Although speech-language pathologists and school-based programs are influenced by ASHA, they are bound by federal mandates, state regulations and guidelines, and local school district policies and procedures. Highlighted in this manual are ASHA inspired roles but be aware that districts may have a different understanding.

Many of you have come from a clinical or hospital setting, which is much different than a School-based Speech Therapist. Below are some of the essential differences.

Characteristics of an Education Model:

• In schools, the dress code is casual. You may wear khakis, walking shorts in the summer, pressed t-shirts.  Shoes should be closed toe.

• Therapists work with children or students not patients.

• The communication disorder must adversely affect the student’s academics. The child can have a pronounced articulation difficulty; however, if he is achieving grade level standards then he can’t be seen for speech therapy in the school setting.

• An educational team, not just the speech therapist, determines decisions regarding the child’s therapy services. The educational team consists of parents, educators and therapists.

• Services are provided primarily on school grounds or through school-sponsored programs.

• Therapists can be responsible for as many as 4-5 schools and travel to and from on a regular basis.

• Therapy supplies are limited and usually come from the therapists themselves. Schools often provide consumables (pencils, paper, crayons etc.)

• There is usually only one therapist per school, so that therapist is responsible for all organization. They are required to manage their own time with regards to scheduled meetings, therapy, and paperwork.

• Services are at no cost to the family.

• Services are provided to students whose ages range from 3 to 21 and are enrolled in a school.

• Services are usually provided in small group settings or may be provided on a individually or on a consultative and/or collaborative status with the classroom teacher. There is an emphasis on maintaining the child in the ‘least restrictive environment’ possible.

• Documentation of student’s communication disorder is written on an individualized educational plan (IEP).

• Emphasis is placed on educational terminology and not medical terminology. The IEP should be written in simplistic terms with examples, so teachers and parents can understand the information.

Characteristics of the Medical Model:

• Therapists work with patients or clients.

• The communication disorder does not have to affect academics in order for speech therapy services to be provided.

• An order for speech therapy from a medical doctor is usually required.

• A speech therapist recommends the focus of therapy, the frequency and the duration; however, third party insurance or government assistance programs may be the ultimate decision maker.

• Some families choose to pay privately and in that case the therapists and family decides on therapy services.

• Treatment settings usually include clinics, hospitals and home visits.

• Clinics often have many testing materials and therapy supplies.

• Treatment is often in a one to one setting but may include small groups.

• Documentation follows the guidelines set up for the particular setting the therapists is working in and written according to insurance requirements in order to assure appropriate reimbursement for services.

• Documentation emphasis is on medical terminology and etiology.

[1] From Guidelines for the Roles and Responsibilities of the school-based Speech-Language Pathologist, ASHA, March 1999.