United States

OSHA 2023

Speech-language pathologists’ approaches to augmentative and alternative communication (AAC) assessments

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The Oregon Speech-Language and Hearing Association (OSHA) is excited to present 2023 Fall Conference theme “Community in Action”. In addition to professional development content at the conference, we look forward to recognizing and celebrating the research, clinical work, and advocacy of our colleagues through our OSHA honors and awards.
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Join us from November 1st to 17th for a compelling virtual experience and continuing education opportunity to those involved in the Speech-Language & Hearing industry on the Underline platform!


#### [**OSHA 2023 On-Demand Offering**](https://drive.google.com/file/d/1jwrAmTttlBTCTRgErURL06kXcmGhJco9/view?usp=sharing)


#### [**The Official Website of the OSHA**](https://www.oregonspeechandhearing.org/fall-conference)


To access the site please register [**here**](https://www.oregonspeechandhearing.org/event-5462300). 

Please register for the 2023 OSHA Fall Conference to join the event.

The Oregon Speech-Language and Hearing Association (OSHA) promises to be a forum of growth, learning, and meaningful exchange, encompassing a rich tapestry of topics that are shaping our field in profound ways. The conference agenda is designed to address a wide array of critical subjects, each reflecting the evolving landscape of speech-language pathology. From early language and literacy development to the provision of gender-affirming and culturally responsive care, we are diving deep into the issues that matter most to our profession and the individuals we serve.

Writing Scripts to Address Sexual Health and Consent: Choose your own adventure!

Early Language and Literacy

Bilingual Aphasia Assessment and Treatment

Statement of Purpose: To instruct colleagues in a model of service delivery which utilizes interdisciplinary, neurodiverse team-teaching to decrease teacher burnout and increase positive outcomes for autistic high schoolers.
Summary: Widespread and pervasive barriers are currently keeping autistic and neurodivergent students from thriving in our public schools. For teachers and school-based speech pathologists currently serving autistic students there are methods that can be implemented immediately to have a measurable impact on the emotional and academic well-being of current students (Bottema-Beutel et al., 2020). These techniques can simultaneously create opportunities for educators to learn from each other and thus relieve the immense load of being a public school employee. Our primary purpose in presenting this information is to encourage attendees to consider adopting a co-teaching model with their special education colleagues, particularly between neurotypical and neurodivergent educators, specifically to support the well-being, confidence, and positive self-regard for their autistic students. The benefits of consistent, intentional relational support, the modeling of communication and collaboration, and the dual approaches of structured academic support and communication/self-advocacy interventions within a classroom setting provides a strong foundation for autistic students (Friend, et al.,2010). 
This presentation lays out a co-teaching model designed to support the development of positive self-image and self-advocacy skills within a neurodiversity-affirming space. The partnering of a special educator and a speech language pathologist is a perfect pairing to support students and provide a strong foundation of skills for success in school (Mentikoski, 2021). Providing explicit instruction in neurodivergence, fostering pride and acceptance in difference and neurodiversity, and supporting students with executive function strategies to apply directly to academic tasks provides students with the tools they need to venture out into the school environment with a strong affinity based community surrounding them. 
Additionally, having two responsive and engaged educators with different backgrounds and educational lenses gives an opportunity for authentic modeling of working relationships for students. Dividing time, teaching materials, content, and one-on-one support is a dynamic and sometimes challenging collaborative effort (Emmons & Zager, 2018). Autistic students benefit from seeing the work and reward that comes out of these partnerships.
Autistic high school students who have the support of two educators with a shared focus on creating a neurodivergent-affirming space and self advocacy, but with differing areas of expertise around academic support and facilitating cross-neurotype communication, have the widespread support they need to feel confident in engaging across a variety of academic environments. When students have the academic support they need, combined with direct instruction in their learning style and in self-advocacy, they make more academic and mental health gains (Sosnowy et al., 2019). The shared responsibility of creating lessons focusing on self-advocacy, executive functioning, and autistic pride means that teachers have more capacity to authentically build relationships with their students, and to do the kind of outreach and education to their general education colleagues needed in order to spread the principals of neurodiversity-affirming practices (Scheerer et al., 2022). 
Isolating the cause of student outcomes in a public school is impossible; there are too many variables to draw hard conclusions about interventions conducted as part of a comprehensive high school education. Anecdotally, however, it is clear that the co-teaching model implemented by the instructors is working: when surveyed about whether they want to continue on in the co-taught class, or move to a check-in model with a case manager, 80% of surveyed students elected to continue with the class.
5 minutes: Introductions
15 minutes: Presentation of relevant research to support the importance of neurodiversity-affirming approaches and co-teaching as beneficial for teachers and students.
10 minutes: Overview of co-teaching model application in a comprehensive high school learning center, including specific outline of how our system has developed, and the model within our school district.
15 minutes: Overview of lessons and structure for the year.
5 minutes: Reports/feedback from co-taught students.
10 minutes: Questions 

Axbey, H., Beckmann, N., Fletcher-Watson, S., Tullo, A., & Crompton, C. J. (2023). Innovation through neurodiversity: Diversity is beneficial. Autism, 0(0). https://doi.org/10.1177/13623613231158685: In a study measuring creativity, innovation, and consistency, neurodiverse groups (autistic and neurotypical people working together) and the most creative and innovative designs.

Bottema-Beutel, K., Cuda, J., Kim, S. Y., Crowley, S., & Scanlon, D. (2020). High School Experiences and Support Recommendations of Autistic Youth. Journal of autism and developmental disorders, 50(9), 3397–3412. https://doi.org/10.1007/s10803-019-04261-0: Recommendations include: providing personal attention, showing care, providing specially designed instruction, supporting kids’ ability to cope with school and stay regulated, and supporting social interaction. Additionally, educators need to intentionally affirm autistic identities and center individual strengths. 

Crompton, C. J., Ropar, D., Evans-Williams, C. V., Flynn, E. G., & Fletcher-Watson, S. (2020). Autistic peer-to-peer information transfer is highly effective. Autism, 24(7), 1704–1712. https://doi.org/10.1177/1362361320919286: In a study measuring effectiveness of peer-to-peer information transfer, autistic to autistic information transfer was as efficient as neurotypical to neurotypical information transfer.

Emmons, C. L., & Zager, D. (2018). Increasing Collaboration Self-Efficacy to Improve Educational Programming for Students With Autism. Focus on Autism and Other Developmental Disabilities, 33(2), 120–128. https://doi.org/10.1177/1088357616686312: Collaborative teaching increases capacity, feelings of success, and leverages resources for educators working with autistic students.

Friend, M., Cook, L., Hurley-Chamberlain, D., & SHamberger, C. (2010). Co-Teaching: An Illustration of the Complexity of Collaboration in Special Education. Journal of Educational and Psychological Consultation, 20(9), 9-27.


Hester, O.R., Bridges, S.A., & Rollins, L.H. (2020). ‘Overworked and Underappreciated’: Special Education Teachers Describe Stress and Attrition. Teacher Development, 24(3), 348-365, https://doi.org/10.1080/13664530.2020.1767189: Special education teachers feel unsupported by administrators and feel that teaching has a negative impact on their overall quality of life. 

Mentikoski, C. (2021, January 12). Why-and How-Co-Teaching Works for Me. AshaWire. https://leader.pubs.asha.org/do/10.1044/leader.SCM.26012021.34/full/

Scheerer, N.E., Boucher, T.Q., Sasson, N.J., & Iarocci, G. (2022). Effects of an Educational Presentation About Autism High School Students’ Perceptions of Autistic Adults. Autism In Adulthood, 4(3), https://doi.org/10.1089/aut.2021.0046: A short educational presentation about autism negated some of the negative perceptions held by neurotypical high schoolers about autistic adults.

Sosnowy, C., Silverman, C., Shattuck, P., & Garfield, T. (2019). Setbacks and Successes: How Young Adults on the Autism Spectrum Seek Friendship. Autism in adulthood : challenges and management, 1(1), 44–51. https://doi.org/10.1089/aut.2018.0009: Autistic students have the most success in developing authentic relationships when their autistic traits are normalized. This acceptance is most often found with other neurodivergent youth. 

Strogilos, V., King-Sears, M.E., Tragoulia, E., Voulagka, A., & Stefanidis, A. (2023). A meta-synthesis of co-teaching students with and without disabilities. Educational Research Review, 38. https://doi.org/10.1016/j.edurev.2022.100504: Co-teachers believe that co-teaching is beneficial for learning for both teachers and students. 


Supporting the Success of Autistic Students Through a Co-Teaching Model

Approximately 48% of children receiving special education services from birth to 3 years are from minoritized linguistic backgrounds (US Department of Education, 2022). However, this rich linguistic diversity is not well recognized; children from non-English speaking backgrounds are frequently misdiagnosed for special education services. Although this disproportionality was first documented at least 55 years ago (Dunn, 1968) and well-studied since then (e.g., Zuckerman et al., 2014), misdiagnosis of linguistically diverse children continues to be a persistent concern. 

One major cause of the lack of linguistic responsivity is the absence of knowledge, tools, and sufficient training (Caesar & Kohler, 2007). Studies reviewing medical records have shown that special education practitioners serving children from birth to 3 are not reliably documenting language histories or employing proper assessment tools for linguistically diverse children (e.g., Huerta et al., 2021). Practitioners report poor guidance on whether to assess and treat in one or more languages. Moreover, language access for the children’s families through the use of interpreters is often not considered (Saenz et al., 2019). Despite years of research, the issue remains largely unresolved (Arham et al. 2021).  

These challenges with services for culturally linguistically diverse populations necessitate the development of a protocol that streamlines and interprets best-practice procedures, many of which already exist but are not well implemented and disseminated. The presentation aims to summarize the Linguistic Diversity Protocol (LDP) created for practitioners as an attempt to respond to linguistic diversity during assessment.  The presentation will also detail the components of LDP and the significance of using linguistic responsive procedures during assessment. 

The Language Development Protocol (LDP) is a training protocol created through input from subject matter experts and practitioners who work with linguistically diverse populations aged from birth to three years. The protocol's framework is an adaptation of special education teacher training models and is based on evidence-based practices. The development of the training outline is based on feedback from the community practitioners through surveys, focus groups and panel discussions. It is an attempt to create and implement one of the many ways to resolve the concern of misdiagnosis in children with linguistically diverse backgrounds. 

The presentation will describe the challenges encountered by practitioners due to the lack of linguistically responsive assessments and present the LDP as a case study of a researcher-practitioner collaboration that aims to provide a tool for implementation in practice. We will also provide recommendations and future directions for practitioners interested in implementing linguistically responsive practices. Additionally, the presentation will also provide guidance for professionals to develop similar protocols with their teams. Specifically, the presentation will summarize the approaches for enhancing linguistic responsivity in assessments and analyze different methods for providing language access, (e.g., the use of language translators and interpreters). The presentation will conclude with a discussion of obstacles to implementing linguistically responsive practices and proposing solutions to overcome them. 


Time –Ordered Agenda – Oral presentation (60 min) 

3 minutes – Introductions and disclosures 

10 minutes – Overview of literature and challenges in linguistic responsivity 

5 minutes – Overview of LDP 

10 minutes – Constructs of LDP / strategies for linguistic responsiveness during assessment 

10 minutes – Language access during assessments 

10 minutes – Future directions and clinical recommendations 

12 minutes – Question and answer 

References

Caesar, L. G., & Kohler, P. D. (2007). The state of school-based bilingual assessment: Actual practice versus recommended guidelines. 
https://doi.org/10.1044/0161-1461(2007/020) 

Dunn, L. M. (1968). Special education for the mildly retarded—Is much of it justifiable?. Exceptional children, 35(1), 5-22. 
https://doi.org/10.1177/0014402968035001 

Huerta, L., Cycyk, L. M., Sanford-Keller, H., Busch, A., Dolata, J., Moore, H., ... & Zuckerman, K. (2021). A retrospective review of communication evaluation practices of young Latinx children. Journal of Early Intervention, 43(4), 295-313. 
DOI: 10.1177/10538151211012703 

Saenz, T. I., & Langdon, H. W. (2019). Speech-language pathologists' collaboration with interpreters: Results of a current survey in California. Translation & Interpreting, The, 11(1), 43-62. 

US Department of Education, 2022. IDEA section 618 Data. 
https://data.ed.gov/dataset/docs/idea-section-618-data-products-state-level-data-files 


Zuckerman, K. E., Mattox, K. M., Sinche, B. K., Blaschke, G. S., & Bethell, C. (2014). Racial, ethnic, and language disparities in early childhood developmental/behavioral evaluations: A narrative review. Clinical pediatrics, 53(7), 619-631. 
DOI: 10.1177/0009922813501378 



Assessment in Early Intervention: Developing the Linguistic Diversity Protocol

Literature Review 

Speech-language pathologists’ (SLPs) expertise in the language underpinnings of speaking, listening, reading, and writing is critical when working with teams to serve individuals with written language difficulties. SLPs’ roles and responsibilities include prevention, assessment, and treatment of written language disorders (ASHA, 2010). Reading and writing disorders, which often co-occur (e.g., Kim, 2022), present in a variety of profiles. Reading disorders are frequently described in terms of decoding and listening comprehension (e.g., the Simple View of Reading) as well as by multi-faceted models such as Scarborough’s (2001) Reading Rope, the Language Literacy Network (Wasowicz, 2021), and the Interactive Dynamic Literacy Model (Kim, 2022). Dyslexia is one such profile; in broad terms, individuals with dyslexia have strengths in language comprehension and difficulties with the phonological aspects of language. Other reading disorder profiles include Developmental Language Disability (DLD) and reading comprehension disorder. 

The presence and nature of reading and writing disorders involve spelling assessments as part of a comprehensive evaluation. Spelling assessments may be standardized norm-referenced (e.g., SPELL-2; Masterson et al., 2002), criterion-based (e.g., Words Their Way; 2008), and/or authentic using spelling samples. An assessment approach that involves an analysis of spelling errors, as opposed to scoring based on the number of words spelled correctly, is powerful in several ways (Masterson & Apel, 2010). First, spelling error analysis provides a window into an individual’s linguistic knowledge (e.g., Henbest & Apel, 2021). Specific types of spelling errors indicate strengths and weaknesses in the language areas of phonological awareness, orthographic knowledge, morphological awareness, and semantic knowledge (Henbest & Apel, 2021; Masterson & Apel, 2010). Second, spelling error analysis informs a treatment approach that builds on the linguistic knowledge not yet mastered by the student. Third, error analysis embedded within the treatment plan allows for ongoing assessment of progress over time. Although there is ample information to support the provision of effective literacy interventions, including word study, SLPs may not be completely comfortable or confident in their ability to provide these interventions (Marble-Flint et al 2022). However, when supported through evidence-based professional development, SLPs may provide effective literacy interventions, leading to improved outcomes for all children (Mahowald & Rentmeester-Disher, 2019).

Statement of Purpose 

Recent results of national outcomes testing indicates that literacy outcomes in most US states declined significantly when compared to scores from 2019 (NAEP, 2023). In addition to reading specialists and special educators, SLPs potentially play a key role in improving reading outcomes for all children, not just those with identified disabilities. They bring expertise in different components of language and the reciprocal relationship between written and oral language that is important in understanding literacy development in all children. The purpose of this presentation is to equip SLPs with the background knowledge and tools that will allow them to elicit and analyze spelling samples, using the multilinguistic model. Attendees will also learn how to identify treatment options that align with language needs based on the results of the analysis. 

Summary of Proposal 

The presenters will review the multilinguistic model of reading and spelling, including phonology, orthography, morphology, and semantics, with emphasis on phonology and orthography as they pertain to beginning readers and spellers. The simple view of reading and reading disorders will be reviewed, including dyslexia and literacy difficulties resulting from developmental language disorder. The presenters will then demonstrate how the multilinguistic model can be applied to spelling analysis. A variety of typical and atypical spelling samples will be presented and participants will be guided through the process of spelling analysis using the language blocks, followed by the development of treatment targets based on the results of the analyses. The presenters will share a variety of resources related to literacy disorders, assessments and interventions. There will be ample time for questions and discussion. 

Outline

5 mins- Introductions and disclosures
10 mins- Review of Simple View of Reading 
10 mins- Review of different types of reading disorders and profiles
30 mins- Language blocks of spelling with examples
30 mins- Spelling Analysis
20 mins- Case studies; Discuss implications for instruction based on spelling error analysis
15 mins- Share resources related to reading disorders and interventions; Q & A



What’s Spelling Got to Do With It?

This presentation is based on a recent article published by Katie Gore and Courtney Luckman Margulis in the May 2022 issue of Perspectives of the ASHA Special Interest Group #4, Fluency and Fluency Disorders (Gore and Luckman Margulis, 2022). As a therapist with 45 years of experience, one learns to pay attention to those occasional articles that have the potential to change how we do our work. This is one of those. I would describe it as seminal, one that will hopefully change how therapy is provided in the future. The concept is simple and long needed: how do we help non-specialists in fluency disorders, including school based SLPs, and especially those who see only one or two clients per year, navigate the tremendous amount of, yes, evidence-based therapy approaches that may unfortunately present competing ideologies. How do we give clinicians a place to start based on best practices that also allow them to use the other two parts of the evidence-based triangle: clinical expertise and client values? How do we increase clinician confidence that they indeed can be of help and not harm? How do we ensure that the therapy they provide is holistic, treating the whole individual and not just their lack of fluency? 

First 15 minutes: This article (and this presentation) introduces a treatment organization and therapy planning tool, NOT a new intervention. It presents and defines three organizational concepts that allow almost all existing therapy approaches to be categorized. The three concepts, each beginning with the letter E are Education, Ease, and Empowerment. 

Education refers to any activity helping the client learn about stuttering: stuttering facts and myths; anatomy and physiology; types of approaches, and how others deal with stuttering. Education taps into the Cognitive aspect of stuttering from the ABCs of stuttering (Cooper and Cooper, 1998). 

Ease refers to ways of reducing the struggle involved in stuttering, making speech less tiring and less effortful, and includes fluency shaping and stuttering modification approaches. Ease deals with the Behavior aspect of stuttering. 

Empowerment relates to the person learning to see herself as more than her stutter, as learning to move toward accepting some stuttering as she says what she wants to say, when she wants to say it and to whom she wants to say it. This of course relates to the Affective (attitudes and emotions) part of the ABCs of stuttering. Empowerment approaches might include self-disclosure, voluntary stuttering, giving a talk where stuttering is allowed to happen, or reducing avoidances. 

The remaining 45 minutes: Once these introductory remarks are out of the way, the bulk of this presentation will be a collaborative activity where participants will be encouraged to name every stuttering therapy approach or activity they have used or heard about in graduate school or read about in the literature, and then place those activities in one of the three E categories. 

A major goal of this session will be to ensure that attendees, as they anticipate providing speech therapy for clients who stutter, will be encouraged to include activities from each of the Es and in so doing to realize they will be delivering helpful and comprehensive (not fluency-only) affirming therapy that yes, may require some reeducation of family members and school personnel about what stuttering is.

REFERENCES: 

Cooper, E. & Cooper, C. (1998). The Cooper Fluency Workshop. Nova Southeastern University's Program in Communication Sciences and Disorders one-day presentation September 19th, 1998.

Gore, K.& Luckman Margulis, C. (2022). 3Es: An All-Inclusive Stuttering Therapy Tool. Perspectives of the ASHA Special Interest Group 4 (May, 2022)

A New User-Friendly Framework for Organizing Stuttering Therapy Approaches

The utilization of telepractice has grown exponentially since early 2020. Innovations abound in the practice of teletherapy, however, not much has changed in terms of telepedagogy or its use in preparing graduate students for clinical practice. This seminar will review current research in teletherapy and introduce its innovative use in telepedagogy. 

Virtually utilizing real patients in the classroom, student clinicians were provided an opportunity to learn about and to demonstrate application of evidenced based concepts in real time. Faculty, student and patient responses in a reflective questionnaire highly supported this telepedagogy. Faculty and students reported positive attitudes towards telepractice engagement, their experience with technology, implementation of the virtual session, learning course content, and professional development.

Current research and innovations were reviewed prior to and during this study. Telepractice is an ever-evolving mode of service delivery that includes innovations and changes in videoconferencing platforms as well as in assessments and therapy materials. Real patients virtually attended class time weekly for the full course of a semester. Small student groups created an informal assessment and treatment plan targeting course constructs. Qualitative data was collected from students via a reflective questionnaire at the end of the semester pertaining to comfort with use of telepractice, value in, and perceptions of professional development. 

Introduction
The use of telepractice as a telepedagogy has the potential to facilitate the application of course constructs to clinical practice, thus improving student learning as reported by faculty and students. Telepractice has grown exponentially since early 2020. Innovations abound in the practice of teletherapy, however, not much has changed in terms of telepedagogy or its use in preparing graduate students for clinical practice. This presentation will review current research in teletherapy and introduce an innovative use of telepractice in telepedagogy. 

Procedures 

Faculty, student clinician and patient questionnaire responses, addressing the phenomenology of perceptions of the use of telepractice during classroom instruction, were collected post completion of virtual assignment. Assignments utilized real patients virtually in the instructional classroom. Faculty developed student assignments considering course objectives and learner’s knowledge & skills. Small student groups developed evidenced based informal assessment measures and clinical activities reflecting course constructs. Remaining students observed and documented the application of course constructs with real patients in real time. Patients attended remotely, engaging with student clinicians and participating the in planned activities. 

Faculty, student clinicians and patients responded to questionnaires addressing the telepedagogical experience. General perspectives on telepractice engagement, experience with technology, implementation of virtual sessions, and overall satisfaction with the experience were obtained from each group. 

Results
Faculty responded to questions addressing perceptions of pedagogical effectiveness, assessing student application of course content to clinical application, changes in faculty - student engagement, and student acquisition of learner objectives. 

Students responded to question addressing perceptions of confidence with virtual engagement, facilitation with learning course content, ability to self-assess effectiveness in engagement with a virtual patient, professional development, an employability. And finally, patients responded to questions addressing their experience with virtual student engagement, and willingness to provide feedback to students. 

Discussion
Faculty responses were highly positive to questions addressing pedagogical effectiveness, observation and evaluation of student application of course content, frequency and quality of faculty-student engagements, and acquisition of learner objectives. Student responses were overwhelmingly positive addressing perceptions of gained confidence in virtual engagement, facilitation of learning theoretical concepts and ability to self-assess effectiveness of virtual engagement. Patient responses were generally altruistic in nature, reporting satisfaction with engaging with student clinicians, providing opportunities for “giving back,” providing real time verbal feedback to students, and in the opportunity to support student learning based on personal experiences with speech-language pathology.

Utilization of telepractice, innovations in practice delivery, and clinical application continues to expand. Positive faculty, student and patient responses to the experience of telepractice in telepedagogy has merit for its inclusion in academic training programs to prepare entry level clinicians for the continuous evolution of the scope of practices in speech-language pathology. 

Overby, M. S., & Baft-Neff, A. (2017). Perceptions of telepractice pedagogy in speech-language pathology: A quantitative analysis. Journal of Telemedicine and Telecare, 23(5), 550-557.
Kim, S., Roman, A. M., & Moore, A. (2022). Patient and caregiver satisfaction regarding telepractice versus in-person services at a university speech, language, and hearing clinic. Clinical Archives of Communication Disorders, 7(3), 83-93.
Lenkey, L. (2020). Connecting speech-language pathology graduate students to their future; Telepractice pedagogy in the classroom. In EDULEARN20 Proceedings: 12th International Conference on Education and New Learning TechnologiesOnline Conference. 6-7 July, 2020. (p. 6740). IATED Academy
Bhattarai, B., Sanghavi, T., & Panchakshari, A. B. (2022). Experience Delivering Tele-practice Services among Upcoming and Working Professionals of Speech Language Pathology. Journal of Health and Allied Sciences NU, 12(04), 441-447.

5 minutes—Introductions and Disclosures
10 minutes—Overview of telepractice in telepedagogy
30 minutes—Présentation/Demonstration - implementation / Questionnaire responses to telepractice in telepedagogy
5 minutes— Conclusion
10 minutes—Q & A


Innovations in Telepractice-How do we integrate it into Telepedagogy

OSHA 2023 Awards

Empowering the survivor of head injury presentation is a model for collaborative treatment including a resource coordinator, occupational and physical therapy working primarily with adults. Motivational interviewing is program foundation. The treatment is individualized to build on the client’s strengths with all clinicians educating in core skills of recovery.

Speech-language pathologists’ approaches to augmentative and alternative communication (AAC) assessments

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