (including consultation) when their ability to communicate effectively and to participate in social, educational, or vocational activities is impaired because of a spoken and written disorder and when there is a reasonable expectation of benefit to the individual in body structure/function and/or activity/participation. Interventions that enhance activity and participation through modification of contextual factors may be warranted even if the prognosis for improved body structure/function is limited.

Speech-language pathologists also may provide services aimed at enhancing spoken and written language abilities and participation in social, education, and vocational activities, if so requested, when a communication difference is present or when spoken/written language development risks have been identified and service delivery is requested.

Clinical Process

Intervention includes collaborative problem solving and providing information and guidance to patients/clients, families/caregivers, teachers, and other significant persons about spoken and written language development and disorders, the course of intervention, an estimate of intervention duration, and prognosis for improvement.

Intervention goals and objectives are determined from assessment (including input from parents, teachers, the child or adolescent, and other relevant persons); are relevant to the educational curriculum, vocational and social-interaction priorities; and are reviewed periodically to determine continued appropriateness.

Depending on assessment results and the age/stage of the child or adolescent, intervention addresses the following:

Knowledge and use of language for listening, speaking, reading, writing, and thinking, including —
- phonology and print symbols (orthography) for recognizing and producing intelligible spoken and written words;
- syntactic structures and semantic relationships for understanding and formulating complex spoken and written sentences;
- discourse structures for comprehending and organizing spoken and written texts;
- pragmatic conventions (verbal and nonverbal) for communicating appropriately in varied situations;
- metacognitive and self-regulatory strategies for handling complex language, literacy, and academic demands.
Spoken and written language for social, educational, and vocational functions, with an emphasis on participation in specific activities identified as problematic for the individual.
Contextual factors that influence the individual's relative success or difficulty in those activities.

Progress is measured by comparing changes in speech-language skills to established performance baselines, including curriculum-based language assessments and classroom or workplace observations.

Intervention extends long enough to accomplish stated objectives/predicted outcomes and ends when there is no expectation for further benefit during the current developmental stage.

Setting, Equipment Specifications, Safety and Health Precautions

Setting: Intervention may be conducted in a variety of settings, including regular or special education classes or in individual/group treatment outside the classroom/workplace setting, selected on the basis of intervention goals and in consideration of the social, academic and/or vocational activities that are relevant to or desired by the individual.

In any setting, intervention addresses the personal and environmental factors that are barriers to or facilitators of the patient's/client's spoken and written language production. There is a plan to generalize and maintain intervention gains and to increase participation in relevant settings and activities.

Speech-language pathologists serve as members of education teams including special education prereferral teams and problem solving teams (e.g., teacher assistance teams). In addition, speech-language pathologists serve as members of an education team when they are providing speech-language instruction in the context of the academic program.

Equipment Specifications: All equipment is used and maintained in accordance with the manufacturer's specifications. Assistive technology needs (e.g., classroom or personal amplification systems, modified computer access software or hardware, augmentative and alternative communication (AAC) systems) are provided as needed and documented in the intervention plan.

Safety and Health Precautions: All services ensure the safety of the patient/client and clinician and adhere to universal health precautions (e.g., prevention of bodily injury and transmission of infectious disease). Decontamination, cleaning, disinfection, and sterilization of multiple-use equipment before reuse are carried out according to facility-specific infection control policies and services and according to manufacturer's instructions.

Documentation

Documentation includes the following:

Written record of the dates, length, and type of interventions (including consultations) that were provided.
Consideration of the need for assistive technology (e.g., classroom or personal amplification systems, modified computer access software or hardware, AAC systems) and a plan for monitoring, maintaining, and updating any technological supports.
Progress toward stated goals (relative to baseline levels and with relevance to the general education curriculum or vocational activities), updated prognosis, and specific recommendations.
Evaluation of intervention outcomes and effectiveness within the WHO framework of body structures/functions, activities/participation, and contextual factors.

The privacy and security of documentation are maintained in compliance with the regulations of the Health Insurance Portability and Accountability Act (HIPAA), the Federal Educational Rights and Privacy Act (FERPA), and other state and federal laws.

Documentation may be a part of the patient's/client's individualized education program or other collaborative treatment plan.

ASHA Policy Documents and Selected References

American Speech-Language-Hearing Association. (1982). Definitions of language. Asha, 24, 44.

American Speech-Language-Hearing Association. (1991). A model for collaborative service delivery for students with language-learning disorders in the public schools. Asha, 33(Suppl. 5), 44–50.

American Speech-Language-Hearing Association. (1996). Inclusive practices for children and youths with communication disorders. Asha, 38(Suppl. 16), 35–44.

American Speech-Language-Hearing Association. (2000). Guidelines for the roles and responsibilities of the school-based speech-language pathologist. In Rockville, MD: Author.

American Speech-Language-Hearing Association. (2003). Appropriate school facilities for students with speech-language-hearing disorders: Technical report. ASHA Supplement 23, 83–86.

American Speech-Language-Hearing Association. (2004). Admission/discharge critieria in speech-language pathology. ASHA Supplement 24, 65–70.

National Joint Committee on Learning Disabilities. (1991). Providing appropriate education for students with learning disabilities in regular education classrooms. Asha, 33(Suppl. 5), 15–17.

World Health Organization. (2001). International classification of functioning, disability and health. Geneva, Switzerland: Author.

#19. Speech-Language Assessment for Individuals Who Are Bilingual and/or Learning English as an Additional Language

Speech-language assessment for individuals who are bilingual and/or learning English as an additional language (i.e., “English Language Learners, ELL”) comprises services to assess speech-language and communication functioning (strengths and weaknesses) in an individual's first language (L1) or a second language (L2). Bilingual assessment services include identification of language use (i.e., the language the individual speaks or is exposed to most of the time) and language proficiency (i.e., degree of ability in each language). In addition, assessment addresses potential impairments, associated activity and participation limitations, and context barriers and facilitators.

Speech-language assessments for individuals who are bilingual and/or learning English as an additional language are conducted according to the Fundamental Components and Guiding Principles.

Individuals Who Provide the Service(s)

Speech-language assessments for individuals who are bilingual and/or learning English as an additional language are conducted by appropriately credentialed and trained speech-language pathologists, supported as necessary by trained interpreters.

Speech-language pathologists may perform these assessments individually or as members of collaborative teams that include the individual, family/caregivers, and other relevant persons (e.g., educators, medical personnel).

Expected Outcomes

Consistent with the World Health Organization (WHO) framework, assessment is conducted to identify and describe —

underlying structural/functional strengths and deficits in language (and literacy) knowledge and skills within the individual's primary language that affect communication performance with others who speak the same language;
effects of speech-language and communication impairments on the individual's activities (capacity and performance in everyday curricular/communication contexts) and participation within the individual's community;
contextual factors that serve as barriers to or facilitators of successful communication and participation.

Assessment may result in the following:

Identification of the individual's relative language proficiency, (e.g., comparable proficiency in L1 and L2; proficiency in L1 but not L2; or limited proficiency in both languages).
Diagnosis of a language disorder.
Clinical description of the individual's speech-language and communication abilities (strengths and needs) in the individual's first language and in English.
Identification of a communication difference, possibly co-occurring with a language disorder.
Evaluation of the effectiveness of prior intervention and supports.
Prognosis for change (if a disorder is diagnosed).
An estimate of language learning capacity and/or a plan to conduct ongoing/dynamic assessment to determine language learning capacity in L1 and/or L2.
Recommendations for intervention and contextual modifications or other follow-up activities.
Referral for other assessments or services.

Clinical Indications

Speech-language assessments for bilingual speakers and individuals who are bilingual and/or learning English as an additional language are conducted as needed, requested, or mandated or when other evidence suggests that individuals may have speech-language/communication impairments associated with their body structure/function and/or activities/participation as defined by the World Health Organization (see Fundamental Components and Guiding Principles).

Assessment is prompted by referral, by the individual's medical or educational status, or by failing a speech and language screening conducted with sensitivity to cultural and linguistic diversity.

Clinical Process

Comprehensive assessment is sensitive to cultural and linguistic diversity and addresses components within the World Health Organization (WHO) framework, including body structures/functions, activities/participation, and contextual factors.

Review of auditory, visual, motor, and cognitive status.
Collection of relevant case history information (using a trained interpreter if necessary), including a profile of current and past exposure to specific languages, as well as parent/caregiver reports, teacher reports, reports by others familiar with the individual's speech community, and the individual's perspectives, as appropriate.
Selection, administration, and interpretation of standardized assessment tools and/or nonstandardized sampling (e.g., interviews and observation in varied settings and multiple activities) conducted with recognition of the unique characteristics of the individual's linguistic community.
Use of trained interpreter as appropriate.
Examination of ability to use speech-language and communication skills, including phonological and grammatical development (compared to the norms of the individual's speech community), ability to comprehend and integrate verbal information, ability to use both verbal and nonverbal communication skills to interact with people from multiple speech communities.
Examination of how language strengths and weaknesses (in both L1 and L2) affect the individual's activities and participation in specific educational, social, and vocational activities identified as problematic by the assessment team.
Examination of contextual factors that influence the individual's relative success or difficulty in educational, social, and vocational activities.
Selection of assessment procedures occurs with consideration for documented ecological validity (including relevance to the individual's language proficiency, sociocultural experiences, educational curriculum, and/or vocational needs).
Follow-up services to monitor language learning capacity and cognitive-communication status and to ensure appropriate intervention and support for individuals who are bilingual or learning English as an additional language and who also have speech-language disorders.

Setting, Equipment Specifications, Safety and Health Precautions

Setting: Assessment is conducted in varied clinical or educational settings and/or other natural environments representing the individual's native/home speech community and conducive to eliciting a representative sample of the patient's/client's language functioning in L1 and L2. Selection of settings for assessment is based on the input of others (including the individual), goals of assessment, and in consideration of the WHO framework. Identifying the influence of contextual factors on functioning (activity and participation) requires the collection of assessment data from multiple language contexts and settings.

Equipment Specifications: Individuals who use AAC devices and techniques are assessed with their devices programmed in the appropriate language; those who are hearing impaired are assessed using their preferred mode of communication and with optimal amplification.

Equipment is used in accordance with the manufacturer's specifications.

Assessment tools are selected with regard to—

evidence of adequate reliability and validity, including ecological validity (e.g., curriculum-based assessment may conducted with components of a student's actual school curriculum and with reference to educational agency standards);
appropriateness for persons from the cultural and linguistic community of the individual.

Safety and Health Precautions: All services ensure the safety of the patient/client and clinician and adhere to universal health precautions (e.g., prevention of bodily injury and transmission of infectious disease). Decontamination, cleaning, disinfection, and sterilization of multiple-use equipment before reuse are carried out according to facility-specific infection control policies and services and according to manufacturer's instructions.

Documentation

Documentation includes pertinent background information, results and interpretation of assessments and observations, prognosis, and recommendations.

Documentation includes a description and results of the procedures used to identify the individual's relative proficiency in each language.

Recommendations may include the need for further assessment, follow-up, or referral.

When intervention is recommended, information is provided concerning recommended frequency, estimated duration, and type of service (e.g., individual, group, classroom-based, home program).

Documentation addresses the type and severity of the individual's speech-language and communication disorder or difference and associated conditions (e.g., medical diagnoses or special education category).

Documentation may include a portfolio of the individual's communication samples in both languages (e.g., audiotaped or videotaped interactions, transcripts of spoken conversations or print samples read aloud, descriptions of nonverbal interactions or writing processes, written language samples).

Documentation includes summaries of previous services in accordance with all relevant legal and agency guidelines.

Results of assessment are reported to the individual and family/caregivers in a language and modality they can understand. Reports are distributed to referral source and other professionals when appropriate and with written consent.

ASHA Policy Documents and Selected References

American Speech-Language-Hearing Association. (1983). Social dialects and implications of the position on social dialects. Asha, 25, 23–27.

American Speech-Language-Hearing Association. (1985, June). Clinical management of communicatively handicapped minority language populations. Asha, 27(6).

American Speech-Language-Hearing Association. (1989, March). Bilingual speech-language pathologists and audiologists: definition. Asha, 31, 93.

American Speech-Language-Hearing Association. (1998). Provision of instruction in English as a second language by speech-language pathologists in school settings. Asha, 40(Suppl. 18), 24–27.

American Speech-Language-Hearing Association. (2002). Technical report: American English dialects. ASHA Supplement 23, 45–46.

American Speech-Language-Hearing Association. (2004). Cultural competence. Available from www.asha.org/policy/.

(2004). Code of Fair Testing Practices in Education. (2004). Washington, DC: Joint Committee on Testing Practices.

World Health Organization. (2001). International classification of functioning, disability and health. Geneva, Switzerland: Author.

#20. Spoken and Written Language Assessment—Adults

These services assess spoken and written language functioning (strengths and weaknesses) in adults, including identification of impairments, associated activity and participation limitations, and context barriers and facilitators.

Assessment is conducted according to the Fundamental Components and Guiding Principles.

Individuals Who Provide the Service(s)

Spoken and written language assessments are conducted by appropriately credentialed and trained speech-language pathologists.

Speech-language pathologists may perform these assessments as a member of collaborative teams that may include the individual, family/caregivers, and other relevant persons.

Expected Outcome(s)

Consistent with the World Health Organization (WHO) framework, assessment is conducted to identify and describe —

underlying strengths and deficits related to spoken and written language factors that affect communication performance;
effects of the language disorder on the individual's activities and participation in ideal settings and everyday contexts;
contextual factors that serve as barriers to or facilitators of successful communication and participation for individuals with spoken and written language disorders.

Assessment may result in the following:

Diagnosis of a language disorder.
Description of the characteristics of the language disorder.
Identification of a communication difference, possibly co-occurring with a language disorder.
Prognosis for change (in the individual or relevant contexts).
Recommendations for intervention and support.
Identification of the effectiveness of intervention and supports.
Referral for other assessments or services.

Clinical Indications

Spoken and written language assessment services are provided to adults as needed, requested, or mandated or when other evidence suggests that they have spoken or written language impairments involving body structure/function and affecting activities/participation.

Assessment is prompted by referral, by the individual's medical status, or by failing a speech, language, or cognitive-communication screening conducted with sensitivity to influences of cultural and linguistic diversity.

Clinical Process

Comprehensive assessment is sensitive to cultural and linguistic diversity and addresses the components within the WHO framework, including body structures/functions, activities/participation, and contextual factors.

Assessment may be static (i.e., using procedures designed to describe current levels of functioning within relevant domains); and/or dynamic (i.e., using hypothesis-testing procedures to identify potentially successful intervention and support procedures) and includes the following:

Relevant case history, including medical status, education, vocation, and socio-economic, cultural, and linguistic backgrounds.
Review of auditory, visual, motor, cognitive, and emotional status.
Standardized and nonstandardized methods, selected with consideration of ecological validity:

Patient's/client's report of areas of concern (listening, speaking, reading, writing), contexts of concern (e.g., social interactions, work activities), and goals and preferences;
- Administration of standardized assessment tools and/or nonstandardized sampling or observational methods to assess and describe the individual's knowledge and skills in the areas of language form (phonology and alphabetic symbols, morphology and orthographic patterns, and syntax), content (semantics), and use (pragmatics) across spoken and written modalities;
- Analysis of natural communication samples gathered in modalities (listening, speaking, reading, or writing) and specific contexts (social. educational, vocational) identified as problematic;
- Assessment of oral, motor, and speech function;
- Identification of contextual barriers and facilitators and potential for effective compensatory techniques and strategies including the use of alternate/augmentative communication (AAC).
Follow-up services to monitor spoken and written language status and ensure appropriate intervention and support in individuals with identified language disorders.

Setting, Equipment Specifications, Safety and Health Precautions

Setting: Assessments are conducted in a clinical and/or natural environment conducive to eliciting a representative sample of the patient's/client's spoken and written language functioning. The goals of the assessment and the WHO framework are considered in selecting assessment settings. Identifying the influence of contextual factors on functioning (activity and participation) requires assessment data from multiple settings.

Equipment Specifications: All equipment is used and monitored in accordance with the manufacturer's specifications. Selection of standardized measures for language assessment occurs in consideration for ecological validity.

Safety and Health Precautions: All services ensure the safety of the patient/client and clinician and adhere to universal health precautions (e.g., prevention of bodily injury and transmission of infectious disease). Decontamination, cleaning, disinfection, and sterilization of multiple-use equipment before re-use are carried out according to facility-specific infection control policies and services and according to manufacturer's instructions.

Documentation

Documentation includes pertinent background information, results and interpretation, prognosis, and recommendations. Recommendations may include the need for further assessment, follow-up, or referral. When intervention is recommended, information is provided concerning frequency, estimated duration, and type of service (e.g., individual, group, home program) required.

Documentation addresses the type and severity of the spoken and written language disorder or difference and associated conditions (e.g., medical diagnoses).

Documentation may include a portfolio of the adult's communication samples (e.g., audiotaped or videotaped samples of interactions, transcripts of spoken conversations or orally read material, descriptions of nonverbal interactions, rough drafts, written language samples).

Documentation includes summaries of previous services in accordance with all relevant legal and agency guidelines.

The privacy and security of documentation are maintained in compliance with the regulations of the Health Insurance Portability and Accountability Act (HIPAA) and other state and federal laws.

ASHA Policy Documents and Selected References

American Speech-Language-Hearing Association. (1990). The role of speech-language pathologists in service delivery for persons with mental retardation and developmental disabilities in community settings. Asha, 32(Suppl. 2), 5–6.

American Speech-Language-Hearing Association. (1991). Guidelines for speech-language pathologists serving persons with language, socio-communicative, and/or cognitive-communicative impairments. Asha, 33(Suppl. 5), 21–28.

Paul-Brown, D., & Ricker, J.H. (2003). Evaluating and treating communication and cognitive disorders: Approaches to referral and collaboration for speech-language pathology and clinical neuropsychology. Technical report. Asha, Supplement 23, 47–57.

World Health Organization. (2001). International classification of functioning, disability and health. Geneva, Switzerland: Author.

Ylvisaker, M., Hanks, R., & Johnson-Green, D. (2003). Rehabilitation of children and adults with cognitive-communication disorders after brain injury. Asha Supplement 23, 59–72.

#21. Spoken and Written Language Intervention—Adults

Intervention services are conducted for adults with spoken and/or written language disorders, including problems in areas of language form (phonology and alphabetic symbols, morphology and orthographic patterns, and syntax), content (semantics), and/or use (pragmatics) across spoken and written modalities.

Intervention is conducted consistent with the Fundamental Components and Guiding Principles.

Individuals Who Provide the Services

Spoken and written language interventions for adults are conducted by appropriately credentialed and trained speech-language pathologists, possibly supported by speech-language pathology assistants under appropriate supervision.

Speech-language pathologists may provide these services as members of collaborative teams that may include the individual, family/caregivers, and other relevant persons.

Expected Outcome(s)

Consistent with the World Health Organization (WHO) framework, intervention is designed to—

capitalize on strengths and address weaknesses related to underlying structures and functions that affect communication;
facilitate the individual's activities and participation by assisting the person to acquire new skills and strategies;
modify contextual factors that serve as barriers and enhance facilitators of successful communication and participation and provide appropriate accommodations and other supports, as well as training in how to use them.

Intervention is expected to result in reduced deficits and contextual barriers, improved spoken and written language abilities and contextual facilitators, and measurably enhanced functioning and participation. Intervention also may result in recommendations for language reassessment or follow-up, or in a referral for other services.

Clinical Indications

Intervention for a spoken and/or written language disorder is prompted by referral or by the results of a speech-language assessment. Adults receive intervention and/or consultation services when their ability to communicate effectively and participate in social, educational, or vocational activities is impaired because of a language disorder and when there is a reasonable expectation of benefit to the individual in body structure/function and/or activity/participation. Interventions that enhance activity and participation through implementation of strategies or modification of contextual factors may be warranted even if the prognosis for improved body structure/function is limited.

Clinical Process

Intervention involves providing information and guidance to patients/clients, families/caregivers, and other significant persons about the nature of spoken and/or written language disorders, the course of treatment, and prognosis for recovery.

Intervention addresses the complexities of a spoken and/or written language disorder in a manner that is sensitive to cultural and linguistic diversity.

Depending on assessment results, intervention addresses the following:

Knowledge and use of language for listening, speaking, reading, writing, and thinking, including —
- phonology and print symbols (orthography) for recognizing and producing intelligible spoken and written words;
- syntactic structures and semantic relationships for understanding and formulating complex spoken and written sentences;
- discourse structures for comprehending and organizing spoken and written texts;
- pragmatic rules for communicating appropriately in varied situations;
- metacognitive and self-regulatory strategies for handling complex language and literacy demands.
Spoken and written language for social, educational, and vocational activities, with an emphasis on participation in specific activities identified as problematic for the individual.
Contextual factors that influence the individual's relative success or difficulty in those activities.
Compensatory communication techniques and strategies including the use of augmentative and alternative communication or other assistive technology.
Training of others in the individual's environment to use communication strategies, cuing techniques, and/or assistive technology to support increased comprehension of spoken and written language and to facilitate increased spoken and written output.
Development of plans, including referral, for problems co-occurring with spoken and written language disorders, such as hearing or visual difficulties, speech or voice disorders, and emotional disturbance.

Intervention extends long enough to accomplish stated objectives/predicted outcomes and ends when there is no longer any expectation for further benefit. Clinicians provide an estimate of treatment duration to patients/clients and their families/caregivers.

Setting, Equipment Specifications, Safety and Health Precautions

Setting: Intervention may be conducted in clinical and natural environments that are selected on the basis of intervention goals and in consideration of the social, academic, and/or vocational activities that are relevant to or desired by the individual. In any setting, intervention addresses the personal and environmental factors that are barriers to or facilitators of the patient's/client's spoken and written language function. There is a plan to generalize and maintain intervention gains and to increase participation in relevant settings and activities.

Equipment Specifications: Equipment will be used and maintained in accordance with the manufacturer's specifications.

Safety Precautions: All services ensure the safety of the patient/client and clinician and adhere to universal health precautions (e.g., prevention of bodily injury and transmission of infectious disease). Decontamination, cleaning, disinfection, and sterilization of multiple-use equipment before reuse are carried out according to facility-specific infection control policies and services and according to manufacturer's instructions.

Documentation

Documentation includes the following:

Written record of the dates, length, and type of interventions that were provided.
Progress toward stated goals, updated prognosis, and specific recommendations.
Evaluation of intervention outcomes and effectiveness within the WHO framework of body structures/functions, activities/participation, and contextual factors.

The privacy and security of documentation are maintained in compliance with the regulations of the Health Insurance Portability and Accountability Act (HIPAA) and other state and federal laws.

ASHA Policy Documents and Selected References

American Speech-Language-Hearing Association. (1991). Guidelines for speech-language pathologists serving persons with language, sociocommunicative, and/or cognitive-communicative impairments. Asha, 33(Suppl. 5), 21–28.

Paul-Brown, D., & Ricker, J.H. (2003). Evaluating and treating communication and cognitive disorders: Approaches to referral and collaboration for speech-language pathology and clinical neuropsychology: Technical report. Asha, Supplement 23, 47–57.

World Health Organization. (2003). International classification of functioning, disability and health. Geneva, Switzerland: Author.

Ylvisaker, M., Hanks, R., & Johnson-Green, D. (2003). Rehabilitation of children and adults with cognitive-communication disorders after brain injury. Asha Supplement, 23, 59–72.

#22. Cognitive-Communication Assessment

Cognitive-communication assessment for children and adults addresses cognitive-communication functioning (strengths and weaknesses), including identification of impairments, associated activity and participation limitations, and context barriers and facilitators.

Assessment is conducted according to the Fundamental Components and Guiding Principles.

Individuals Who Provide the Service(s)

Cognitive-communication assessments are conducted by appropriately credentialed and trained speech-language pathologists.

Speech-language pathologists may perform these assessments as a member of collaborative teams that may include the individual, family/caregivers, and other relevant persons (e.g., educators, medical personnel).

Expected Outcome(s)

Consistent with the World Health Organization (WHO) framework, assessment is conducted to identify and describe —

underlying strengths and weaknesses related to cognitive, executive function/self-regulatory, and linguistic factors, including social skills that affect communication performance;
effects of cognitive-communication impairments on the individual's activities (capacity and performance in everyday communication contexts) and participation;
contextual factors that serve as barriers to or facilitators of successful communication and participation for individuals with cognitive-communication impairment.

Assessments may result in the following:

Diagnosis of a cognitive-communication disorder.
Clinical description of the characteristics of a cognitive-communication disorder.
Identification of a communication difference, possibly co-occurring with a cognitive-communication disorder.
Prognosis for change (in the individual or relevant contexts).
Recommendations for intervention and support.
Identification of the effectiveness of intervention and supports.
Referral for other assessments or services.

Clinical Indications

Cognitive-communication assessment services are provided to individuals of all ages as needed, requested, or mandated or when other evidence suggests that they have cognitive-communication impairments affecting body structure/function and/or activities/participation.

Assessment is prompted by referral, by the individual's educational or medical status, or by failing a language or cognitive-communication screening that is sensitive to cultural and linguistical diversity.

Clinical Process

Comprehensive assessment is sensitive to cultural and linguistic diversity and address the components within the WHO framework, including body structures/functions, activities/participation, and contextual factors.

Assessment may be static (i.e., using procedures designed to describe current levels of functioning within relevant domains) and/or dynamic (i.e., using hypothesis-testing procedures to identify potentially successful intervention and support procedures) and includes the following:

Relevant case history, including medical status, education, vocation, and socio-economic, cultural, and linguistic background.
Review of auditory, visual, motor, cognitive, and emotional status.
Patient/client reports of goals and preferences, as well as domains and contexts of concern.
Standardized and/or nonstandardized methods selected with consideration for ecological validity:
- Observe and describe the individual's processing of varied types of information under ideal conditions (i.e., capacity) and in the context of varied activities and settings (i.e., performance) (e.g., ability to attend to, perceive, organize, and remember verbal and nonverbal information, to reason and to solve problems);
- Observe and describe the individual's executive or self-regulatory control over cognitive, language, and social skills functioning (e.g., set goals, plan, initiate and inhibit, self-monitor and self-evaluate, solve problems, think and act strategically);
- Analyze the cognitive and communication demands of relevant social, academic, and/or vocational tasks and to identify possible facilitative effects in modification of those tasks;
- Identify the communication and support competencies of relevant everyday people in the environment and possible facilitative effects of modification of their support behaviors;
- Identify the individual's potential for effective compensatory behaviors and associated motivational barriers and facilitators.
Follow-up services to monitor cognitive-communication status and ensure appropriate intervention and support for individuals with identified cognitive-communication disorders.

Setting, Equipment Specifications, Safety and Health Precautions

Setting: Assessment is conducted in a clinical or educational setting, and/or other natural environments conducive to eliciting a representative sample of the patient's/client's cognitive-communication functioning. The goals of the assessment and the WHO framework are considered in selecting assessment settings. Identifying the influence of contextual factors on functioning (activity and participation) requires assessment data from multiple settings.

Equipment Specifications: All equipment is used and monitored in accordance with the manufacturer's specifications.

Safety and Health Precautions: All services ensure the safety of the patient/client and clinician and adhere to universal health precautions (e.g., prevention of bodily injury and transmission of infectious disease). Decontamination, cleaning, disinfection, and sterilization of multiple-use equipment before re-use are carried out according to facility-specific infection control policies and services and according to manufacturer's instructions.

Documentation

Documentation includes pertinent background information, results and interpretation, prognosis, and recommendations. Recommendations may include the need for further assessment, follow-up, or referral. When treatment is recommended, information is provided concerning frequency, estimated duration, and type of service (e.g., individual, group, home program).

Documentation addresses the type and severity of the cognitive-communication disorder and associated conditions (e.g., medical diagnoses).

Documentation includes summaries of previous services in accordance with all relevant legal and agency guidelines.

The privacy and security of documentation are maintained in compliance with the regulations of the Health Insurance Portability and Accountability Act (HIPAA), Family Educational Rights and Privacy Act (FERPA), and other state and federal laws.

ASHA Policy Documents and Selected References

American Speech-Language-Hearing Association. (1987, June). Role of speech-language pathologists in the habilitation and rehabilitation of cognitively impaired individuals. Asha, 29, 53–55.

American Speech-Language-Hearing Association. (1990). Interdisciplinary approaches to brain damage. Asha, 32(Suppl. 2), 3.

American Speech-Language-Hearing Association. (1993). Definitions of communication disorders and variations. Asha, 35(Suppl. 10), 40–41.

American Speech-Language-Hearing Association. (1995). Guidelines for the structure and function of an interdisciplinary team for persons with brain injury. Asha, 37(Suppl. 14), 23.

American Speech-Language-Hearing Association. (2004). Admission/discharge criteria in speech-language pathology. ASHA Supplement 24, 65–70.

Paul-Brown, D., & Ricker, J. H. (2003). Evaluating and treating communication and cognitive disorders: Approaches to referral and collaboration for speech-language pathology and clinical neuropsychology. ASHA Supplement 23, 47–57.

World Health Organization. (2001). International classification of functioning, disability and health. Geneva, Switzerland: Author.

Ylvisaker, M., Hanks, R., & Johnson-Green, D. (2003). Rehabilitation of children and adults with cognitive-communication disorders after brain injury. ASHA Supplement, 23, 59–72.

#23. Cognitive-Communication Intervention

Intervention services are provided to individuals with cognitive-communication disorders, including problems in the ability to attend to, perceive, organize, and remember information; to reason and to solve problems; and to exert executive or self-regulatory control over cognitive, language, and social skills functioning.

Intervention is conducted according to the Fundamental Components and Guiding Principles.

Individuals Who Provide the Service(s)

Interventions for cognitive-communication disorders are conducted by appropriately credentialed and trained speech-language pathologists, possibly supported by speech-language pathology assistants under appropriate supervision.

Expected Outcome(s)

Consistent with the World Health Organization (WHO) framework, intervention is designed to—

capitalize on strengths and address weaknesses related to underlying structures and functions that affect communication;
facilitate the individual's activities and participation by assisting the person to acquire new skills and strategies;
modify contextual factors that serve as barriers and enhance facilitators of successful communication and participation including development and use of appropriate accommodations.

Intervention is expected to result in reduced deficits and contextual barriers, improved abilities and contextual facilitators, and measurably enhanced functioning and participation. Intervention also may result in recommendations for cognitive-communication reassessment or follow-up, or in a referral for other services.

Clinical Indications

Treatment for cognitive-communication disorders is prompted by the results of a cognitive-communication assessment. Individuals of all ages receive intervention and/or consultation services when their ability to communicate effectively is impaired because of a cognitive-communication disorder and when there is a reasonable expectation of benefit to the individual in body structure/function and/or activity/participation. Interventions that enhance activity and participation through modification of contextual factors may be warranted even if the prognosis for improved body structure/function is limited.

Clinical Process

Intervention services include providing information and guidance to patients/clients, families/caregivers, and other significant persons about the cognitive-communication disorder, and the course of treatment and prognosis for recovery.

Intervention addresses the complexities of a cognitive-communication disorder, including possible reactions, defensive behaviors, and coping strategies of the person who has the cognitive-communication disorder and the reactions of significant others in the environment in a manner that is sensitive to cultural and linguistic diversity.

Depending on assessment results, intervention addresses the following:

Processing of varied types of information under ideal conditions (i.e., capacity) and in the context of varied activities and settings (i.e., performance) (e.g., ability to attend to, perceive, organize, and remember verbal and nonverbal information, including social cues, to reason, and to solve problems).
Executive or self-regulatory control over cognitive, language, and social skills functioning (e.g., set goals, plan, initiate and inhibit, self-monitor and self-evaluate, solve problems, think and act strategically).
Modification of the cognitive and communication demands of relevant social, academic, and/or vocational tasks to facilitate performance of those tasks.
Modification of the communication and support competencies of relevant everyday people in the environment.
Development and use of effective compensatory behaviors and communication techniques and strategies.
Development of plans, including referral, for problems other than in cognitive-communication that may accompany the disorder, such as hearing or visual difficulties, language or speech disorders, and emotional disturbance.

Intervention is long enough to accomplish stated objectives/predicted outcomes. The intervention ends when there is no longer any expectation for further benefit. Clinicians provide an estimate of treatment duration to patients/clients and their families/caregivers.

Setting, Equipment Specifications, Safety and Health Precautions

Setting: Intervention may be conducted in clinical or educational settings and/or natural environments and are selected on the basis of intervention goals and in considerations of the social, academic, and/or vocational activities that are relevant to or desired by the individual. In any setting, intervention addresses the personal and environmental factors that are barriers to or facilitators of the patient's/client's cognitive-communication function. There is a plan to generalize and maintain intervention gains and to increase participation in relevant settings and activities.

Equipment Specifications: All equipment will be used and maintained in accordance with the manufacturer's specifications.

Safety and Health Precautions: All services ensure the safety of the patient/client and clinician and adhere to universal health precautions (e.g., prevention of bodily injury and transmission of infectious disease). Decontamination, cleaning, disinfection, and sterilization of multiple-use equipment before reuse are carried out according to facility-specific infection control policies and services and according to manufacturer's instructions.

Documentation

Documentation includes the following:

Written record of the dates, length, and type of interventions that were provided.
Progress toward stated goals, updated prognosis, and specific recommendations.
Evaluation of intervention outcomes and effectiveness within the WHO framework of body structures and functions, activities and participation, and contextual factors.

The privacy and security of documentation are maintained in compliance with the regulations of the Health Insurance Portability and Accountability Act (HIPAA), Family Educational Rights to Privacy Act (FERPA), and other state and federal laws.