Speech-Language Pathologists and RTI

There have been 2 journals in speech and language with an issue devoted to the roles of SLPs in RTI:
Topics in Language Disorders edited by Barb Ehren (Volume 25 #2, 2005 ) and Seminars in Speech Pathology edited by Froma Roth (Volume 20 #2, 2009 ). Combined these issues include 10 great articles about SLPs in various roles related to RTI.

RTI is a framework where key elements occur, yet it looks differently in each school or district depending on the culture, combination of staff, expertise of staff, and preference of the staff. Professionals from different disciplines may serve in the various roles. I have seen SLPs serve in different roles depending on their expertise, comfort level, preferences and directives.

SLPs as organizers/designers/leaders
Some SLPs have played a leading role in helping their district get started in developing a Multi-tiered System of Supports (MTSS). They may have helped their building and/or district select universal screening measures, build infrastructure (who will do what and when) school-wide, or designate and structure team time or grade level meeting time. These SLPs often work closely with a leadership team to help develop these key elements.

SLPs as data interpreters
SLPs have incredible training in assessment, data analysis, designing instructional changes in response to discrete changes in data. Any team is fortunate when an SLP can attend data meetings. We bring a perspective and raise questions that may not be observed by other team members in the same way.

SLPs as intervention providers or consultants to intervention providers
SLPs have amazing intervention skills in language and literacy. RTI has provided a vehicle for many SLPs to shine – to use their expertise in ways that helped the entire school or district and enabled principals and teachers to finally understand their expertise. It has also provided a vehicle for SLPs to move into a more inclusive and relevant service delivery model. There simply isn’t time to see students on caseload in isolation and consult with teachers and provide help to students at-risk for disabilities. For some SLPs, RTI has taken the debate out of service delivery. The result is that everyone involved sees the benefits of having the SLP and teachers collaborate closely.

Here are a number of resources that I rely on for Vocabulary and Comprehension Instruction:

1. Website Doing What Works (DWW)
The Doing What Works website is sponsored by the U.S. Department of Education. It is an online library of resources to help educators implement research-based instructional practices from the What Works Clearing House. It provides extensive information and examples with practice summary, videos, lesson planning tools, self-assessment and more. Vocabulary instruction and Comprehension strategy instruction are topics I refer to frequently on this site. Here is a link to the Vocabulary section which is found in the Adolescent literacy section.

2. Book and Website
The book Explicit Instruction: Effective and Efficient Teaching By Anita L. Archer and Charles A. Hughes is part of the What works for Special Needs Learners series of books by Guilford. It has an extensive companion website with video demonstrations. Here is a link to a demonstration vocabulary lesson for adolescents.

3. Book and Website
Another great book that has great online resources is: Word Wise and Content Rich: Five Essential Steps to Teaching Academic Vocabulary by Douglas Fisher and Nancy Frey, 2008. Portsmouth, Heinemann The author’s five-step model shows you how to:

• Make it intentional: select words for instruction and use word lists and up-to-date website lists wisely
• Make it transparent: model word-solving and word-learning strategies for students
• Make it useable: offer learners the collaborative work and oral practice essential to understanding concepts § Make it personal: give and monitor independent practice so students take ownership of words
• Make it a priority: create a school-wide program for word learning. Heinemann provides online resources including chapter-by-chapter study guides, audio podcasts, and video podcasts.

4. Website
Missionliteracy.com is a website put together by regional literacy coordinators in Michigan. Here is a link to the Vocabulary Resources page.

5. Intervention program examples
In our Tier two and three Intervention programs we have worked with the schools to look beyond reading decoding.

• Sequential instruction of comprehension strategies for content areas and narratives.
• West Ed Academic Literacy
• Teaching Reader’s Apprenticeship strategies in the content areas. SRA/McGraw Hill
• Read to Achieve Comprehending Content Area Text and Read to Achieve Comprehending Narrative Text
• Programs that teach morphemes: prefixes, suffixes and word bases Spelling with Morphographs by SRA McGraw Hill Vocabulary with Morphemes by Sopris West

Indeed, students experiencing language difficulties who may turn out to be students with LLD would be identified through an RTI process in the same manner as other students. More to the point –how many students with LD don’t have language issues? Very few. This construct relates to my plea for having SLPs as integral members of RTI teams to ferret out who needs what with respect to language. For me SLP roles revolve around:

1. Triaging students

• Looking at students individually
• Deciphering patterns of strengths and challenges in learning with an eye on language underpinnings
• Helping to decide who needs what service from whom

2. Guiding language-sensitive assessment/instruction/intervention delivered by others, including accommodations for students with disabilities.

3. Providing intervention to students on language underpinnings in collaboration with others.

4. Providing speech and language therapy to students eligible for Speech Language Impaired (SLI) programs. With respect to #4 we have to remember that RTI is an overarching framework that includes special education.

A systemic implementation of RTI will require a great deal of collaboration from teachers and support personnel at a school. For focus on Tier 1, or core instruction, SLPs may very well be in classrooms assisting teachers in differentiating instruction for diverse learners, including those with language issues (some of whom may have language disabilities). Interventions in other tiers may take place in a variety of settings, including classrooms. Details regarding how this actually works need to be negotiated with all involved educators. Having other professionals in a classroom doesn’t have to disrupt instructional time if logistics are discussed by all. I suspect that at the root of this issue, however, is “culture” (i.e. there has to be a culture of collaboration at a school for this kind of partnership to occur). And RTI surely requires partnerships. I suggest on-going professional development, perhaps including the creation of a PLC (Professional Learning Community) to address collaboration on behalf of all students at a school, especially those who struggle.

Hooray for you for recognizing the complexity of language comprehension processes! One of the biggest challenges we have in RTI is progress monitoring – keeping track of “real” targets that make a difference in a way that makes sense. For example, tracking words per minute tells you nothing about comprehension. I think the idea of using rubrics is worth exploring and these tools CAN provide quantitative data, especially if you construct analytical rubrics that define aspects to the process. So for example, instead of a holistic rubric on vocabulary construct an analytical one that lists several aspects of vocabulary – maybe (1) understands the meaning of x number of words taught this period (2) gives a synonym or defines function for x number of words (3) uses in a sentence, etc. (You get the idea). A comprehension rubric could capture all the items you list and more. The trick is to provide enough gradations on a scale to show progress; so a rubric that has many points and is sensitive to growth might be a way to go. I know we are used to 5 or fewer points on a scale, but more might give us the sensitivity we need

Regarding #1, I feel strongly that we belong as integral members of high school faculty. For a glimpse of how strongly I believe this please read:

• Ehren, B. J. (2002). Speech-language pathologists contributing significantly to the academic success of high school students: A vision for professional growth. Topics in Language Disorders, 22(2), 60-80.
• Ehren, B. J. (2002, April 16). Getting in the adolescent literacy game. The ASHA Leader. Rockville, MD: American Speech-Language-Hearing Association.
• Ehren, B. J. & Whitmire, K. A. (2009). Speech-language pathologists as primary contributors to RTI at the secondary level, Seminars in Speech and Language, 30(2), 90-104.

Regarding #2, I feel that cognitive referencing should not be used to make decisions about who receives therapy. The issue for me is “who will not thrive without intervention from an SLP.” However, that intervention may take several forms, including indirect services where the SLP works with others on behalf of students.

For the most part with the populations you mention, the central issue is the kind of CORE INSTRUCTION they are receiving. It is not primarily an intervention issue. RTI has to be predicated first and foremost on a robust core curriculum, appropriate to the students in a given school community. So, for example, if we already know that a school has an ELL or low SES population the basic curriculum has to address the needs of these students.

Interventions in preliminary tiers of RTI (outside of special education) do not constitute placement in special education. However, what many states/districts are grappling with is how to utilize personnel previously associated with special education (like SLPs and special ed teachers) to deliver some of these interventions. The complexity of the situation increases when mixing students with IEPS with students who don’t have them in instructional groupings. Such groupings may make perfect sense and be beneficial to students. However, state regulations and district policies may have provisions about this. All educational agencies are struggling with catching their rules up to current RTI implementation. Check the regulations in your area. Hopefully we all will get further guidance when IDEA and ESEA (formerly NCLB) are reauthorized in the near future.

To my knowledge there have not been any empirical studies addressing this issue of a sequence; therefore, there is no strong evidence base. However, from my experience in working with schools, districts, and states on RTI implementation, here are leverage points I think SLPs should focus on when rolling out involvement in RTI:

1. Advocate for important and appropriate roles
2. Make room on the plate for substantive work with the language underpinnings literacy and curriculum.
3. Expand service delivery options
4. Develop IEPs carefully
5. Create and maintain a flexible schedule
6. Move toward a workload approach

Across Tiers
Look at students individually, deciphering patterns of strengths and challenges in learning.

• Look at students individually, deciphering patterns of strengths and challenges in learning.
• Analyze tasks by identifying component parts, breaking them down into smaller parts, and highlighting language components.
• Select instructional and assessment language to match students’ comprehension
• Scaffold instruction based on the learners’ language needs within the context of classroom performance.
  

Tier 1

• Guide teachers’ language-sensitive content instruction.
• Identify the nature of poor academic performance in the classroom, with an emphasis on language underpinnings.
• Analyze screening and progress monitoring data to uncover language factors in performance.
• Administer screening and progress measures on selected students who may be suspected of language problems, as opposed to taking on administration of screening and assessment measures for the entire school.
• Assist teachers in identifying language underpinnings that may be interfering with learning academic content.

Tier 2

• Provide input with regard to the selection of interventions.
• Collaborate with other interventionists to implement interventions.
• Interpret progress monitoring data with regard to language implications.
• Provide short-term interventions for students not enrolled in special education.

Tier 3
(In many places Tier 3 includes intervention outside of special education and then ultimately special education. Other places have a 4th tier which is special education. For clarity here I’ll call special education Tier 4)

• Provide input with regard to the selection of interventions.
• Collaborate with other interventionists to implement interventions.
• Interpret progress monitoring data with regard to language implications.
• Provide intensive, individualized interventions outside of special education.

Tier 4

• Provide therapeutic intervention for students with language impairment LI within special education.
• Determine accommodations needed to access the curriculum for students with LI.

It is essential for RTI implementation that SLPs implement a “workload approach” (ASHA, 2002) which involves scheduling and accounting for all the work they do with and on behalf of students, along with other activities that are part of their school day. However, for that to happen to the extent necessary to fully implement RTI, major changes have to be made in the way SLP services are funded. As long as money is attached to students eligible for services under IDEA, states and districts will continue to count heads (i.e. use a caseload approach). If you can get your system to move to a workload approach and count all your activities, that would be great. Many places are exploring alternative formulae for “counting” the work of SLPs although these efforts are at rudimentary stages.

For current ASHA policy regarding SLPs’ roles, see the new policy documents on Roles and Responsibilities of Speech-Language Pathologists in Schools (ASHA, 2010). For my role definition for RTI, see the response to another question where I outline activities in tiers.

In most places they are not counted as part of caseload as caseload is defined as students with IEPs. A few states/districts do count non-IEP students as caseload. However, the real issue is that our systems need to abandon the caseload structure of defining workscope and load and move to a “workload approach.” See ASHA, 2002 policy documents on a workload analysis approach.

1. SLPs provide services that make use of their unique contributions.
2. SLPs are involved in some way across tiers.
3. SLPs implement IEPs of identified students.
4. SLPs support teachers in providing assistance to struggling students.
5. SLPs utilize a variety of delivery models, including indirect services.
6. SLPs have a reasonable workload; that is, RtI activities are not add-ons to their existing workload

• American Speech-Language-Hearing Association. (2001).
• Roles and Responsibilities of Speech-Language Pathologists With Respect to Reading and Writing in Children and Adolescents [Guidelines].

It is important that we provide the services we deem necessary as professionals. At times that means that the services we provide may be billable and by all means we should bill for those billable service. However, we should not shape what we do for students around what is billable.

I speak about this in some of my other responses. In an RTI model, the school is developing a system of supports that increases in intensity. Language should not be treated differently than reading, so that means an entire continuum of supports is built from solidifying the core curriculum, supplementing the core (often by the teacher), to providing tier 2 supports (often by a number of service providers). If the student is seen for intensive intervention by the SLP for a short time, it would be the last choice. Many students have ‘wobbly’ language skills that can be addressed in a number of ways by the team, sometimes with the consultation of the SLP. There may be a student who does not respond to these efforts, who the team is beginning to suspect has a disability and want to rule out whether a short intensive treatment would bump the student back on track.

There are really two different kinds of progress monitoring that often require different tools. One is for the purpose of benchmarking student progress against a specific standard to see if a student is meeting growth expectations. The other is more of a formative assessment to ascertain what direction should be taken in intervention. The instruments/procedures used for benchmarking don’t always help with informing intervention at the level of specificity needed to determine an intervention path. For example if one uses words per minute as a measure of progress in reading fluency, you still don’t know what accounts for the student’s performance and therefore what to do about it. A student could lack oral reading fluency for a number of reasons. Each reason would have a different intervention direction. It is my suggestion that benchmarking assessments be done in terms of curriculum targets. Ordinarily these have been in reading and writing (and core academic subjects in secondary). While listening and speaking are also key curricular areas, we are struggling with how to benchmark them. Ron and Sandy Gillam are doing some interesting work with narrative assessment that holds promise. Regarding formative assessment, the data an SLP would normally provide to capture a student’s progress in language underpinnings would serve this purpose. In another question Nicole talked about use of rubrics. Check my response to that question for thoughts about the use of rubrics.

Bingo! You have said it beautifully! The key is not adding one more thing to our already full plates but judiciously selecting the students with whom we can have substantial impact on their educational success. Let’s take a look at whom we are serving, whether or not these students’ “problems” meet the test of educational impact required by federal law. Do we really think students with single sound articulation errors meet the IDEA definition of students with a disability, no matter how much we want that error to be resolved? Let’s also consider how we are serving students to ascertain whether we can be more effective and efficient with a variety of delivery models, including in-classroom services, both directly with students and on their behalf (indirectly with teachers and others.)

As I reported in another response, the litmus test of educational significance is required by federal law. We cannot serve a student as a student with a disability unless the disorder has adverse educational impact. So it’s not your district who invented this policy. I feel strongly that students with single sound articulation errors without adverse educational impact should not even be treated under the auspices of an RTI process. I do think these students can be helped in a kind of “speech club” framework that might be part of an SLP’s workload. However, to call that RTI, to me trivializes the substantive work with academic and behavior problem solving that should be the hallmark of RTI in which the SLP participates. The language underpinnings of literacy, curriculum and behavior should be what we address within RTI. But by all means find alternative ways to avoid labeling students with single sound artic students as students with a disability. Call your work something else, like “speech club.” Just don’t call it RTI. If you do you may just be reinforcing our stereotype as “speech teachers” that we have been trying to overcome.

Ah-where to begin in such a situation? I would say by all means focus on students with substantive language disabilities adversely affecting academic learning, social interaction, and behavior. Then I would address helping teachers strengthen core instruction (Tier 1) because without that you don’t really know who needs intervention.

Please remember that interventions within an RTI framework do NOT mean packaged programs. If you are an SLP, you know how to address oral language problems. It is no different in RTI. My suggestion is to get to the heart of the problem by using curriculum as a context and uncovering the language underpinnings that are interfering with success in reading.

An article by Staskowski and Rivera below outlines how increasing your curriculum-relevant practices can lead to, and make it easier to, participation in the school’s RTI initiative. Another article listed below provides a rubric for SLPs’ self-assessment of their participation as part of the school’s literacy team. I would review ASHA's recently revised professional issues statement on the Roles and Responsibilities of the SLP in Schools and perhaps Nancy Creaghead and colleague’s article in Perspectives about the current roles of SLPs.

• Staskowski, M. & Rivera, E. (2005). Speech-language pathologists’ involvement in responsiveness to intervention activities: A complement to curriculum-relevant practice. Topics in Language Disorders, 25, pp. 132-147.
• Staskowski, M. & Zagaiski, K. (2003). Reaching for the stars: SLPs shine on literacy teams. Seminars in Speech and Language, 24, pp. 199-214. Roles and Responsibilities of Speech-Language Pathologists in Schools American Speech-Language-Hearing Association. (2010).
• Roles and Responsibilities of Speech-Language Pathologists in Schools [Professional Issues Statement]. Available from www.asha.org/policy.
• Perspectives on Preparing Graduate Students To Provide Educationally Relevant Services in Schools by Debbie Elledge, Emily Hasselbeck, Amy Hobek, Sandra Combs, Lesley Raisor-Becker, and Nancy Creaghead Perspectives on School-Based Issues 11 40-49 June 2010. doi:10.1044/sbi11.2.40 Copyright 2010 by American Speech-Language-Hearing Association

“Sensitivity to gradual growth in basic language” I’m going to address regarding oral language. I recommend that we look to some outstanding work that has been done in Australia as a springboard for continued development in this area. See “The Language Support Program" (LSP) is a substantial program comprising direct assistance to teachers in developing strong oral language competency in children and young people to maximise their learning potential. It is founded on a framework of empirical evidence, which acknowledges that improved teacher knowledge and skills, conveyed in explicit teaching, respond to students’ readiness to learn, and result in positive learning outcomes. The Language Support Program is based on the extensive research of Dr John Munro (The University of Melbourne).”

An excellent article by Sandra Gillam & Laura Justice in the ASHA Leader in 2010 discussed the monitoring of language skills.

Gillam, S. L. & Justice, L. (2010, September 21). RTI Progress Monitoring Tools : Assessing Primary-Grade Students in Response-to-Intervention Programs. The ASHA Leader.

A presentation entitled, “Curriculum-Based Language Assessment for Intervention Planning” By , Lesley Raisor-Becker, and Nancy Creaghead at the Ohio Speech Language Hearing Convention in 2010 covered this topic very well.

A great resource for looking up progress monitoring tools is the National Center for RTI's Progress Monitoring Tools page

A great resource for direction and examples of RTI in preschool with a collaborative teacher-SLP team is in the Pre-K section of he RTI Action Network. There is a link to a document and webinar entitled, "Read the Roadmap to Pre-K RTI: Applying Response to Intervention in Preschool Settings"

Yes. See Froma Roth's work, among others.

In the article cited below Laura Justice provides a nice overview of the RTI model. I believe that too often, RTI is reduced to the idea of intervening off-caseload. Sometimes you will hear people use RTI as a verb - "RTI him" or refering just to an intervention "it's RTI time."

RTI is really about systems change. It is about building a Multi-Tiered System of Supports (MTSS) in general education so that all students can access learning. In the white paper by NASDSE and CASE (the link is below), notice that the first steps in implementing this model are providing a high-quality curriculum within which most children achieve. In an RTI model, benchmark information is used to assess the success of core instruction and analyze areas to improve instruction for all students. I believe that in the application of RTI to language, sometimes this foundational step is lost and suddenly we are talking about individual services for students (off caseload). If we are to talk about oral language in an RTI model, then the first step is assessing the success of core instruction in helping all children to achieve in oral language.

When issues are addressed with all students, then there is a continuum of increasingly intensive supports for children with language needs, there is not an immediate ‘jump’ to providing services by a special ed service provider (SLP) without an IEP. This should be a strategy that is a last step/resort.

Justice, l. (2006) EBP and the prevention of reading difficulties. Language, Speech, and Hearing Services in Schools, vol. 37, p. 284–297. Response to Intervention.

NASDSE and the Council of Administrators of Special Education (CASE) White Paper on RtI. Download a free copy of the CASE White Paper on RtI.

All of the above. As we have indicated in other responses work with RTI involves direct work with students and indirect work with others.

Once you reference IEP goals, you are talking about special education, which is the most intensive option in a multi-tiered instructional/intervention system (RTI). As with any IEP, when you have one in place you have already decided that special education and/or related services is/are required. The issue is who is qualified to provide speech and language therapy. I feel strongly that that is the SLP. However, I can't imagine SLPs providing intervention without collaboration from classroom teachers, if we really want to see progress.

A great description of the data-based decision making process is part of the Online Learning Module by the Iris Center.

It is not surprising that older students encountering academic or behavioral problems have language problems (and perhaps impairments) at their base. While it is possible to identify many students with language problems early in their schooling, it is also the case that some students do not experience difficulty until the academic requirements become more complex in later grades. We may not always find packaged programs, but SLPs know how to address language underpinnings in older students.

We find that sometimes, when the team has not included the SLP, the intervention selected did not as specifically target his needs, and therefore it is still not know as to whether he/she will benefit from intervention.

The answer to this question would vary among states and school districts. Some agencies do not even use the term "tiers." In general, however, one would expect a Tier 2 intervention to be less intensive and of shorter duration than later tiers. There is no one set of criteria for the meaning of intensity and duration. Tier 2 would also likely be implemented in small groups.

I do think these students can be helped in a kind of “speech club” framework that might be part of an SLP’s workload. However, to call that RTI, to me trivializes the substantive work with academic and behavior problem solving that should be the hallmark of RTI in which the SLP participates. The language underpinnings of literacy, curriculum and behavior should be what we address within RTI. But by all means find alternative ways to avoid labeling students with single sound artic students as students with a disability. Call your work something else, like “speech club.” Just don’t call it RTI. If you do you may just be reinforcing our stereotype as “speech teachers” that we have been trying to overcome.

Also - it is soemtimees difficult for teachers to scaffold phonemic awareness when students are stuck. Simple modeling by SLPs within the classroom has proven very helpful for teachers.

This response will likely differ from place to place as there is no one RTI model used across the country. My suggestions for SLP role definition are contained in my responses to Lisa Duffy and to L. Syverson.

For one tool in formative assessment, I love to teach SLPs how to use the Qualitative Reading Inventory V to uncover language underpinnings at the root of reading problems

If one considers RTI as the umbrella framework under which all services in a multi-tiered system of supports fits, then the speech-language services for which SLPs would normally bill Medicaid remain the same. Medicaid guidelines have to be followed.

Documentation requirements vary with school districts.

There is not a federal documentation process, so school systems have developed this (or are in the process of developing this). In some places, it comes from the state and others at the local level.

ASHA's recent documents of the changing role of SLPs in schools (referenced in another question) is a great help.

CEC and IDEA Partnership also have helpful documents about the SLPs' role and expertise related to RTI.

Without stepping up and volunteering, you are right that the school's interpretation of RTI will ultimately affect the SLP, so we must speak up and participate. Besides, in economic times like these it is vital that we be seen as integral and effective staff members.

YES. YES. YES. YOU HAVE THE KEY!!!!!

More and more SLPs are sharing strategies for writing intervention with school teams. Mark Shinn has suggestions for CBM for writing that have been incredibly useful for progress monitoring.

Vocabulary can be approached from many angles. One intervention is to address morphology. There is a vignette on the Doing What Works website that shows a teacher using Greek Mythology to teach this. Specific intervention products for morphemes is in another answer.