si eligibility guidelines for voice ppt presentation - region 13

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SI Eligibility Guidelinesfor Voice

Janice W. Lougeay, M.A./CCCHost: Region 13 ESC

Introduction

Host Site: Region 13 ESC www.esc13.netModerator: Kathy Clapsaddle Handouts available for download:

SI G id li M l f V iSI Guidelines Manual for VoiceFAQs ~ VoiceThis Power point

SI Eligibility in Texas (genericmanual)

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Earning CEUs

http://www.txsha.org/continuing_education/Online_Course_Completion.aspx

2.0 hours TSHA continuing education credit available for this training moduleFollowing the session, complete the Online Course Completion Submission Form – Your name, license #, email address, phone #

TSHA b hi #– TSHA membership #– The name and number of this course

Shown on last slide of this presentation– Course completion date– 3-questions Learning Assessment– CE evaluation of online course

You will receive a certificate of course completion via email

FAQs

Listen for answers to your questions during the training sessionRefer to the FAQ ~ Voice handout for additional informationadditional informationEmail unanswered questions to TSHA– [email protected]

Generic SI Eligibility Manual

This manual is to be used as an extension of the TSHA Eligibility Guidelines for Speech Impairment, 2009This information is not intended to beThis information is not intended to be used as a standalone guideWe will refer to the Generic Manual throughout this voice eligibility guidelines training

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IDEA 2004 DefinitionSpeech or Language Impairment–“means a communication disorder, such as stuttering, impaired articulation, a language impairment or a voice impairmentimpairment, or a voice impairment that adversely affects a child’s educational performance”[emphasis added]

CFR 300.8 (c) (11)

Purpose and Intended Use of the Voice Guidelines

Consistent, evidence-based evaluation practices consistent with the law to:– Provide information about voice and voice

disorders– Conduct a comprehensive evaluation to

determine whether a voice disorder is present– Guide eligibility deliberations relative to SI-

Voice– Make recommendations to ARD committee

related to voice

Eligibility Issues Specific to Voice

Standardized tools not availableInstrumentation to measure vocal parameters unavailable in the schoolsFew norms available for comparisonClinicians must rely on clinical judgmentsThe subjectivity of clinical judgments make measuring progress difficult

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Voice cases account for a small part of caseload in the schoolsClinicians sometimes lack confidence in dealing with this population

More Issues

dealing with this populationSchool districts must pay for visits to otolaryngologists

Let’s put the idea to sleep that voice disorders do not impact educational

Important Fact

impact educational performance

A speech/language impairment adversely affects educational performance when the communication (voice) disorder is judged sufficiently severe to require the provision of speech pathology services to the student because of adverse impact on

The Federal Law

of adverse impact on– Academic achievement– Functional performance

Common Practice: Use observation and evaluation data to document & describe adverse effects of voice disorder on academic achievement or functional performance

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Confusion between medical and therapeutic strategies for treating voice disordersDifficulty determining when therapeutic

i ill k d l

More Issues

strategies will not work due to structural or medical issues

Voice Disorders 101(Information for SLPs, Teachers, Parents…)

FunctionalAbuse/Overuse/Misuse

Edema/laryngitisEdema/laryngitisPolypsCystsNodulesSulcus Vocalis

Voice Disorders 101

OrganicCongenital

–Laryngeal WebWeb

–Atypical Laryngeal Structure

Acquired–Papilloma

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Voice Disorders 101Neurological

Cerebral PalsyMuscular dystrophyHead Injury

Voice Disorders 101Resonance Disorders

HypernasalityHyponasalityNasal Air Emission

Vocal Fold Dysfunction

What:Vocal folds close during inhalation Produces asthma-like symptomsStudent can’t get breath/panicsOften misdiagnosed as asthmaSometimes co-occurs with asthma

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Sometimes called paradoxical vocal fold vibrationSometimes asthma medications worsen symptomssymptomsAttacks often triggered by the same types of things as trigger asthma attacks (pollutants, change in weather)

Who is at risk for VCD?Typically seen in students middle school through high schoolMost common in girlsU ll thl t hi h hi i d b i htUsually athletes, high achieving and bright

Is this a voice disorder?

Not a disorder of vocal productionIs a disorder in our scope of practiceThough these students may not be

f d t it i i t t th t breferred to you, it is important that you be educated about the disorder

Mathers-Schmidt, Barbara. (2001). Paradoxical Vocal Fold Motion: A Tutorial on a Complex Disorder and the Speech-Language Pathologist’s Role. American Journal of Speech-Language Pathology, 10, 111-125.

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TSHA Voice GuidelinesHow does the handy dandy TSHA Voice Eligibility Guidelines help with the diagnosis and placement of students in Speech Pathology services?Pathology services?Well, stand up and cheer as we have a tool for you. You will wonder how you ever functioned without it…………

Procedures to guide the evaluation process in review

Professional judgment CAN be used

TSHA Voice Guidelines

Must use more than one “source” to qualifyMust evaluate all areas related to suspected disorder – If it is suspected that an area may be related to

the disability more in-depth evaluation must be done.

Walking through the

TSHA Voice Template

process

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Let’s Get Started…Fi stFirst:

Someone is concerned

PREPRE--REFERRAL DATAREFERRAL DATA

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Data Sources When Reviewing Concerns

Health InformationParent/Teacher InformationStudent InformationStudent Support Team DeliberationsResults of Classroom Interventions

Data Source: Health Information

Vision and Hearing Screening ResultsHealth information from ParentHealth information from school nurseHistory of ear infections

Data Source: Parent/Teacher Information

General information from district formsSpecific information from Parent/Teacher Ch kli t f V i CChecklist of Voice Concerns

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Collecting InformationCollecting Information

Voice Case History Form– Allergies?– Has student had chronic ear infections,Has student had chronic ear infections,

colds, asthma?– Has student been under care of

physician/hospitalized?

TSHA Voice Template


Voice Case History Form (continued)y ( )Diagnosed with reflux/heartburn/upset stomach?Hearing?

TSHA Voice Template


Voice Case History Form (continued)S dd d l f bl ?Sudden or gradual onset of problem?Variations in voice

Times of daySeasons or weatherDays of week

Family voice problem?

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Data Source: Student Support Team Deliberations

Refer to district process and forms documenting Student Support Team DeliberationsDeliberations

Data Source: Results of Classroom Interventions

Type of intervention providedDuration of interventionDocumented resultsStudent Support Team Decision– Continue interventions– Referral for speech-language evaluation

Classroom Considerations and Intervention Recommendations for Voice

Harsh, breathy, or hoarse voiceHyper- or Hypo-nasal voiceIntermittent voice or loss of voiceVolume – too loud or too softVolume too loud or too softPitch – too high or too lowVoice interferes with communicationVoice causes unfavorable listener reactionSigns of frustration

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Classroom Strategies

Suggestions for use by classroom teacher/parentsRemember-there must be evidence h h bl b h dl dthat the problem can not be handled

within classroomSource: Hagan, J.S., McDonnald, S.B., Meyer, J., (1990) Speech

and Language Classroom Intervention Manual. Columbia, MO: Hawthorne Educational Services, Inc

…and if all of that doesn’t kwork…

Student Information

1. Draws Attention to Self?

Parent Information

Teacher Information

Health Information

STUDENT SUPPORT TEAM DELIBERATION

2. Will Progress in Severity without therapy?

If “NO” to both questions, NO EVALUATION is Required at this time

If “YES” to one or both questions,

EVALUATION REQURIED

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Assessment Plan

Based on referral information, develop assessment plan– For voice

For any other areas of concern in– For any other areas of concern in communication (articulation, fluency, language)

– For other developmental and learning areas (with multi-disciplinary team)

Eligibility “The Final Frontier”

1. Does the student have a communication (voice disorder)? I.e. is a disability condition present?

2 If so is there an adverse effect2. If so, is there an adverse effect on educational performance resulting from the voice disorder ~ adverse effect on academic achievement or functional performance?

3. If so, does the voice disorder require the services of a Speech-Language Pathologist?

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Specific Legislative Informationthat Explains Federal Position on

Education Need

OSEP (Office of Special Education Programs)ASHA’s interpretation of IDEA relative to voiceASHA s interpretation of IDEA relative to voice disorders– ESL– UNTREATED Upper Respiratory Infection/Allergies– ENT examination

More ASHA Information12.7 Voice Assessment 12.8 Resonance and Nasal Airflow15.6 Voice TreatmentTechnical report: “Role of the Speech-Language Pathologist and Teacher of Singing in Remediation of Singers with Voice Disorders”

TSHA Voice Guidelines

EvaluationEvaluation

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Stage I

Is a voice disorder present?

TSHA Voice Template

Voice Eligibility FormsVoice Eligibility Forms

Four Forms To Assist YouFour Forms To Assist YouVoice Sample ProceduresVoice Evaluation Protocol Voice Eligibility DeterminationVoice Progress Report

Voice Sample Procedures

Use audiotape/videotapeName, birth date, day, month and yearff fEfficiency of air use

Evaluate ability to phonateEvaluate all parameters on Voice Eligibility Protocol Evaluate Physical Mechanism

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Voice Sample Procedures

•• Evaluate variability in pitchEvaluate variability in pitch•• Evaluate LoudnessEvaluate Loudness•• Evaluate PitchEvaluate Pitch•• Evaluate PitchEvaluate Pitch•• Evaluate Evaluate HypernasalityHypernasality and/or nasal emissionand/or nasal emission•• Evaluate Evaluate hyponasalityhyponasality•• Evaluate possible nasal air emissionEvaluate possible nasal air emission

TSHA Voice Template

Use of the Voice Evaluation Protocol

AkaAkaVisual Analog Scale

Visual Analog Scale

What is a Visual Analog Scale (VSA)?Use of scale from 1 – 100U o a o 00Rank disorder

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Visual Analog Scale

Why a Visual Analog Scale (VSA)?Add bj ti itAdds objectivityAllows for test/retestUsed in other disciplinesUniversal application

How does it work?

Using the VSA to score1 – 100 Continuum00 o uuAbsent / Present

Try it

4045

6065

7075

80853525

300155

1055

9095

1005020

0 – Absence of Beauty

100 – Presence of Beauty

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Try it

4045

6065

7075

80853525

300155

1055

9095

1005020

0 – 10 Normal11 – 29 Mild30 – 54 Moderate55 – 79 Severe80 – 100 Very Severe

Voice Evaluation Protocol

Take a Peek……..


Phonation/Vocal Quality1. Hoarseness2. Harshness/Tension/3. Hard/Harsh Glottal Attack4. Breathiness5. Aphonia6. Tremor

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Resonance1. Hypernasality2. Nasal Air Emission3. Articulation Errors


Pitch1. Habitual Speaking Pitch2 Pitch Range2. Pitch Range3. Pitch Breaks

Voice Evaluation ProtocolAssociated Factors1. Habitual Volume2. Breathing Pattern3. Efficiency of Air Use4 Th oat Clea ing/Co ghing4. Throat Clearing/Coughing5. Abusive Vocal Noises6. Hyponasality7. Cul-de-Sac Resonance

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Additional Information1. Oral Mechanism Structure2 Otolaryngology2. Otolaryngology


EVIDENCE Circle ALL That Apply

1 = Parent Report 2 = Student Report p3 = Teacher Report 4 = Physician Report 5 = Speech Language Pathologist

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Data Analysis

All Data indicate voice disorder presentAll Data indicate voice disorder not presentC fli ti d t d i i t dditi lConflicting data – administer additional informal measures

Determine EligibilityVoice Eligibility Determination

FormQualifies for Voice Therapy?

Presence of Disorder in 1 or morePresence of Disorder in 1 or more voice areaEvidence per at least two sourcesAdverse Effect on Educational Performance

Stage 2

Is there an adverse effect on educational performance resulting

from the voice disorder?

Academic AchievementFunctional Performance

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Determine Eligibility

ADVERSE EFFECT ON EDUCATIONAL PROCESS Circle ALL That Apply

1 = Oral Communication (Oral Participation and Oral Reading) 2 = Social Emotional Adjustment / Behavior 3 = Reaction of peers, teachers, parents

SLP Brings Evidence of Adverse Effect to ARD Committee

Effect of voice disorder on meeting grade level expectations/TEKSReview Referral Information & Teacher/ Parent Information for evidence of adverseParent Information for evidence of adverse effect on functional performanceStudent report of adverse effects on functional performanceSummarize SLP’s observational data

Stage 3

Are specially designed instructional and/or support services needed from the SLP to help the student pmake progress in the curriculum and ameliorate the voice condition?

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SLP Brings Recommendation of Need for Service to the ARDC

Current status of voiceDetermine amount of support needed if any from the SLPD t i h id iDetermine who can provide serviceRefer to Flow Chart – Role of SLP, if any –for students not SI eligible

Determine Eligibility

Voice Eligibility ConclusionDoes Not Qualify?

Voice Disorder is judged to be normalOnly Voice area in which student scored in disorder range is:

TremorTremorPitch Breaks due to pubertyHyponasalityCul-de-sac ResonanceAssociated FactorsOral Mechanism

Secondary to untreated upper respiratory and/or allergy symptoms

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Eligibility Guidelines - Assessing Progress

Phonation/Vocal Quality

VOICE PROGRESS REPORT

Phonation/Vocal QualityResonancePitchAssociated Factors

Eligibility Deliberation at Annual Review

Consider evidence for Stage 1, Stage 2 and Stage 3 at every ARD Committee meeting– Voice disorder?– Voice disorder?– Adverse effect on academic achievement or

functional performance?– Need for SLP services?

The Next Step

IEP DevelopmentTEKS Examples

RESOURCES

pHelpful WebsitesResources to help

withgoal writing

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When are you finished?

Dismissal Guidelines

Earning CEUshttp://www.txsha.org/continuing_education/Online_Course_Completion.aspx

2.0 hours TSHA continuing education credit available for this training moduleFollowing the session, complete the Online Course Completion Submission Form – Your name, license #, email address, phone #– TSHA membership #TSHA membership #– The name and number of this course

Shown on next slide of this presentation!!! – Course completion date– 3-questions Learning Assessment– CE evaluation of online course

You will receive a certificate of course completion via email

www.txsha.org

[email protected]

si eligibility guidelines for voice ppt presentation - region 13

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