School-Based SLP Services in the Time of COVID-19

Introduction

“That which does not kill us, makes us stronger.” Some version of this Nietzsche quote has been bouncing around in my head since the coronavirus pandemic began to change all of our lives so unexpectedly… closing schools and businesses, sending many workers home, and instantly creating a country full of telecommuters and distance learners. Schools and communities sprang into action, providing needed materials, arranging meal pickups, and transitioning to home-based and online learning options. Knowing that many families would have limited or no internet access, partnerships were established to increase broadband access, create free hotspots, and provide necessary hardware and software. The state supplied interpretation of revised regulations, offered guidance for navigating barriers, hosted professional development for educators, administrators, and related service providers, and shared resources related to special education, licensure laws, teleservices, and best practices.

Students with speech-language impairments and those who serve them were foremost in my mind as I witnessed the stress, challenges, and barriers my colleagues were encountering as they pivoted to telepractice with no warning or time to prepare. Schools are now re-opening even as this public health crisis continues to evolve, and there remain many questions and struggles ahead for school districts, students and families, community leaders, and the state agencies guiding them. All of the challenges to be navigated this school year cannot be anticipated, but we must continue to expect and prepare for the unexpected.

Regardless of the choices made by your districts for re-opening in the Fall, school-based SLPs must be prepared to provide services in new and creative ways this year, all while keeping themselves, their students, and colleagues safe and healthy. Based on guidance from the CDC, ASHA, ASCD, OCERS, ADE, SEACDC, speech-language and special education professionals, (and some fun ideas from SLP blogs), this series of articles will review multiple factors to consider in preparing and providing school-based SLP services in the time of COVID-19.

Part 1: REOPENING SCHOOLS

How to Prepare for Onsite Service Delivery

So much to do and so little time! It is important to consider multiple factors in order to establish therapy environments and procedures that facilitate continued learning and achievement at school while maintaining required health and safety practices.

When schools across the country were closed in March 2020, we all… educators, students, and parents alike… were forced to instantly adapt how, when, and where we worked, learned, and communicated with each other. Over the summer, America has learned how vital hand washing, wearing masks in public, and social distancing is to suppressing and surviving this pandemic. Now we are charged with the task of reopening schools in such a way as to be minimally intrusive to learning but maximally protective of everyone’s health and safety, a burden never before asked of SLPs or other school personnel.

(Please note: The National Institute for Occupational Safety and Health’s (NIOSH) hierarchy of controls recommends physically removing (elimination), replacing (substitution), and isolating people from (engineering controls) the hazard as more effective in stopping the spread of infection than changing how people work (administrative controls) and protection via personal protective equipment (PPE). Continued use of telepractice as the primary means of speech-language service delivery is recommended whenever possible.)

Local, state, and federal regulations vary, and there is no “one-size-fits-all” approach to preparing for onsite service delivery. However, there are several important factors to consider in order to create an onsite therapy environment that facilitates continued learning, maintains required health precautions, and feels genuinely safe and welcoming to students.

A. Masks and Barriers

Reducing the risk of exposure to COVID-19 by cleaning and

disinfecting is an important part of reopening public spaces that will require careful planning. Everyone has a role in making sure

our schools are as safe as possible.

An important protective barrier during this pandemic is the use of face masks, but they may create new obstacles for those who already struggle to communicate clearly.

Masks muffle speech, obstruct facial expression, and alter communication by reducing overall speech clarity and loudness.
Masks interfere with both auditory and visual sources of input and output, blocking even a simple, sometimes much needed, smile of reassurance.
Children especially are likely to experience increased communication stress, fatigue, and anxiety.
This is only compounded by hearing loss or other cognitive challenges, amidst the urgency of new and unfamiliar routines and practices at home, in classrooms, on campus, and in the community.

Although critical to infection control, an SLP must use independent clinical judgment (within required compliance) regarding whether to wear a mask or use some other possibly more facilitative protocol for onsite speech-language service delivery. (If you choose to modify any recommended best practices, make sure you document informed consent from the parent.) It’s important to note that there is no documented clinical evidence regarding if or how these modifications impact the effectiveness of overall infection control.

For low risk students who have not been exposed to or contracted the virus, modifications to mask use may include, but are not limited to:

wearing face shields (I like ShieldPals.)
wearing masks with clear panels (I like Safe’N’Clear’s Communicator Surgical Mask.)
using a plexiglass or other clear barrier (I like ShopPOPDisplay’s Modular Clear Table Divider Sneeze Guard.)
using a portable speaker (I like the Giecy Voice Amplifier.).

SLPs need to provide a model of appropriate communication habits

and supports for students of all ages who have communication disorders,

as well as their peers and teachers.

First begin by practicing, modeling, and coaching the use of Clear Speech. Oticon defines Clear Speech as "a technique of speaking in which the speaker attempts to express every word and sentence in a precise and accurate manner.” Clear Speech communications are...

Accurate and fully formed.
Expressed at a rate and volume that are naturally slower and louder.
Lively, with a full range of vocal intonation and stress on key words.
Characterized by pauses between all phrases and sentences.

Email me at info@shellysconsultationservices.com to request the Clear Speech brochure (no longer available from Oticon); it was originally designed to support those with hearing impairments, but contains brief instructions and a few practice exercises that can be used to create a short, simple, (fun, if you’re creative) Clear Speech in-service for teachers and staff, or even an activity for both general and special education students.

To help alleviate some of the difficulties presented by mask use, SLPs should also take the lead in coaching and reminding everyone to follow these simple, but easy-to-forget practices and recommendations.

Make sure you have a student’s attention before speaking.
Face students directly without an obstructed view or competing noise.
Enhance spoken messages by using your eyes, hands, and body language.
Supplement communication with visual references, notes, and images.
Check comprehension frequently by asking students to repeat important information.
Resolve misunderstandings by rephrasing or writing down messages as needed.
Ask students about their preferences for making communication easier.
Check hearing devices daily and augment listening by using a portable amplifier.
Share with administrators this information from the Educational Audiology Association about the use of Classroom Audio Distribution Systems (CADS) to improve auditory access for all students.

SLPs must be open to adopting and providing whatever accommodations are needed to maintain accessibility when working onsite with students and to navigate the new obstacles to communication created by mask use during this unprecedented time of crisis and change.