**8. Speech pathology and RTI**

The American Speech-Language-Hearing Association (ASHA) defines RTI as an increasingly intense, multitiered system to providing services and interventions to struggling students and encourages speech-language pathologists (SLPs) to assist in identification. As mentioned before, this approach incorporates increasingly intensive levels of intervention, meeting the student where they currently are, in terms of academic success. Universal speech screenings, frequent progress monitoring, high-quality and evidence-based interventions, and response data are the core foundations of RTI that are utilized, in an attempt to identify students early and provide them with the support to be successful.

#### **8.1. Identifying students at risk**

and the need for extensive Tier 3 instruction are reduced [6]. Numerous studies have shown the utility of RTI programs. One study showed consistent decreases in special education placements. In particular, that study showed a 39% decrease in special education placements in kindergarten, a 32% decrease in special education placements in the first grade, a 21% decrease in special education placements in the second grade, and a 19% decrease in special education placements in the third grade. Another study reported that engagement in Tier 1 interventions reduced the percentage of students going to special education by 12%. Participation in all three tiers reduced the rate of students placed in special education by 8% [12]. Because RTI helps ensure that all students receive quality instruction and proper supports, it lessens the likelihood that a student will be misdiagnosed with a disability and placed in special education [4].

One study on the barriers and benefits of RTI sought feedback from special education teachers about the benefits that students experience from RTI [13]. A majority of responses from the surveyed teachers showed that students were receiving better instruction that more quickly identified and addressed problems so that students did not fall further behind waiting for necessary assistance. Other responses indicated that teachers found the RTI process to help correctly identify students with learning disabilities during the special education referral process so that students without special needs are not improperly shuffled into special education programs. However, the study noted that many teachers found the benefits of RTI to extend beyond special education programming, for teachers noted that the one-to-one intervention

RTI has also been found to lead to other benefits for schools and teachers, including better data collection on student growth and achievement [13]. Furthermore, teachers have disclosed that the individualized nature of RTI has helped general education teachers and educational teams more precisely and accurately identify individual skill areas or behaviors in which a student is struggling. Finally, many educators have noted that RTI has increased

The American Speech-Language-Hearing Association (ASHA) defines RTI as an increasingly intense, multitiered system to providing services and interventions to struggling students and encourages speech-language pathologists (SLPs) to assist in identification. As mentioned before, this approach incorporates increasingly intensive levels of intervention, meeting the student where they currently are, in terms of academic success. Universal speech screenings, frequent progress monitoring, high-quality and evidence-based interventions, and response data are the core foundations of RTI that are utilized, in an attempt to identify students early

strategies of RTI assisted students across the learning spectrum [13].

**7.2. Student benefits**

108 Learning Disabilities - An International Perspective

**7.3. Benefits to schools and teachers**

**8. Speech pathology and RTI**

collaboration between teachers and parents [13].

and provide them with the support to be successful.

Speech-language pathologists play a vital role in identification of students with needs, both those with speech-language impairments and those students presenting with specific learning disabilities. Prior to the introduction of RTI, students were found eligible for special education services based on discrepancies between performances on standardized tests and performance in the classroom. In hearings related to the reauthorization of IDEA, the US Congress found that using these measures was insufficient to identify learning disabilities, as the IQ-achievement discrepancy formulas that had previously been utilized cannot be applied in a reliable and valid manner. In addition, students living in poverty or students from culturally and linguistically diverse backgrounds may be mistakenly viewed as having intrinsic intellectual limitations, although their differences on such tests are really reflective of a lack of experience or educational opportunity.

With RTI in place, students are able to access these services based on their personal performance or response to increasingly intense interventions provided to them in their area of deficit. Speech-language pathologists can be integral to successful RTI initiatives in a school [14]. In Tier 1, they should be providing consultation services regarding possible disorders and impairments within their scope of practice and dissemination of information regarding speech-language disabilities and how they interplay with curriculum, assessment, and instruction.

#### **8.2. SLPs and their role in the school**

According to ASHA, there are many ways in which speech-language pathologists can make unique contributions to RTI in their school. They can explain the role that language plays in curriculum, assessment, and instruction, as a basis for appropriate program design, as well as explain the interconnection between spoken and written language. They can identify and analyze existing literature on scientifically based literacy assessment and intervention approaches and make recommendations on their implementation in the school. Speech-language pathologists can also assist in the selection of screening measures and plan for and conduct professional development on the language basis of literacy and learning [15].

Trainings that include information regarding typical articulation/phonological errors and the ages when they should no longer occur could be appropriate trainings for a school-based speech-language pathologist to provide to his/her colleagues. By informing classroom teachers of these developmental norms, it is likely that more students will be properly identified through screenings and assessments and that interventions will be implemented for the students who need it most. Furthermore, evidence supports the use of dynamic assessment for reducing overidentification and identifying students for small-group language intervention [16].

Speech-language pathologists should be presenting information on a variety of speech-language disorders including but not limited to language impairments, speech disorders, phonological impairments, dysfluency (stuttering), and voice production problems/vocal abuse. Another important component of Tier 1 is the instructional information that speech-language pathologists can provide to their colleagues including special education teachers, teachers, and other support staff in the school, who may be making referrals [17]. Providing other professionals with strategies to address general speech-language difficulties can increase the effectiveness of general teaching procedures and assist all students in the classroom.

#### **8.3. SLP implementation of RTI**

Many techniques can be implemented quickly in the classroom and can support improved student performance. For example, students demonstrating difficulty learning-related vocabulary may benefit from direct and explicit strategies, such as teaching the vocabulary in context, using word webs, pre-teaching key words and concepts, and using visuals (gestures/ pictures) to teach meaning. Other strategies that are effective across subjects and grade levels include stating the objectives; providing direct instructions; utilizing multiple modalities; engaging students in group activities; using feedback, reinforcement, and recognition; highlighting similarities and differences; and utilizing advanced visual organizers [18].

#### **8.4. SLPs and Tier 1**

As previously mentioned, RTI also provides schools with an opportunity to take preventative steps by providing evidence-based practices to groups of students that are at risk. Reading is a fundamental skill for academic success, and it is closely linked to phonemic awareness. Phonemic awareness is the ability to understand that words are composed of individual sounds (phonemes) and manipulate those sounds, sound sequences, and sound structures in a syllable or word. It may be difficult to develop for many groups of students, including those with phonological impairment, speech impairment, students learning English as a second language and those from low-income households [19]. Strong phonemic awareness has been found to be a predictor for reading skills, and in its absence, students will struggle with reading [20]. The curriculum for upper grades relies heavily on independent reading skills, and students who have struggled to build a solid foundation in the early grades will begin to demonstrate difficulties in all academic areas based on their reading difficulties. Speechlanguage pathologists can assist by providing classroom teachers with evidence-based strategies for teaching phonemic awareness. For example, students struggling with literacy skills have been found to benefit from structured teaching activities such as name writing, alphabet recognition, and phonological awareness activities. If incorporating these supports into the curriculum class-wide does not prove to be intense enough, and the student continues to perform below curriculum-based measures and/or benchmarks, he/she will be referred for Tier 2 of RTI to be provided with need-based learning in intensive small groups.

#### **8.5. SLPs and Tier 2**

Tier 2 intervention typically is provided in collaboration with the general education teachers. It usually consists of small groups of students being provided with high-quality, but specific and explicit, short-term instruction in the area of difficulty. This Tier is the most important in terms of using clinical expertise and data from performance during Tier 1 to identify students that need these groups. Dynamic assessment can take place over a relatively brief period, and his/her response to intervention can be an indicator of their ability to progress academically throughout the school year [21].

Intervention at this stage will vary greatly depending on the nature of the difficulty that the student is having. For example, if the student is struggling in the area of articulation (the actual production of sounds based on place, manner, and voicing) and is stopping his/her /s/ sounds (replacing the /s/ sound with a sound like /d/ or /t/), the speech-language pathologist may provide the classroom teacher and parents with specific strategies for practicing and producing the correct /s/ sound. Articulation strategies can include word lists with the target sound, modeling, and descriptive instruction for production and embedding "traditional" articulation therapy techniques, such as sound discrimination and correcting productions until the sound can be produced in all contexts and speaking situations [22]. If progress is not made and/or the misarticulated sounds further impact the student's academic and/or social/ emotional functioning in the classroom, a referral to Tier 3 may be warranted.

Students experiencing dysfluencies (stuttering) may also require Tier 2 if their dysfluency is impacting their academic progress or their social/emotional functioning in the classroom, but it is unclear whether there is an obvious disorder. The speech-language pathologist should identify one to three possible strategies that the classroom teacher can implement such as modeling, providing think-time (for the student before providing a verbal response), refraining from interrupting [23], and decreasing stress in the classroom. If dysfluent behaviors become pervasive across environments, the student may need to be referred to Tier 3 and/or require therapy provided by a speech-language pathologist with expertise in treating stuttering [24].

Speech-language pathologists may also receive referrals to Tier 2 for students experiencing voice difficulties, such as hoarse voice, problems with nasality, or decreased volume. Recommendations for the classroom may include reviewing good vocal hygiene such as the importance of hydration and appropriate volume/loudness but may also implement self-monitoring strategies for the student, such as charting appropriate vocal productions throughout the school day.

#### **8.6. SLPs and Tier 3**

and other support staff in the school, who may be making referrals [17]. Providing other professionals with strategies to address general speech-language difficulties can increase the

Many techniques can be implemented quickly in the classroom and can support improved student performance. For example, students demonstrating difficulty learning-related vocabulary may benefit from direct and explicit strategies, such as teaching the vocabulary in context, using word webs, pre-teaching key words and concepts, and using visuals (gestures/ pictures) to teach meaning. Other strategies that are effective across subjects and grade levels include stating the objectives; providing direct instructions; utilizing multiple modalities; engaging students in group activities; using feedback, reinforcement, and recognition; high-

As previously mentioned, RTI also provides schools with an opportunity to take preventative steps by providing evidence-based practices to groups of students that are at risk. Reading is a fundamental skill for academic success, and it is closely linked to phonemic awareness. Phonemic awareness is the ability to understand that words are composed of individual sounds (phonemes) and manipulate those sounds, sound sequences, and sound structures in a syllable or word. It may be difficult to develop for many groups of students, including those with phonological impairment, speech impairment, students learning English as a second language and those from low-income households [19]. Strong phonemic awareness has been found to be a predictor for reading skills, and in its absence, students will struggle with reading [20]. The curriculum for upper grades relies heavily on independent reading skills, and students who have struggled to build a solid foundation in the early grades will begin to demonstrate difficulties in all academic areas based on their reading difficulties. Speechlanguage pathologists can assist by providing classroom teachers with evidence-based strategies for teaching phonemic awareness. For example, students struggling with literacy skills have been found to benefit from structured teaching activities such as name writing, alphabet recognition, and phonological awareness activities. If incorporating these supports into the curriculum class-wide does not prove to be intense enough, and the student continues to perform below curriculum-based measures and/or benchmarks, he/she will be referred for Tier 2

effectiveness of general teaching procedures and assist all students in the classroom.

lighting similarities and differences; and utilizing advanced visual organizers [18].

of RTI to be provided with need-based learning in intensive small groups.

Tier 2 intervention typically is provided in collaboration with the general education teachers. It usually consists of small groups of students being provided with high-quality, but specific and explicit, short-term instruction in the area of difficulty. This Tier is the most important in terms of using clinical expertise and data from performance during Tier 1 to identify students that need these groups. Dynamic assessment can take place over a relatively brief period, and his/her response to intervention can be an indicator of their ability to progress academically

**8.3. SLP implementation of RTI**

110 Learning Disabilities - An International Perspective

**8.4. SLPs and Tier 1**

**8.5. SLPs and Tier 2**

throughout the school year [21].

Tier 3 provides the most support prior to a referral to special education. Where oftentimes the small groups in Tier 2 may meet two times a week for 30 minutes, the students identified as needing Tier 3 may receive up to double the amount of time previously allotted in Tier 2. Tier 3 instruction is characterized by more explicit, individualized, and systematic instruction to support students' speech-language skills in addition to indirect activities that may include helping to select research-based interventions, completing student observations, assisting with frequent progress monitoring, and helping the team make decisions regarding referral for special education evaluation.

Speech-language pathologists may need to complete a detailed and individualized language/ literacy battery of formal, informal, and curriculum-based assessments, including assessment of receptive and expressive vocabulary and language, articulation, phonology, pragmatics, reading, and written language, as well as the speech components of voice, fluency, and resonance. Interpretation of these assessment results will further assist in determining if the student has special education needs, and if indicated, the basis for the Individualized Education Plan (IEP) goals [25].

Many school-based speech-language pathologists often have heavy caseloads, overflowing with mandated individual and group sessions and making the task of being involved in RTI a seemingly impossible one, but as an integral part of the multidisciplinary educational team, their therapeutic interventions are critical to student success. Prevention of speech, language, and communication disorders is one of the key roles and responsibilities of school-based speech-language pathologists and as such can complement and augment RTI services..
