Guidelines for dismissal of a student who has been receiving educational interventions are available from both the American Speech-Language-Hearing Association (ASHA) Ad Hoc Committee on Admission/Discharge Criteria and from the Individuals with Disabilities Education Act (IDEA). Yet as speech—language pathologists (SLPs) in the schools enroll students and subsequently make decisions about the students' dismissal, many questions remain, especially in regard to children having persistent communication difficulties. A thorough review of the decision-making process for dismissal is one aspect of SLPs' training and serves as the foundation for decisions about when intervention should end. IDEA guidelines differ in many respects from the guidelines set forth by ASHA.There is no research that clarifies how these differing guidelines are reconciled when SLPs begin working in the schools, but the authors have anecdotal information from their experiences and from colleagues in South Carolina. An introduction to some of the other factors that may affect dismissal decisions is included. Current practice patterns and considerations for the future of speech—language services in the schools are discussed.
The affective components that arise as speech-language pathologists (SLPs) interact with the clients they serve and how these factors impact the process of ending therapy and SLPs' job satisfaction were discussed within the lead article to this scientific forum (Hersh, 2010 ). The development of a decision-making paradigm for dismissal is an expected outcome of training programs for SLP students, but this area may need more emphasis in the curriculum. Graduate students in the United States often complete practicum experiences in 10-12 weeks. Their assignments may require continuing an intervention program initiated by others, and they generally move to another practicum site before their patients' dismissal. This training schedule may limit the opportunities to develop a solid foundation in dismissal guidelines and practices unless this area is emphasized. Increased efforts to engage students in focused discussions about patient dismissal from the time treatment is initiated might lead to greater confidence in making these decisions independently after graduation. Discussions of dismissal should include case load management, service delivery models, review of practice guidelines from credentialing organizations and funding sources. Development of the counseling skills needed to promote improved understanding of the affective components that impact both SLPs and their patients must be cultivated.
In the United States, bipolar disorder is an increasingly common diagnosis in children, and these children can present with severe behavior problems and emotionality. Many studies have documented the frequent coexistence of behavior disorders and speech-language disorders. Like other children with behavior disorders, children with bipolar disorder are probably at greater risk for concomitant speech-language difficulties that can further complicate their behavioral presentation. This article reviews the features of the disorder based on current research perspectives as well as the most common coexisting conditions and evidence-based medical and psychological interventions. The goal is to increase awareness of pediatric bipolar disorder as a potential consideration in the behavioral presentation of children who have a coexisting speech-language disorder. Speech-language intervention should be one component of the comprehensive intervention program. A case study highlights the need for collaboration among caregivers and other team members as intervention plans are developed, implemented, and evaluated.
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