CHILDREN WITH COMMUNICATION DISORDERS
OAFCCD Service Delivery Model Analysis of
School Speech-Language Pathology Ratios And Costs
The Ontario Association for Families of Children with Communication Disorders believes that speech and language services administered by speech-language pathologists (SLP) provide crucial services which advance the mission of education, to prepare children for life.
The majority of school boards understand the range and uniqueness of the language experience of school speech-language pathologists and are aware of the ways in which this knowledge is applicable and complementary to teacher expertise. That is, the value added is recognized. The services of speech-language pathologists in the schools have evolved over the past 15 years to focus on practical classroom needs and programming that are integrated into the student's daily life. In addition, the speech-language pathologists have contributed significantly to curriculum development, staff education, and the collaboration that children with communication disorders need to maximize development (OSLA, 1996a).
OAFCCD believes that an efficacious service is a school-based service. For OAFCCD, the provision of service by the speech-language pathologist using an educational delivery model is as critical as the ratio of service providers to students. We support the speech-language pathologist as a member of the school board team who then has the opportunity to use a wide range of intervention practices flexibly. The comprehensive services of school speech-language pathologists encompass a continuum of speech and language needs including communicative development, communicative differences, and communicative disorders (OSLA, 1996a; OSLA, 1996a). Figure 1 illustrates this continuum and types of services. (See Appendix A for a complete description of the continuum and services provided)
|Teacher Aide Programs|
|Direct Short Term|
|Resource/Withdrawal Teacher Programs|
|Outside Services (except Audiological and Medical)|
|Direct Programs in Class|
|Parent Group Programs|
|Direct Regular Therapy|
|Special Education Classes|
* Ontario Association for Speech-Language Pathologists and Audiologists (1996). Speech-Language Pathology Services in Ontario Schools, pg. 74. Toronto, Ontario, Canada.
As is evident in the Figure, the speech-language pathologist provides not only service to children with disorders but also services that foster the development of communication for all children in school. Children who have weak language skills are vulnerable to school failure (Nelson, 1993) and good verbal language skills act as a protective factor making children at risk for failure more resilient (Herrero & Hechtman, 1994; Hechtman & Weiss, 1986). Good communication skills are a fundamental outcome of education and support for students with disordered or weak language skills is essential.
CURRENT STATUS OF SPEECH AND LANGUAGE SERVICES IN THE SCHOOLS
Of the approximately 2 million students in Ontario Schools, roughly 50,000 students are serviced by school speech-language pathologists (School Health Support, 1993). This represents about 2 1/2% of the estimated 10% of children who need speech and language service. (Beitchman, et al. 1986; Casby, 89). Clearly the speech and language needs of our school age children are not being met.
Given that the schools presently employ roughly 300 speech-language pathologists to provide speech and language service, the current ratio is approximately 1:6666 school children. This overall figure, however, provides a misleading picture of the current situation because of the disparity in service from board to board, with some boards providing no service from speech-language pathologists. As demonstrated in Table 1, the range of ratios is from 1:2250 to 1:10,000 for boards where services are available.
As proposed in the OAFCCD Model, the ratio of speech-language pathologist to school age children should be 1:1500 (OAFCCD, 1996). Given the current fiscal restraints, however, a ratio of 1:2250 would be realistic and would represent the present ratio in the better serviced boards.
One of the important elements of educational reform in Ontario is an educational system that is equitable. OAFCCD believe that all children in Ontario should be provided with equitable speech and language services provided by the best qualified personnel, speech-language pathologists and support personnel supervised by them.
We recognize that the ratio of 1:2250 is not ideal but
would seem to be well-within the range of funding available and would provide
service for 100,000 to 120,000 children. Establishing this ratio would
consume only 0.03% (1/3 of a percent) of the total budget of $12,850.000,000
now spent to educate our student population of 1,928,203 (Ernst and Young,
1997). Given the average cost of a per student of $6500 per year, this
ratio would cost $19.50 per student to meet the needs of 4-6% of the students.
Beitchman, J., Nair, R., Clegg, M. Fergusaon, B. & Patel, P (1986). Prevalence of speech and language disorders in 5-year-old kindergarten children in the Ottawa-Carlton region. Journal of Speech and Hearing Disorders, 51, 98-110.
Casby, M.W. (1989). National data concerning communication disorders and special education. Language, Speech and Hearing in the Schools, 20, 22-30.
Ernst and Young (1997). A Report on School Board Spending: 1995-1996. <http://www.edu.gov.on>: Toronto, Ontario, Canada.
Herrero, M. & Hechtman, L. (1994). Antisocial disorders in hyperactive subjects from childhood to adulthood: Predictive factors and characterization of subgroups. American Journal of Orthopsychiatry, 65(4), 510-521.
Hechtman, L. & Weiss, G. (1986). Controlled prospective fifteen year follow-up of hyperactive as adults: non-medical drug and alcohol use and anti-social behaviour. Canadian Journal of Psychiatry, 31(6):557-567.
Ontario Association for Families of Children with Communication Disorders (1996). Provincial Model of Speech and Language Service for Children. Ontario, Canada.
Ontario Association for Speech-Language Pathologists and Audiologists (1996a). Speech-Language Pathology Services in Ontario Schools. Toronto, Ontario, Canada.
Ontario Association for Speech-Language Pathologists and Audiologists (1996b). The Number of Full-time Equivalent Speech-Language Pathologists in Ontario. Toronto, Ontario, Canada.
Nelson, N. (1993). Childhood Language Disorders in Context: Infancy Through Adolescence. N.Y., N.Y.: Merrill.
School Health Support, Interministerial Committee (1993). Speech and Language Services in Ontario Schools. Paper presented at the Education Symposium, December, Mississauga, Ontario.
Table 1: Number of Pupils and Speech-Language Pathologists (SLPs) and ratio of SLP to Pupil for a
sampling of School Boards in Ontario representing approximately 60% of the total school
|*Number of Pupils||*Number of SLPs||**Ratio of Pupils to SLPs|
Halton Region SSB
Ottawa French RCSS
|Metro Toronto RCSS
(60% of total # of pupils in school)
**Ernst and Young (1997). A Report on School Board Spending: 1995-1996. <http://www.edu.gov.on>: Toronto, Ontario, Canada
*Ontario Association for Speech-Language Pathologists and Audiologists (1996). The Number of Full-Time Equivalent Speech-Language Pathologists Employed in Ontario Toronto, Ontario, Canada.
Ontario Association for Speech-Language Pathologists and
Audiologists (1996). Speech-Language Pathology Services in Ontario Schools,
pg. 72-74. Toronto, Ontario, Canada.
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