To Screen or Not to Screen. . .  That is the Question

Barbara Moore-Brown, Ed.D.
Director, Special & Alternative Education
El Rancho Unified School District
Pico Rivera, CA
 
Beth Nishida, M.A.
Coordinator, Special Education
Hacienda LaPuente Unified School District
La Puente, CA
 
 
In 1975, Congress passed Public Law 94-142, the Education for All Handicapped Children Act (EAHCA), which mandated educational services for children with disabilities in this country.  Since that time, special education has continually evolved.  Some of these changes may have seemed subtle, yet were extremely important, like changing the name of the law to the Individuals with Disabilities Education Act (IDEA).  Others have seemed dramatic and have raised high levels of controversy, like the inclusion of students with significant disabilities into general education program, or including students with disabilities in statewide testing.  Each change has been rooted in the fight to provide a free appropriate public education (FAPE) to students with disabilities.  Additionally, the climate of special education has made us increasingly aware of our legal obligations and critical of our practices under the law.  Presently, we are on the cusp of another reauthorization that may bring sweeping change to how special educators operate in schools, creating the need to examine what we do and why we do it.  In some cases, these practices are held near and dear by some individuals who provide service to students with disabilities.
 
Child Find
In 1975, school districts in many parts of our country were denying educational services to children with disabilities.   These circumstances led to a federal mandate for special education in the United States.  To ensure that such denial would not occur, procedural safeguards, or rights and protections, were guaranteed to parents and children.  Among these procedural safeguards were requirements regarding evaluation and identification of children as having a disability.  Key to these rights and protections is parent consent for assessment.  In order to ensure that all children with disabilities that might not be in school were located and provided with an education, requirements for “search and serve” or “child find” were put into the law. 
 
The U.S. Department of Education (2000) has reported to the Congress that the original intent of special education, to locate and provide access to children with disabilities, has been met.  In 1997, the focus of IDEA shifted from access to services, to a focus on educational results (IDEA, 1997, SS 601[c]).  As noted, many things have changed between 1975 and 1997, but one of the most noteworthy is in how we “search” for, or locate and find students with disabilities.  In 1975, one of the easiest ways to find children who might have disabilities was to conduct massive classroom screenings of all children in certain groups, such as those entering kindergarten, or those at certain grade levels.  This usually involved conducting a short battery of sample test items with students to check their articulation, vocabulary, language development and pre-academic skills.  In 1975, some children who did not appear “school ready” would be sent home to mature for another year, while others would be tested to determine if they needed special education services.
 
In 2002, many children have some sort of pre-school experience prior to entering kindergarten.  While there is still a great disparity of skills between children entering school for a variety of reasons, there is no “screening” for academic readiness.  It is also rare to find speech-language pathologists (SLPs) who feel compelled to screen kindergarten classes for children who might need services.  There are several reasons for this.  One is because mass screening is extremely time-consuming, with seemingly little actual benefit in terms of identification.  Since many children have attended pre-school, most children with speech and/or language difficulties would have been referred at that level.  As educators, we also understand that even children with no prior school experience, need opportunities to enter school, learn the routine and have time to learn, adjust and mature in the educational environment.  Children need to be given time to adjust to the learning environment of school, so conducting a screening of their skills early on in their school experience would be meaningless.  At all grade levels, teachers and other support staff have a greater understanding of accommodations, modifications and techniques for adjusting the academic curriculum so that children can be successful.  The current focus on literacy has resulted in a greater focus on individualized needs that can be addressed in the general education classroom.  One final reason that SLPs no longer conduct mass screenings is that most of them do not need to go in search of students for their caseloads.
 
Child find continues to be a mandate under the IDEA, but school systems have different ways to conduct child find than existed in 1975.  When individual children are having difficulties in school, they are referred to the school’s Child Study Team (CST) or Student Study Team (SST).  This process is a general education function, and is designed to assist teachers, students and families by identifying methods of assisting the student.  If interventions are not successful, and a student continues to struggle, then the student may be referred for special education assessment to determine if s/he is a child with a disability requiring special education.  Key to this process is considering all areas which might be impacting the student. 

Evaluation Procedures

The IDEA is very specific in the procedures that must be followed for evaluation.  The Code of Federal Regulations (CFR, 1999) requires that:

• No single procedure is used as the sole criterion for determining whether a child is a child with a disability and for determining an appropriate educational program for the child.
(34CFR§ 300.532 (2)(f)).
• The child is assessed in all areas of suspected disability, including, if appropriate, health, vision, hearing, social and emotional status, general intelligence, academic performance, communicative status, and motor abilities. 
(34 CFR§ 300.532(2)(g)).
• In evaluating each child with a disability. The evaluation is sufficiently comprehensive to identify all of the child’s special education and related services needs, whether or not commonly linked to the disability category in which the child has been classified. (34 CFR§ 300.532(2)(h)).
• Upon completing the administration of tests and other evaluation materials -- A group of qualified professionals and the parent of the child must determine whether the child is a child with a disability. (34 CFR§ 300.534(a)(1).

Concerns About Screening As a Pre-Referral Activity

Even though SLPs in schools have, for the most part, abandoned the practice of mass screenings of groups of children, a common practice is pre-referral screening of individual children.  SLPs may conduct a screening as a result of a request by an individual teacher for them to "check" a child or as a result of a SST recommendation.  Many SLPs believe screening is a very efficient practice.  They view it as a way to prevent having to conduct a full assessment on an individual child, especially if the referral is inappropriate.  They feel they can quickly determine if the child appears to require the services of an SLP or if the concern that the teacher has brought to their attention is developmental.  The problem with this rationale, and practice, is that it is contrary to the requirements described above for evaluation to determine eligibility.
 
Screening has been an accepted practice for many years in our field, and is even outlined in the 1989 Program Guidelines for Speech-Language Hearing Specialists in California (California Department of Education, 1989), the ASHA Preferred Practice Patterns (ASHA, 1997) and the Guidelines for the Roles and Responsibilities of School-Based Speech-Language Pathologists (ASHA, 1999).  Screening is also an approved activity for speech-language pathology assistants (SLPAs).  Typically, a screening is used to check if the child might potentially qualify for services, and if further evaluation is warranted.  The problem is that once that has been done, the team has begun conducting an evaluation, most often without parental consent.  This practice is contrary to requirements for evaluation.
 
The practice of screening for the purpose of determining whether or not the child should have additional evaluation is problematic for several reasons.  By conducting a screening in this way, a single assessor has pre-determined eligibility, violating the requirements for parental consent, assessing in all areas of suspected disability and the for a multi-disciplinary team assessment.  If the student is recommended for further evaluation as a result of the screening, no other issues may be considered, possibly missing areas of need.  If the student is not recommended for further evaluation, then the SLP alone has made the determination of eligibility, absent parental and multi-disciplinary team participation. One other problem is that when assessments are conducted, a meeting is required to review the evaluation and this has also not occurred when a screening is done.
 
SLPs may believe that nothing is wrong with going into a classroom and listening to a child, at the teacher’s request.  The belief holds because they are not administering any formal tests, they are listening to the child at the teacher’s request, and they are protecting themselves from time-consuming, inappropriate referrals.  The CFR require that qualified personnel be the conductors of evaluation and providers of service (SS 300.23).  When an SLP goes into a classroom and singles out a given child, and uses his/her trained ear and knowledge skill set to listen to the child, s/he has just conducted an assessment [e.g. data collection and the gathering of evidence (ASHA, 1999; p. 19)] and evaluation [e.g. bringing meaning to that data through interpretation, analysis and reflection].  Even though this assessment may not be a formal one and no formal tests were administered, it can be considered an evaluation because of the knowledge base and expertise of the SLP.   However, this assessment has been done without parental consent or following the other requirements identified above.  Violating these requirements can be considered a violation of the child’s due process rights, and could lead to legal problems for the school district.

Legal Concerns

As early as 1986, a case regarding screening held that a school district was conducting an assessment when they used procedures for one student that they did not use for everyone in that child’s class. (Forest Park (MI) School District, 352 IDELR 182; OCR 1986; cited in Gilyard, 2002)  In this case, the procedures were used without consent from the parent.  That case has implications for speech-language pathologists, as well as for other special education assessors.  The outcome of this case suggests that general consultation about student difficulties is acceptable, but when the specialist interacted with the student in an attempt to determine whether more assessment was warranted, the evaluation had already begun.
 
A more recent 9th Circuit Court of Appeals case, in 1996, reinforced the importance of parental consent, and not having dual tracks for determining eligibility. (Pasatiempo v. Aizawa, 103 F.3d 796 (9th Cir.1966).)  In this case, the state of Hawaii defended their use of a dual-track system of evaluation, depending on the suspicion of the school’s screening committee as to whether or not the child had a disability.  The 9th Circuit Court found that it is not in the purview of the school to make this determination prior to evaluation, and that parents cannot be denied their procedural rights to consent.  In essence this case emphasized:  1) there need to procedures in place; 2) the procedures need to be systematic; 3) parents need to give consent prior to assessment; and 4) this consent needs to be informed consent.  This case can be interpreted to apply to this discussion about screening, in that if screening is used as part of the procedures to determine whether or not a child has a disability, then such procedures need to be identified.   It is noteworthy that since this case is a 9th Circuit decision, it has applicability to California. 
Using Effective Procedures
Changing legal requirements, as well as increased due process cases, have forced school personnel to re-examine current practices.  The good news is that by analyzing our practices, it may be possible to solve more than one problem at once.  Consider for a moment, a long-time complaint of many SLPs in schools, that “they (teachers, administrators, parents, etc.) don’t know what I do!”   Current thinking on service delivery has suggested that the best way to solve this problem is by not separating ourselves from the functions of the classroom or school. (Moore-Brown & Montgomery, 2001).   In other words, the more we are involved with the issues and concerns of teachers and principals, related to student need, then the greater the opportunity they have to learn about the skill set and knowledge base of the SLP.  By extending this line of thinking to utilization of the SST process for consideration of all students with learning problems and suspected disabilities, it is possible to see how on-going discussion and participation by the SLP can help the team understand how speech and language issues impact the child’s academic achievement.  For example, the SLP can help the team understand how concerns about phonemic awareness and reading concerns in children may be related to their suspected phonological impairment.  Through utilizing the school’s problem solving process to address student need, the goal to avoid inappropriate referrals can be achieved.  We may also be able to increase team members’ general awareness of the role of the SLP, and how speech and language issues impact academics.

Local Decisions

Whether or not to utilize screening as a part of the protocol for pre-referral is a local decision that should be addressed with the special education administration at the school district and Special Education Local Plan Area (SELPA).  If it is decided to utilize screening as a pre-referral practice, then parental consent should be obtained.  This is critical as a single child is being identified as being suspected as having a disability.  Failure to obtain parental consent could be construed as denial of due process procedures.  Should further speech and language evaluation not be conducted as a result of the screening results, and the parent had not been informed or consent received, the district could be responsible for the cost of that evaluation and services if the parent sought private evaluation and services.
 
ASHA Director of School Services, Sue Karr, indicated to the authors of this article that ASHA does advise members to follow procedures consistent with the parental consent requirements of IDEA and to check state and local education agency requirements.    Unfortunately, the state of California Department of Education (CDE) does not yet have updated program guidelines for speech-language-hearing programs.  However, justifying the use of screening procedures using the program guidelines from 1989, when no less than two major reauthorization of the law have been made since then, would not be considered advisable. 
 
SLPs may be reluctant to use the SST as a method for determining whether a student should receive a comprehensive speech and language evaluation, due to dysfunction of the SST at their school site.  However, the SLP may find that helping the school solve those problems may be more productive for students and staff in the long run.   The benefits of an effective SST process may eventually outweigh the work required to revamp the system so that it is responsive to many needs. 
 
In the long run, the answer on whether to screen or not to screen lies at the local level.  Screening is a permissive activity.  Mass screenings, as they are completed with large groups of children, do not require parental consent.  However, any time an individual child is singled out, parental consent should be obtained. 
 
In looking at updated procedures for child find, SLPs (and RSP teachers) should utilize the SST process of the school, which is designed to be a problem-solving vehicle for teachers, students and parents.  Through this system, team members can learn about developmental milestones for speech and language, how to provide accommodations and modifications, implications for literacy concerns with children suspected of having a speech or language disorder, and how to look at the whole child, and not just one presenting issue.  By training SST members in these skills, the SLP will also be training the team on how speech and language issues impact school performance, and what types of concerns would warrant an appropriate referral.
 
Before deciding whether to screen or not to screen, SLPs should examine what the purpose of the screening is.  If it is to save time and to prevent inappropriate referrals, the problems may outweigh the perceived benefit.  SLPs need to understand that legally there is no such thing as an individual screening or just popping into a teacher’s classroom to listen to a child.  The expertise utilized to perform that task just constituted that act as an assessment. 
 
With mandates to consider how the child’s disability affects their ability to progress in the general education curriculum, utilizing the procedures set forth for assisting students seems to be natural.  But most importantly, the increasing world of litigation in special education makes examination of our practices critical.  Whatever practice your local agency decides to follow, make sure that you have addressed the required components of multidisciplinary assessment, receiving informed parental consent and assessing in all areas of suspected disability.

References

  • American Speech-Language-Hearing Association (1999).  Guidelines for the roles and responsibilities of the school-based speech-language pathologist.  Rockville, MD:  Author.
  • American Speech-Language-Hearing Association (1999).  Preferred practice patterns for the profession of speech-language pathology.  Rockville, MD:  Author.
  • California Department of Education. (1989).  Program guidelines for language, speech, and hearing specialists.  Sacramento, CA.  Author.
  • Code of Federal Regulations (1999).  Assistance to states for the education of children with disabilities and the early intervention program for infants and toddlers with disabilities; Final regulations, C.F.R., Title 34, § 300, 301, and 303. (1999).
  • Gilyard, K. (2002, January).  Preparing special education assessors for I.E.P. team meetings and due process hearings.  [Handout].  Presentation at the Association of California School Administrators Conference, Monterey, CA.
  • Individuals with Disabilities Education Act (IDEA) Amendments, 20 U.S.C. SS 1400 ed seq. (1997).
  • Moore-Brown, B. & Montgomery, J. (2001).  Making a difference for America’s children:  speech-language pathologists in public schools.  Eau Claire, WI:  Thinking Publications. 
  • Pasatiempo v. Aizawa, 103 f.3D 796 (9TH Cir. 1996).  Available [online].  http://caselaw.lp.findlaw.com/scripts/getcase.pl?navby=search&case=data2…9417092.htm. 
  • U.S. Department of Education (2000).  Twenty-second annual report to Congress on the implementation f the Individuals with Disabilities Education Act.  Washington D.C.:  Author.
  • American Speech-Language-Hearing Association (2001).  Scope of practice in speech-language pathology.  Rockville, MD:  Author.

Special Thanks to Sue Karr of ASHA and Drin Barber, Esq. of WACSEP for their assistance with this article.