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Volume 17, Number 1April 2004

Journal of

SpecialEducation

LeadershipThe Journal of the Council of Administrators of Special Education

A Division of the Council for Exceptional Children

What Do We Know and What Do We Want to Know About RelatedServices Personnel?........................................................................................................3—Mary Jane K. Rapport, PT, Ph.D., and Pamela Williamson, M.A.

Personnel Issues in School-Based Therapy: A Look at Supply and Demand,Professional Preparation, Licensure, and Certification ................................................7—Mary Jane K. Rapport, PT, Ph.D., and Susan K. Effgen, PT, Ph.D.

Occupational Therapy in School-Based Settings ........................................................16—Yvonne Swinth, Ph.D., OTR/L, Barbara Chandler, MOT, OTR, Barbara Hanft, M.A., OTR, FAOTA, Leslie Jackson, M.Ed., OT, and Jayne Shepherd, M.S., OTR

Personnel Preparation and Credentialing in Speech-Language Pathology ................26—Kathleen A. Whitmire, Ph.D., CCC-SLP, and Diane L. Eger, Ph.D., CCC-SLP/A

Audiology Services in the Schools ..............................................................................33—Susan J. Brannen, M.A., CCC-A, Nancy P. Huffman, M.S. Ed., CCC-A/SLPJoan Marttila, M.A., CCC-A, and Evelyn J. Williams, M.S., CCC-A

Paraprofessionals in Schools: Topics For Administrators............................................46—Teri Wallace, Ph.D.

CASE IN POINT: Related Service Personnel Are Important EducationTeam Members..............................................................................................................62—Bill East, Ed.D

Articles

Editorial Board

The Editorial MissionThe primary goal of the Journal of Special Education Leadership is to provide both practicing administrators and researchersof special education administration and policy with relevant tools and sources of information based on recent advancesin administrative theory, research, and practice. The Journal of Special Education Leadership is a journal dedicated to issuesin special education administration, leadership, and policy. It is a refereed journal that directly supports CASE’s mainobjectives, which are to foster research, learning, teaching, and practice in the field of special education administrationand to encourage the extension of special education administration knowledge to other fields. Articles for the Journal ofSpecial Education Leadership should enhance knowledge about the process of managing special education service deliverysystems, as well as reflect on significant techniques, trends, and issues growing out of research on special education.Preference will be given to articles that have a broad appeal, wide applicability, and immediate usefulness to administra-tors, other practitioners, and researchers.

ISSN 1525-1810

Editor

Dr. Mary Lynn BoscardinUniversity of Massachusetts atAmherst

Assistant to the Editor

Ms. Meredith BeckerUniversity of Massachusetts atAmherst

Board of Associate Editors

Dr. Patricia AnthonyUniversity of Massachusetts-LowellLowell, MA

Dr. Judy MontgomeryChapman University • Orange, CA

Dr. Carl LashleyUniversity of North Carolina at Greensboro

Dr. Edward Lee VargasHacienda La Puente Unified School DistrictCity of Industry, CA

Review Board

Dr. Kenneth M. BirdWestside Community Schools Omaha, NE

Dr. Rachel Brown-ChidseyUniversity of Southern MaineGorham, ME

Dr. Leonard C. BurrelloIndiana University • Bloomington, IN

Dr. Colleen A. CapperUniversity of Wisconsin-Madison

Dr. Jean B. CrockettVirginia Tech • Blacksburg, VA

Dr. Pia DurkinBoston Public SchoolsDorchester, MA

Dr. Margaret E. GoertzUniversity of Pennsylvania Philadelphia, PA

Ms. Charlene A. GreenClark County School District Las Vegas, NV

Dr. Susan Brody HasaziUniversity of VermontBurlington, VT

Dr. Robert HendersonUniversity of IllinoisUrbana-Champaign, IL

Dr. William HickeyAvon Public Schools • Avon, CT

Dr. Dawn L. HunterChapman University • Orange, CA

Dr. Shirley R. McBrideCanadian Government • Victoria, BC

Dr. Eileen McCartheyHenry Viscardi School • Albertson, NY

Dr. Harold McGradyDivision of Learning DisabilitiesColumbus, OH

Dr. Jonathan McIntireOrange County Public SchoolsOrlando, FL

Dr. Margaret J. McLaughlinUniversity of MarylandCollege Park, MD

Dr. Tom ParrishAmerican Institutes For Research Palo Alto, CA

Dr. David P. RileyThe Urban Special EducationLeadership CollaborativeNewton, MA

Dr. Kenneth E. SchneiderOrange County Public SchoolsOrlando, FL

Dr. James ShrinerUniversity of IllinoisUrbana-Champaign, IL

Dr. Thomas M. SkrticUniversity of Kansas • Lawrence, KS

Dr. William SwanUniversity of Georgia • Athens, GA

Dr. Martha ThurlowNational Center on Educational Outcomes, University of Minnesota • Minneapolis, MN

Dr. Deborah A. VerstegenUniversity of VirginiaCharlottesville, VA

Dr. David WoodFlorida Southern CollegeLakeland, FL

Dr. Jim YatesUniversity of Texas at Austin

CASE Executive Committee 2003–2004

Brenda Heiman, President

Steve Milliken, President-Elect

Beverly McCoun, Past President

Emily Collins, Secretary

Cal Evans, Treasurer

Jeanne Collins, Representative of CASE Units

Nissan Bar-Lev, Representative to CEC

Cheryl Hofweber, Canadian Representative

Eileen McCarthey, Membership Chair

Gerald Hime, Policy & Legislation Chair

Mary Lynn Boscardin, Journal Editor

John Faust, Publications and Product Review Chair

Jim Chapple, Professional Development Chair

Bill Swan, Research Liaison

Luann Purcell, Executive Director

SubscriptionsThe Journal of Special Education Leadership is published by the Council of Administrators of Special Educationin conjunction with Sopris West. Copy requests should be made to CASE, 1005 State University Drive, FortValley, GA 31030. Single copies may be purchased. Orders in multiples of 10 per issue can be purchased at areduced rate. Members receive a copy of the Journal of Special Education Leadership as part of their membershipfee. See back cover for subscription form.

AdvertisingThe Journal of Special Education Leadership will offer advertising for employment opportunities, conferenceannouncements, and those wishing to market educational and administrative publications, products, materials, and services. Please contact the editor for advertising rates.

PermissionsThe Journal of Special Education Leadership allows copies to be reproduced for nonprofit purposes without permission or charge by the publisher. For information on permission to quote, reprint, or translate material,please write or call the editor.

Dr. Mary Lynn Boscardin, EditorJournal of Special Education Leadership175 Hills SouthSchool of EducationUniversity of MassachusettsAmherst, MA 01003

CopyrightThe Journal of Special Education Leadership, a journal for professionals in the field of special education adminis-tration, is published by the Council of Administrators of Special Education in conjunction with Sopris West tofoster the general advancement of research, learning, teaching, and practice in the field of special educationadministration. The Council of Administrators of Special Education retains literary property rights on copy-righted articles. Any signed article is the personal expression of the author; likewise, any advertisement is theresponsibility of the advertiser. Neither necessarily carries CASE endorsement unless specifically set forth byadopted resolution. Copies of the articles in this journal may be reproduced for nonprofit distribution with-out permission from the publisher.

Published in partnership with:Sopris West Educational Services4093 Specialty PlaceLongmont, CO 80504

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Journal of Special Education LeadershipVolume 17, Number 1

2Journal of Special Education Leadership 17(1) • April 2004

There has been much publicity about teacher shortages in special education but little about the shortages ofqualified special-education related services personnel. To begin to better understand the shortage issues, theCenter on Personnel Studies in Special Education (COPSSE) was created by the U.S. Department ofEducation, Office of Special Education Programs, under grant number H325Q000002, awarded to Dr. PaulSindelar, Center Director, at the University of Florida, Gainesville (see www.copsse.org). One of the projectssupported by COPSSE has been the study of personnel shortages in the much overlooked field of relatedservices personnel. Not only were the policies affecting shortages considered as part of this project, so werepolicies influencing paths to training, licensure, recruitment, and retention of these personnel. In an era thattouts the need for highly qualified teachers, it would only seem prudent to have highly qualified relatedservices personnel.

Dr. Mary Jane Rapport, guest editor of this issue of the Journal of Special Education Leadership, offers anintegrated continuum of thematic papers, commissioned through COPSSE, that focus on related services sup-ply-and-demand issues and the effect of the shortages in five service areas. Rapport and Pamela Williamsonintroduce the articles in this special issue with a challenge to change our thinking about the different facets ofthe administration of related services. Rapport and Susan Effgen report on the personnel concerns of physicaltherapists. Yvonne Swinth, Barbara Chandler, Barbara Hanft, Leslie Jackson, and Jayne Shepherd consider thepersonnel needs of occupational therapists. Kathleen Whitmire and Diane Eger discuss the effects speech andlanguage therapy personnel issues have on the provision of services. Susan Brannen, Nancy Huffman, JoanMarttila, and Evelyn Williams address the personnel challenges facing audiologists as schools increase solici-tation of these services. Teri Wallace looks at paraprofessional services, which are often thought of as“instructional” rather than “related.” Bill East stresses the importance of each of these areas but expressesconcern that, as credentialing requirements increase, shortages may be exacerbated. CASE appreciates thetime, effort, and excellent contribution made to this issue of JSEL by Dr. Rapport and the cadre of authors.The collection of articles in this issue of JSEL provides insight into the enormous amount of attention andwork that is needed in this area of special education by administrators so that students with disabilities andtheir teachers receive the support they need to produce improved educational outcomes. On behalf of theCASE Executive Committee, I hope you enjoy this issue of JSEL.

Mary Lynn Boscardin, Ph.D., [email protected]

A Letter from the Editor

What Do We Know and What Do We Want to Know About Related Services Personnel?

Mary Jane K. Rapport, PT, Ph.D. Pamela Williamson, M.A.University of Colorado Health Sciences Center University of Florida

District and building-level administrators are often responsible for the hiring and supervising of related ser-vices personnel. Thus, a deeper understanding of the personnel issues that exist in the related servicesdisciplines becomes important. What we know about the supply and demand, professional preparation, andcertification and licensure of school-based related services personnel:

• School-based employment of personnel in audiology, occupational therapy, physical therapy, and speech-language pathology is an outgrowth of public school attendance of students with disabilities as mandatedin the Individuals with Disabilities in Education Act (IDEA) and other federal, state, and local mandates.

• There is a shortage of related service providers and paraprofessionals employed to work in schools.

• Shortages vary by location and are more severe in some areas, and in some disciplines, than others.

• Related service providers and paraprofessionals generally begin working in school-based settings lackingthe necessary skills related to their school-based role.

• Multiple factors contribute to attrition.

• There is a greater need for collaboration across related services disciplines and paraprofessionals.

• There are multiple avenues to obtain the qualifications necessary for employment in schools.

• There are differences in certification and licensure requirements across the states.

• Changes in service delivery models have not been adequately addressed by changes in personnel preparation.


Personnel issues can be challenging for district andbuilding-level administrators alike. Thus, it is

important for administrators to fully understandhow the research community is responding to anincrease in the knowledge base of what is knownabout special education personnel issues. The Centeron Personnel Studies in Special Education (COPSSE)is one organization that is working to add to thisknowledge base. The Center is currently supportedby a cooperative agreement between the U.S.Department of Education, Office of SpecialEducation Programs (OSEP), and the University ofFlorida. The mission of the Center is to develop andinitiate a research agenda regarding the initial prepa-ration of special education personnel. Currentinitiatives include (a) a cost effectiveness studyexamining the relative costs of preparing specialeducators through various routes, (b) a beginning

teacher quality study that seeks to establish criteriafor evaluating the impact of initial preparation, (c)an indexing of alternative route certificationprograms in special education across the UnitedStates, and (d) an analysis of the School and StaffingSurvey data to determine whether or not alternativeroute certification programs have reduced shortagesand diversified the workforce by recruiting moreminorities and more males to the teachingprofession.

In addition to these initiatives, the Center com-missioned six issue briefs in the related servicesdisciplines including paraprofessionals, physicaltherapy, occupational therapy, speech-languagepathology, audiology, and school psychology. Eachauthor, or group of authors, was charged with exam-ining extant literature in each discipline, reportingwhat is known about supply and demand, profes-


sional preparation, and certification and licensure.Five of the six papers are presented in this issue inan abbreviated form. In contrast to these disciplinespecific papers, this brief overview attempts to sum-marize what we know across multiple relatedservices disciplines.

Each of the professional organizations support-ing a particular discipline has addressed the issuesas they relate to the particular discipline of thegroup. Key references are available within each ofthe discipline specific papers and are not repeatedfor the reader here in the summary.

TASH, an international advocacy association ofpeople with disabilities, their family members, otheradvocates, and people who work with people withdisabilities, recently passed and published a resolu-tion addressing many of the very same issues inpersonnel preparation as the various COPSSE issuebriefs and summary papers. We would be remiss ifwe did not mention this document here. The TASHResolution on Preparation of Related Services Personnelfor Work in Educational Settings can be found on theTASH website at www.tash.org and should be con-sulted as further evidence of the need to addressthese issues across disciplines.

Although there are a number of variables thatare consistent across disciplines, there are also essen-tial differences. Thus, while one can make a casesupporting a unified approach to address issues ofsupply and demand, personnel preparation, and cer-tification and licensure of all related services, theissues facing each discipline are not always identical.

What We Know About PersonnelIssues in the Related ServicesDisciplinesTen key points emerged across all papers. As men-tioned earlier, this is intended to be a brief overview.Readers are encouraged to read the papers in thisissue for more discipline-specific information.

First, school-based employment of personnel inaudiology, occupational therapy, physical therapy,and speech-language pathology is an outgrowth ofpublic school attendance of students with disabili-ties as mandated in the Individuals withDisabilities in Education Act (IDEA) and other fed-eral, state, and local mandates. These mandates

generated expanded roles for related service person-nel. In addition, as populations of students withdisabilities in our schools increased, the demand forrelated services increased.

There is a shortage of related service providersand paraprofessionals employed to work inschools. Vacancy rates are reported in all disciplines,and several of these reports make it clear that evenwhen full employment is reached, quality and exper-tise cannot be inferred. Caseloads can be very high;thus, it may not be accurate to assume that a schooldistrict is “fully staffed” even when all availablepositions are filled.

Shortages vary by location and are more severein some areas, and in some disciplines, than others.To some extent, shortages are influenced by proxim-ity to universities that offer preparation programsfor a specific group, or discipline, of related servicespersonnel. Since most universities are located inmore urban settings, it is not surprising that short-ages may be felt more keenly in rural areas.

Related service providers and paraprofessionalsgenerally begin working in school-based settingslacking the necessary skills related to their school-based role. Because professional preparationprograms offer content aimed at preparing individu-als to work in the most common practice settings,these programs are often focused upon workingwith adults in settings other than schools. This isespecially true for all of the related disciplines inhealth, where clinical settings are more common andadults are often the population of focus.

Related service personnel preparation programsdo not necessarily provide skills for employmentin schools. Other than school psychology, mostother preservice programs tend to focus on prepar-ing generalists who may work in any number ofother settings. Early professionals exit programswith little or no knowledge of curriculum andinstruction, collaboration and consultation withother team members, modifications for academicassessment, and development of individual educa-tion plans. In addition, because students areprepared to work with all age ranges, knowledge ofpediatric concerns may be limited.

Multiple factors contribute to attrition. Oneconsistent contributing factor to attrition across thedisciplines is salary. Salaries offered in school-based

What Do We Know and What Do We Want to Know?


settings tend to be lower than those offered in alter-native clinical settings. Additional factors thatcontribute to attrition include excessive paperwork,limited clerical assistance, limited access to technol-ogy, and lack of administrative support. Sinceconsultation has replaced direct services in manylocations, providers are challenged by extensivetravel to various sites, limited interaction with teammembers on a regular basis, little planning time, andextremely large caseloads. There are also fewadvancement opportunities for related services per-sonnel in schools.

Salaries offered in school-based settings tend to

be lower than those offered in alternative clinical

settings.

There is a greater need for collaboration acrossrelated services disciplines and paraprofessionals.Due to changing delivery models, collaborationamong other related service providers, teachers, andparaprofessionals has become more important.Collaboration and consultation components are oftenmissing in preservice preparation programs.

There are multiple avenues to obtain the quali-fications necessary for employment in schools.Each of the related service disciplines has its owncriteria, or level of academic achievement, requiredfor employment in a school-based setting. Theserequirements vary from one discipline to another,and there are also some variations from state tostate. In addition, each of the disciplines is currentlyexperiencing a transition period as the requirementsare shifting to higher education and degree levels.

There are differences in certification andlicensure requirements across the states. Each disci-pline or profession has its own guidelines andrequirements for certification and licensure. In addi-tion, there are some differences that exist across thestates regarding licensure requirements and the typeof credential required to work in schools in the state.

Changes in service delivery models have notbeen adequately addressed by changes inpersonnel preparation. Although there have beensignificant changes in service delivery models overthe past several decades, personnel preparation doesnot appear to have adequately addressed these

changes in preservice curriculum through adequatecontinuing education. There is generally a greateremphasis on interdisciplinary service delivery. Inaddition, at times, student teams may not be inagreement about how services should be delivered.Although professional opinions and differences willalways exist to some extent, they might be lessenedwith adequate preparation that includes an under-standing of the requirements of IDEA andeducationally related services.

Thus, with a clearer understanding of what isalready known regarding the supply and demand,professional preparation, and certification and licen-sure of school-based related services personnel, theCenter was interested in developing a researchagenda that might illuminate the unknown.Following a process first initiated by the Center todevelop a research agenda for the Beginning TeacherQuality Study, the Center pulled together expertsfrom across the nation to begin the process.

Developing a Research AgendaIn order to develop a meaningful research agenda inthe area of related services, COPSSE convened, inFebruary 2003, a Research Design Panel (RDP) com-posed of 30 interested parties, including researchers,related services personnel educators, and practition-ers. The purposes of the panel were to (a) identifycritical unanswered research questions related tosupply and demand, professional preparation, andcertification and licensure, (b) identify potentialfunding sources for such research, (c) develop a planfor initiating and sustaining a strategic effort toobtain funding for such research, and (d) discusshow COPSSE might support this plan. Unable tocomplete all of the tasks assigned, the panel wasreconvened in May 2003 to finish what it hadstarted. This meeting resulted in the formulation ofmany research questions.

These questions were then presented in surveyformat at a Policy Makers’ Summit in August 2003that was cohosted by the Center and the PolicyMakers Partnership at the National Association ofState Directors of Special Education. The related ser-vices panel consisted of interested parties, includingstate department officials, professional organizationrepresentatives, and practitioners. Summit partici-



pants ranked the importance of the research ques-tions to be more reflective of their constituencies’concerns, edited questions for clarity, and developedadditional questions they deemed important andthat were missing from the research agenda as for-mulated by RDP participants. Participants thenranked the importance of these newly created ques-tions. These data are being analyzed to determinethe most pertinent, pressing questions as defined bypolicy makers and the report will soon be availableon the COPSSE website (www.copsse.org).

Going ForwardThe Center has posted issue briefs to its website(www.copsse.org) and has developed policy briefson several key topics and personnel issues. Theresearch agenda will be used to help the Center seekanswers to questions that plague the efforts of all

school personnel and challenge school administra-tors daily.

These papers provide a foundation for the workof the Center and should enhance the understandingof related services personnel by schooladministrators.

About the AuthorsMary Jane K. Rapport, PT, Ph.D., is an associateprofessor in the Department of Pediatrics at theUniversity of Colorado Health Sciences Center,UCHSC – JFK Partners, 4200 E. Ninth Avenue, C221,Denver, CO 80262. E-mail: [email protected].

Pam Williamson, M.A., is a doctoral student in theDepartment of Special Education, University ofFlorida, P.O. Box 117050, Gainesville, FL 32611. E-mail: [email protected]


The role of physical therapists in schools is defined,to a large extent, by the Individuals with

Disabilities Education Act (IDEA, 1997) and the needto provide children with disabilities some educa-tional benefit in the least restrictive environment(McEwen, 2000). There is no requirement for allchildren to “receive the best education or onedesigned to help them reach maximum potential”(Hanft & Place, 1996); therefore, physical therapy isprovided only for children with disabilities whoneed therapy to benefit from special education.Although IDEA federal regulations do not providemuch detail, physical therapy services are intendedto address a child’s posture, muscle strength, mobil-ity, and organization of movement in the educationalenvironment. As a related service, physical therapymay be provided to prevent the onset or progressionof impairment, functional limitation, disability, orchanges in physical function or health (NICHCY,2001). Federal regulations help us to differentiatebetween those services that are necessary for a childto achieve some educational benefit and those ser-vices that are not a fundamental part of the child’sspecially designed instructional program (Rapport,1995). Physical therapy in school settings focuses onoutcomes and is based on meeting the educationalneeds of the child or student (Effgen, 2000a). Theschool-based pediatric physical therapist “must beknowledgeable about the civil and educational laws

as well as services and resources available for chil-dren from birth through 21 years and their families.They must not only be advocates for these children/youth and families, but also teachers to children/youth, families, educational staff, and citizens in thecommunity” (Fischer, 1994, p. 146).

Although IDEA federal regulations do not provide

much detail, physical therapy services are intended

to address a child’s posture, muscle strength,

mobility, and organization of movement in the

educational environment.

There are a number of therapy models that canbe used to deliver physical therapy in schools.Generally, these service delivery models fall into twobroad categories: direct services and indirect services(Effgen, 2000a; NICHCY, 2001). Direct services usu-ally involve face-to-face interactions between thetherapist and the child/student. Indirect servicesinvolve the therapist interacting with other adults(professionals, paraprofessionals, teachers, parents)so that they can appropriately carry out the interven-tions during naturally occurring opportunitiesduring daily routines even when the therapist is notpresent. This is referred to as consultation or moni-


Personnel Issues in School-Based Physical Therapy A Look at Supply and Demand, Professional Preparation, Licensure, and Certification

Mary Jane K. Rapport, PT, Ph.D. Susan K. Effgen, PT, Ph.D.University of Colorado Health Sciences Center College of Health Sciences University of Kentucky

• The supply of physical therapists is, on the whole, slightly less than adequate; however, real personnelshortages continue to exist in rural areas and in populated areas with less desirable schools or workplaceenvironments.

• An adequate supply of physical therapists does not mean adequate training, and there are ongoing issuesregarding what constitutes adequate professional preparation for the delivery of pediatric physical therapyin school-based settings.

• Licensure requirements are relatively consistent across states with some states requiring additionalcertification to work in school-based settings.

toring. The art of consultation continues to be a chal-lenge for most physical therapists despite the manybenefits that can be achieved through collaborationwith educational staff. Professional preparation ofphysical therapists does not generally include train-ing on consultation, and the focus on working inschools is limited (Hanft & Place, 1996). Both directand indirect services should include collaborationwith all team members (Effgen, 2000a; Rainforth &York-Barr, 1997).

In addition to IDEA, the provision of physicaltherapy in school may also be the responsibility ofthe school district under Section 504 of theRehabilitation Act of 1973. Children who qualify asindividuals with disabilities under this federal lawmay not necessarily have a disability that adverselyaffects educational performance, as required forIDEA eligibility, but may benefit from some accom-modations as a protection of their civil rights(Rapport, 1995). An example of a reasonable accom-modation under Section 504 can be found in theprovision of physical therapy through consultativeservices to a student, and to the middle school fac-ulty and staff, regarding mobility needs as thestudent prepares for the transition from elementaryto middle school. The physical therapist may pro-vide some instruction on negotiating stairs and otherobstacles in school for a child with the deficits asso-ciated with hemiplegia (paralysis on one side of thebody) or juvenile rheumatoid arthritis. A child witheither of these conditions might not require specialeducation, but they may require some accommoda-tions in the educational setting. Another example ofan accommodation is consulting with school admin-istrators and teachers regarding appropriateemergency evacuation plans for a child with animpairment in mobility who is educated in a regularclassroom.

Despite the expansion in delivery modelsbeyond direct one-to-one intervention, and the useof multiple team members, to achieve outcomes forstudents in educational environments (McEwen &Sheldon, 1995), there continue to be shortages ofphysical therapists in many school districts. Thus,while the consultative, collaborative, and monitoringmodels may be helpful in spreading the expertise ofa limited number of physical therapists, these mod-els of service delivery have the potential to

compromise the level of service delivery required toachieve some educational benefit. The developmentof alternative models of service delivery has beenhelpful but has not been the solution to the problemof too few therapists for the number of children whoneed physical therapy as a related service in schools.

Supply and DemandThe economic principle of supply and demand canbe applied when analyzing the growth of the physi-cal therapy profession. Generally, in a healthyeconomy, supply increases proportionally to demandthereby creating a balance to meet the needs of thepopulation without either excess or waste. For mostof its relatively young life, the physical therapy pro-fession has seen great demand, and the supply ofphysical therapists remained relatively low, com-pared with the ever-increasing demand, through the20th century. The number of physical therapistsgrew exponentially during the last quarter of thecentury, and the American Physical TherapyAssociation (APTA) estimates that there are cur-rently 120,000 physical therapists, 90,000 of whomare either employed, or are seeking employment, asphysical therapists. In 1997, the APTA commissioneda study of the supply and demand of physical thera-pists for three different years—1995, 2000, and 2005.Although the report indicates that there has been,and continues to be a shortage of qualified physicaltherapists, that shortage is diminishing. The studypredicted a 20–30% surplus of physical therapists by2005–2007 (Vector Research, 1997).

The economic principle of supply and demand

can be applied when analyzing the growth of the

physical therapy profession.

This workforce study by APTA preceded theBalanced Budget Act (BBA) of 1997 (BalancedBudget Act of 1997). This federal legislation had asignificant impact on the health care system, particu-larly for those persons dependent on receivingservices under the Medicare and Medicaid pro-grams, and the health care providers upon whomthey relied for their care. The legislation led to


Personnel Issues in School-Based Physical Therapy


changes in the level, systems, and provisions ofhealth care under these federal health care programs.

Rates of unemployment for physical therapists

peaked at 3.2% in the later months of 1999, and,

since then, the rate has subsided to around 1.1%

Among physical therapists, those who wereemployed in skilled nursing facilities or private out-patient offices were, perhaps, the most affected bythese legislated cut backs in health care. Many losttheir jobs or saw their incomes drop substantially asa result of these changes from the BBA. For the firsttime in the history of the profession, unemploymentgrew during the period following the BBA. Rates ofunemployment for physical therapists peaked at3.2% in the later months of 1999, and, since then, therate has subsided to around 1.1% (AmericanPhysical Therapy Association [APTA], 2001). Therewere significant differences across geographicregions in unemployment rates (Goldstein, 1999),but several years later, these differences had becomeless pronounced (Goldstein, 2001).

In addition, there have been other changesimpacting the overall demand for physical thera-pists. These include (a) the increase in physicaltherapy preparation programs during the 1980s andearly 1990s, (b) the introduction and increasedpreparation of physical therapist assistants duringthe 1970s and 1980s, and (c) the desire of employersto seek out physical therapists who were qualifiedand possessed special skills or interests when fillingjob vacancies. During the later part of the 1990s,increasing numbers of physical therapists were find-ing themselves unemployed and consideringpositions in second-choice settings, including long-term care settings and in jobs in rural areas andinner cities (APTA, 2001). The resultant job marketchanges could result in physical therapists workingin the schools despite not having the specific knowl-edge required of a successful provider of relatedservices in the educational setting.

Among physical therapists who identify them-selves with the specialty area of pediatrics, workingin schools appears to be the prominent employmentsetting (Sweeney, Heriza, & Markowitz, 1994). A sur-vey of APTA members and nonmembers (n = 36,498)

conducted in spring 2001 (APTA, 2001) revealed thatapproximately 5.5%, or about 2,000, of the therapistssurveyed, were practicing in schools. Data gatheredfor the 1998-99 school year, reported in the 23rdAnnual Report to Congress (U.S. Department ofEducation, 2002), revealed that there were 5,457 fullycertified physical therapists, and 53 physical thera-pists who were licensed to practice but were notcertified within the educational system of their state.Even so, these uncertified therapists were employedto provide related services for children and youthwith disabilities, ages 3–21. During the same period,there were 3,836 physical therapists employed toprovide early intervention services to infants andtoddlers with disabilities and their families underPart C of IDEA. The most recent Annual Report toCongress did not include vacancy rates for physicaltherapy positions. However, the report from theprevious year (1997–98) (U.S. Department ofEducation, 2001) identified a vacancy rate forunfilled physical therapy positions to be somewherearound 7% for children 6–21 compared with avacancy rate for teachers of 1%. Similarly, thevacancy rate for preschool teachers of children ages3–5 years was 2%. This data from the Annual Reportto Congress represents a collection of informationreported by the Comprehensive System of PersonnelDevelopment (CSPD) in each of the states.

In an effort to address the vacancy rate andshortage of personnel that exists in some areas of thecountry, particularly the more rural areas, the hiringof physical therapist assistants has gained momen-tum. IDEA requires related services to be providedby qualified personnel, and it is up to each state todetermine qualifications for personnel providingspecial education and related services in that state(see 34 CFR 300.136(a)(1)(ii)). State law also dictateswhether paraprofessionals and assistants can beused to assist in the provision of special educationand related services (NICHCY, 2001).

Paraprofessionals are limited in the scope of theirservices, but they are able to carry out interventionsdesigned and implemented by the physical therapistwhen they have been appropriately trained, moni-tored, and supervised by licensed physicaltherapists. Thus, the effectiveness of services pro-vided by a paraprofessional will be determined inlarge part by the skill of the physical therapist



responsible for delegating these tasks (Rainforth &Roberts, 1996). Even though paraprofessionals maybe working with children to accomplish goalsrelated to physical therapy, paraprofessionals maynot hold themselves out to be a physical therapist.Physical therapy practice acts—state laws regardingthe delivery of physical therapy—protect against thedelivery and billing of services that are made out tobe physical therapy but are not provided by alicensed physical therapist with specialized training(Rainforth, 1997).

Physical therapists are not flocking to seekemployment in schools in great numbers. The number of physical therapists with an interest inpediatrics is relatively small (see figures discussedearlier). This makes the pool of potential applicantsfor schools rather limited. Even the lure of a 9 to 10month employment year no longer exists in manylocations, where year-round schools, extendedschool year programs, and the delivery of services toinfants and toddlers have become part of the job ofthe school-based physical therapist.

Schools tend to offer physical therapists lowersalaries than they might receive in hospitals, clinics,and other medical, clinical, or health-care settings. In addition to salary, several other factors have beenlinked to job dissatisfaction among related serviceprofessionals in school settings. These factorsinclude inadequate work and/or office space, inade-quate equipment or materials, excessive caseloads,limited staff development, and isolation from col-leagues (Gonzalez, 1995). An overabundance ofpaperwork has been an ongoing complaint in specialeducation, and physical therapists are challenged bythis demand also. There is paperwork associatedwith Individualized Education Plans, documentingtherapy services, and billing Medicaid or other third-party insurance. The absence of a career laddercreates another frustration for many physical thera-pists working in schools by limiting their ability tomove to higher employment levels at school build-ing or district levels.

An overabundance of paperwork has been an on-

going complaint in special education, and physical

therapists are challenged by this demand also.

Professional PreparationProfessional, entry-level preparation programs forphysical therapists and physical therapist assistantsare accredited by the Commission on Accreditationin Physical Therapy Education (CAPTE). Since 1989,CAPTE has been responsible for the formulation,adoption, and timely revision of the evaluative crite-ria for accreditation of all professional physicaltherapist and physical therapist assistant programs.In the United States, graduation from an accreditedprogram is required as a part of physical therapylicensure.

There are several educational pathways throughwhich one can enter the profession. Over the years,physical therapy education programs have offeredentry-level degrees at various levels, ranging from abachelor’s to a doctorate. As of 2002, all entry-levelphysical therapist programs are at the master’s ordoctorate levels while the profession continues tomove toward acknowledging the DPT, or doctor ofphysical therapy, as the entry-level degree. The DPTwill eventually replace all other entry-level degreesand will recognize the clinical skills of the physicaltherapy professional just as podiatry, optometry, andaudiology have done in their respective professions.Programs offering a DPT will not necessarily includeany more pediatric content in their academic pro-gram than existed prior to making the transition tothis higher degree. As of October 2002, there were atotal 146 master’s degree programs (Master ofScience (MS) or Master of Physical Therapy (MPT))and 67 doctoral programs (Doctor of PhysicalTherapy, or DPT) accredited (APTA, 2002).Additional programs are in the process of seekingaccreditation. All entry-level baccalaureate programshad been phased out.

CAPTE has been responsible for insuring thatthere is a foundation of knowledge required by anyphysical therapy program regardless of the degreethat is offered. Physical therapy students are pre-pared for any number of job settings, populationranges, and skills to provide intervention in severalbody systems. Therefore, it is no surprise thatpediatric physical therapy is a relatively smallcomponent of the curriculum, and practice in educa-tional settings is even more specialized and lesslikely to be addressed with any major focus duringphysical therapy preparation (Rainforth & Roberts,



1996). This diverse preparation affords little oppor-tunity for the entry-level physical therapist to learnabout the practice of physical therapy in educationalsettings (Effgen, 2000a; McEwen, 2003).

As of 2002, all entry-level physical therapist pro-

grams are at the master’s or doctorate levels while

the profession continues to move toward acknowl-

edging the DPT, or doctor of physical therapy, as

the entry-level degree.

Despite recognizing the very limited exposure topediatrics physical therapists received in their edu-cational preparation programs, a 1993 study (Cherry& Knutson) reported that 93% of the entry-level pro-grams required some coursework in pediatrics. Theamount of time devoted to pediatrics and the con-tent focus varied, and most programs had only 2 to 4hours of laboratory experience in pediatrics. Only8% of the programs required pediatric clinical affilia-tions or field experiences for all students (Cherry &Knutson, 1993). In addition, there are limited pedi-atric affiliations available for clinical internships, andmany of these are in settings where children withdisabilities are isolated from typically developingpeers or there is a strong medical approach to diag-nosis and treatment (e.g., acute care pediatrichospitals) (Effgen, 1988). Although these experiencesmay be helpful, they are not likely to provide thetype of preparation necessary for physical therapistsworking in schools, who must offer themselves as“clinical experts” on the educational team (Stuberg& McEwen, 1993). Faculty in postprofessional pro-grams may have specialized skills to prepare PTs forschool-based practice, but they also need to knowwhat it is that is important to teach (McEwen, 2003).

A fact sheet compiled by the American PhysicalTherapy Association (2002) provides current and his-torical information about physical therapisteducation programs, students, and faculty. From thisfact sheet, one can glean a picture of the averagephysical therapist student and graduate during the2001–2002 academic year. There were 16,072 studentsenrolled in 213 accredited and developing (not yetaccredited) programs. The average physical therapistprogram was located at a public institution (51.6%)

in the Middle Atlantic region (NJ, NY, PA) (20.2%)and included a planned class size of 40 students.Over half of the physical therapist students werewomen (70.7%), and 15.8% of the students were con-sidered to be an ethnic/racial minority. In 2001,92.8% of the graduates passed their licensure exami-nation on the first attempt.

According to the fact sheet (APTA, 2002), therewere slightly more than 1985 full-time and part-timecore faculty preparing these future physical thera-pists, and 96 vacant faculty positions needed to befilled, almost a 100% increase from 1999. The aver-age number of full-time core faculty in each programwas 8.9, with a faculty/student ratio of 1:9.4. Thecore faculty was predominately female (61.9%),40–49 years of age (43.9%) and white (92.5%). Therewere 113 programs that did not have any minorityrepresentation among their faculty. The majority(46.6%) of all core full-time and part-time physicaltherapist faculty held a master’s degree, while 10.9%held a professional doctorate, and 40% a Ph.D. Therehas been a consistent increase in the number of doc-torally prepared faculty over the last decade. Only7.2% of the core faculty indicated pediatrics as theirprimary area of content expertise.

Licensure and CertificationPhysical therapy licensure is granted by state boardsand is mandated by state legislation. Each state hasits own rules and criteria regarding physical therapylicensure and practice. These are included in theState Practice Act. Therefore, physical therapistsmust obtain licensure directly from each state inwhich they intend to practice. Licensure cannot begranted until the physical therapist has met the crite-ria for licensure in that state. This generally includesgraduation from an accredited program, an accept-able score on the national licensure examination, andevidence of competence in making decisions. In1986, an organization was formed to provide a struc-ture through which state boards could work togetherto protect the health, welfare, and safety of theAmerican public by helping to assure the highestquality of physical therapy health care. TheFederation of State Boards of Physical Therapy(FSBPT) includes boards in all 50 states, the Districtof Columbia, Puerto Rico, and the U.S. Virgin



Islands, and it is responsible for the administrationof the National Physical Therapy LicensureExamination. Physical therapists can function rela-tively independently through what is called directaccess in 38 states (APTA, 2003). In the remainingstates, a physical therapist requires a referral from aphysician to treat an individual. Many states alsohave licensure requirements for physical therapistassistants as well as requirements for physical thera-pists educated outside of the United States. Finally, afew states require an additional certification fromtheir own state department of education for physicaltherapists to work in schools (e.g., Colorado,Washington, and New Jersey). The requirements forthis state certification vary widely.

In 1986, an organization was formed to provide a

structure through which state boards could work

together to protect the health, welfare, and safety

of the American public by helping to assure the

highest quality of physical therapy health care.

In addition to physical therapy licensure, thereare several other types of formal professional recog-nition. The specialist certification program wasestablished by the APTA in 1978, and the first exami-nation for pediatric specialists was offered in 1986from the American Board of Physical TherapySpecialties. As of 2003, there were 4,686 certifiedclinical specialists, and 566 (12.1%) of those werePediatric Clinical Specialists (PCS). For comparisonpurposes, it is interesting to note that 54.7% of thecertified specialists are in orthopedics, reflecting themajor area of physical therapy practice.

The specialist certification program was established

by the APTA in 1978, and the first examination for

pediatric specialists was offered in 1986 from the

American Board of Physical Therapy Specialties.

Clinical residency and fellowship programs arepost-professional programs that focus a defined areaof practice or a subspecialty area of clinical practice,education, or research. The APTA Committee on

Clinical Residency and Fellowship Credentialingoversees the requirements and application processfor programs seeking a credential from the APTA. Atpresent, there are no APTA approved residency orfellowship programs in pediatrics or school-basedpractice, although there is certainly a need for suchprograms. Continuing education is another commonmethod of ongoing professional developmentrequired in 30 states to maintain licensure(Federation of State Boards of Physical Therapy,2002). Continuing education does not, however,assure continuing competence.

IDEA requires that all related services, includingphysical therapy, be provided by qualified personnel(34 CFR 300.136(a)(1)(ii)). The specific requirementsare established by each state but must include the“highest entry-level academic degree needed for anystate-approved or recognized certification, licensing,registration, or other comparable requirements thatapply to a profession or discipline” in which a per-son is providing the service (34 CFR 300.136(a)(2)).Thus, states must require at least a baccalaureatedegree (and soon it will be a master’s or DPT) andstate licensure for any physical therapist providingphysical therapy as a related service under IDEA.

Summary, Conclusions,and RecommendationsPhysical therapists receive limited preparation intheir entry-level professional program for employ-ment in a school-based setting. Physical therapisteducation does not include a strong focus on thearea of pediatrics, and even less time in the overallprofessional preparation curriculum is devoted tothe provision of physical therapy as a related serviceunder IDEA. There are a few physical therapist pro-fessional preparation programs that include anelective focused on school-based intervention oradditional course content or clinical experience inpediatrics. Thus, it can be assumed that most entry-level physical therapists are not well prepared toassume employment in school-based physical ther-apy without either additional (continuing educationor graduate education) training or mentorship froman experienced colleague. However, many schooldistricts are content with hiring a licensed physicaltherapist regardless of whether or not that individ-



ual has any knowledge or experience associatedwith pediatrics or with working in an inclusive edu-cational or school-based setting.

Additional competencies and requirements maynot be the answer. If the requirement of pediatric orschool-related experience became an essential quali-fication for obtaining a job as a physical therapist inthe schools, it is likely that this would only placeadditional limitations on the already small pool ofqualified physical therapists available for employ-ment. Any increase in the availability of the pool ofpotential job applicants for school-based pediatricphysical therapists is likely to come from the largergroup of physical therapists with experience in areasother than school-based pediatrics. In order toincrease both the number of available pediatricphysical therapists and the quality of the profes-sional skills with which a physical therapist entersemployment as a related service provider, it will benecessary to make changes in personnel preparationand on-the-job training. These changes include: • More emphasis on pediatric content in the initial

physical therapist professional preparation program.

• Increasing the number of, and access to, accept-able clinical sites for physical therapist studentsinterested in a clinical experience in a school-based setting.

• More mentoring opportunities for those physicaltherapists who are considering, and those entering, employment in school-based settings.

• More appropriate continuing education andpost-graduate course work in pediatrics anddelivery of intervention services in educationalenvironments.

In order to increase both the number of available

pediatric physical therapists and the quality of the

professional skills with which a physical therapist

enters employment as a related service provider, it

will be necessary to make changes in personnel

preparation and on-the-job training.

The outcome of efforts to improve quality andquantity of appropriately prepared pediatric

physical therapists could lead to increased numbersof qualified physical therapists working in schools,improved job satisfaction for school-based physicaltherapists, and, most importantly, improved servicesfor children with disabilities.

The provision of services under IDEA can bechallenging, particularly when there is lack of quali-fied providers. Perhaps a well-prepared physicaltherapist will be better able to overcome the manyobstacles (e.g., large caseloads, insufficient time,amount of paperwork, etc.) that related serviceproviders encounter in schools on a daily basis.Experienced, mature physical therapists, who aremembers of the APTA Section on Pediatrics, reportfew difficulties in discharging children from physicaltherapy services in schools (Effgen, 2000b), althoughdischarge is sometimes a serious problem perhapsfor those with less professional experience andinvolvement. Physical therapists in schools need toknow how to delegate responsibilities to other teammembers for follow through when appropriate andto consult with the team on a regular basis. Theymust also tackle paperwork associated with specialeducation and IEPs and billing for reimbursement.Many of the skills—clinical, administrative, andtechnical—required of school-based physical thera-pists are not part of an entry-level professionalpreparation program.

Today’s economic climate has forced some schooldistricts to cut back on the number of therapists thatthey will contract or employ. In these periods whenbudget decisions are part of the everyday fabric ofpublic education, research is needed to better under-stand the implications of using less-qualifiedpersonnel (i.e., physical therapist assistants andparaprofessionals) to fulfill the requirements of pro-viding physical therapy as a related serviceaccording to the child’s IEP. Future research shouldfocus on (a) the use of alternate personnel, (b)improving professional preparation programs, (c)the quantity and quality of supervised clinical expe-riences, and (d) the mentoring of persons interestedin employment as school-based physical therapists.There are also questions to answer regarding thecontinuing move towards entry-level doctoraldegrees and the impact on post-professional educa-tion in specialty areas such as pediatrics. It isimportant to the future of therapists considering a



professional career choice in school-based physicaltherapy that some of these questions begin to beanswered.

ReferencesAmerican Physical Therapy Association (2000). Evaluative

criteria for accreditation of education programs forthe preparation of physical therapists. AccreditationHandbook, Revised August 2000.(http://www.apta.org).

American Physical Therapy Association (2001). APTAphysical therapist employment survey Spring 2001:Executive summary. Retrieved July 21, 2003, from theAmerican Physical Therapy Association website:http://www.apta.org/Research/survey_stat/pt_employ_nov01.

American Physical Therapy Association (2002, October).2002 Fact sheet. Physical therapist education programs.Retrieved July 21, 2003, from the American PhysicalTherapy Association website:https://www.apta.org/pdfs/accreditation/PTFactSheet2002.pdf.

American Physical Therapy Association (2003). Louisianabecomes 38th state to pass direct access legislation.Retrieved July 21, 2003, from the American PhysicalTherapy Association website:http://www.apta.org/news/news_releases/la_directaccesspass.

Balanced Budget Act of 1997 [BBA], P.L. 105-133. Cherry, D. B., & Knutson, L. M. (1993). Curriculum struc-

ture and content in pediatric physical therapy: Resultsof a survey of entry-level physical therapy programs.Pediatric Physical Therapy, 5(3), 109–116.

Effgen, S. K. (1988). Preparation of physical therapists andoccupational therapists to work in early childhoodspecial education settings. Topics in Early ChildhoodSpecial Education, 7(4), 10–19.

Effgen, S. K. (2000a). The educational environment. In S.K. Campbell, R. J. Palisano, & D. W. Vander Linden(Eds.), Physical Therapy for Children (2nd ed.), pp. 910–933. Philadelphia: Saunders.

Effgen, S. K. (2000b). Factors affecting the termination ofphysical therapy services for children in school set-tings. Pediatric Physical Therapy, 12(3), 121–126.

Federation of State Boards of Physical Therapy. (2002).2002 Jurisdiction licensure reference guide. p. 9.Retrieved July 21, 2003, from the Federation of StateBoards of Physical Therapy website:http://www.fsbpt.org/pdf/Continuing_Competency.pdf.

Fischer, J. L. (1994). Physical therapy in educational envi-ronments: Moving through time with reflections andvisions. Pediatric Physical Therapy, 6(3), 144–147.

Goldstein, M. (1999). The effect of the Balanced BudgetAct on the employment of physical therapists. PT—Magazine of Physical Therapy, 7(11), 22–24.

Goldstein, M. (2001). Positive employment trends in phys-ical therapy. PT—Magazine of Physical Therapy, 9(7),24–26.

Gonzalez, P. (1995). Factors that influence teacher attri-tion. NSTEP Information Brief #1-95. Washington, DCNational Association of State Directors of SpecialEducation.

Hanft, B. E., & Place, P.A. (1996). The consulting therapist: Aguide for OTs and PTs in schools. San Antonio, TX:Therapy Skill Builders.

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Individuals with Disabilities Education Act [IDEA]Amendments of 1999, Assistance to states for the edu-cation of children with disabilities, Part B, 34 CFR300.136(a)(1)(ii).

McEwen, I. (2003). Preparation of occupational therapistsand physical therapists to work in educational set-tings: The TASH resolution. Physical & OccupationalTherapy in Pediatrics, 23(3), 1–6.

McEwen, I. (ed.) (2000). Requirements and qualificationsof physical therapists in educational environments.Providing physical therapy services under Parts B & C ofthe Individuals with Disabilities Education Act (IDEA).Alexandria, VA: Section on Pediatrics, AmericanPhysical Therapy Association.

McEwen, I. R., & Sheldon, M. L. (1995). Pediatric therapyin the 1990s: The demise of the educational versusmedical dichotomy. Physical & Occupational Therapy inPediatrics, 15(2), 33–45.

NICHCY (2001). Related services. News Digest, ND16, 2ndEdition, September, 2001. National InformationCenter for Children and Youth with Disabilities,P.O. Box 1492, Washington, DC 20013.

Rainforth, B. (1997). Analysis of physical therapy practiceacts: Implications for role release in educational envi-ronments. Pediatric Physical Therapy, 9, 54–61.

Rainforth, B., & Roberts, P. (1996). Physical therapy. In R.A. McWilliam (Ed.) Rethinking Pull-Out Services inEarly Intervention. Baltimore, MD: Paul H. Brookes.

Rainforth, B., & York-Barr, J. (1997) Collaborative teams forstudents with severe disabilities: Integrating therapy andeducational services (2nd ed.) Baltimore, MD: Paul H.Brookes.



Rapport, M. J. K. (1995). Laws that shape therapy servicesin educational environments. Physical & OccupationalTherapy in Pediatrics, 15(2), 5–32.

Stuberg, W., & McEwen, I. (1993). Faculty and clinicaleducation models of entry-level preparation in pedi-atric physical therapy. Pediatric Physical Therapy, 5(3),123–127.

Sweeney, J. K., Heriza, C. B., & Markowitz, R. (1994). Thechanging profile of pediatric physical therapy: A 10-year analysis of clinical practice. Pediatric PhysicalTherapy, 6(3), 113–118.

U.S. Department of Education. (2001). Twenty-secondannual report to Congress on the implementation of theIndividuals with Disabilities Education Act. Washington,DC: Author.

U.S. Department of Education. (2002). Twenty-third annualreport to Congress on the implementation of theIndividuals with Disabilities Education Act. Washington,DC: Author.

Vector Research (1997). Workforce study. Alexandria, VA:American Physical Therapy Association.(http://www.apta.org)

About the AuthorsMary Jane K. Rapport, PT, Ph.D., is an associateprofessor in the Department of Pediatrics at theUniversity of Colorado Health Sciences Center,UCHSC – JFK Partners, 4200 E. Ninth Avenue, C221,Denver, CO 80262. E-mail: [email protected].

Susan K. Effgen, PT, Ph.D., is the Joseph HamburgProfessor in Rehabilitation Sciences, College ofHealth Sciences, University of Kentucky, 900 S.Limestone, Lexington, KY 40536-0200. E-mail: [email protected].



The Individuals with Disabilities Education Act(IDEA, 1997) requires schools and early interven-

tion programs to utilize appropriately qualifiedpersonnel to provide services in schools. These ser-vices are designed to help meet the educational anddevelopmental needs of eligible children with dis-abilities. IDEA, via its Comprehensive System ofPersonnel Development and State ImprovementGrant provisions, also has required states to ensurethat they have an adequate supply of qualifiedproviders who can offer special education, relatedservices, and early intervention services.

For the past ten years or so, concerns have beenvoiced about the preservice preparation of occupa-tional therapy (OT) practitioners to work in schoolsand early childhood programs. States and local dis-tricts have long complained of shortages ofoccupational therapists (OTs) in these settings. Inaddition, the Twenty-Second Annual Report to Congresson the Implementation of the IDEA (U.S. Department ofEducation [USDOE], 2000) highlighted the need foradditional full-time therapy positions.

OTs address the occupational performanceneeds, or the ability to participate in life activities, ofindividuals of all ages. For a majority of OT practi-tioners, the focus of work has been on individualswith disabilities. Offering preventative services,however, and working with non-disabled individu-als who are experiencing occupational performance(participation) problems are growing areas of prac-

tice. Occupations are the “ordinary and familiarthings that people do every day” (AmericanOccupational Therapy Association [AOTA], 1995, p.1015) that bring purpose and meaning to their livesin home, school, work, community, and leisure set-tings. Thus, OT practitioners focus on restoring andpromoting performance and participation in dailylife occupations relevant to an individual’s (a) devel-opmental and chronological age; (b) role as student,family member, and worker; and (c) social participa-tion within the physical, social, and cultural context.The focus of OT in a particular setting is guided bythe setting, reimbursement mandates, and client(student) needs.

Unique Role of OT in the SchoolsOT practitioners work with children and youth whohave physical, behavioral/psychosocial, andcognitive delays, or diagnosed disabilities from birthto age 21, as well as with their family members.They may also provide consultation to other profes-sionals (e.g., medical staff, educational staff, supportstaff) who work with these children, families, andsystems (e.g., school districts, departments ofeducation). Therapy and consultative services areprovided in a variety of settings, including schools,early intervention programs, hospitals andrehabilitation centers, private clinics, homes,

Occupational Therapy in School-Based Settings

Yvonne Swinth, Ph.D., OTR/L, Barbara Chandler, MOT, OTR, Barbara Hanft, M.A., OTR, FAOTA,University of Birmingham, UK James Madison University Hanft Consulting

Leslie Jackson, M.Ed., OT, Jayne Shepherd, M.S., OTRAmerican Occupational Therapy Association Virginia Commonwealth University

• Findings suggest that there may be a shortage of occupational therapists within the next five years.

• Some content specific to school settings is usually included in the preservice preparation of occupationaltherapists.

• Most school-based occupational therapy practitioners have a state certification or license, but it may not bespecific to educational settings.


community/institutional mental health programs,and juvenile correction facilities.

The majority of OT practitioners who work withchildren provide these services in public school andearly intervention programs under Parts B and C ofthe IDEA. IDEA Part B identifies OT as a relatedservice for eligible children ages 3–21 years whorequire assistance to benefit from special education.Under Part C, OT is a primary service for eligibleinfants and toddlers from birth until age 3, and theirfamilies. In early intervention, OT services enhanceyoung children’s development and functionalperformance (ability to participate) in daily settingsand support family members and other key adultsin their parenting and childcare responsibilities.Although this paper focuses on OT servicesunder IDEA Part B, many of the core issuesregarding preparation, supply/demand, andcertification/licensure of OT practitioners are similarfor Part C programs. (See Case-Smith (1998), Hanft& Anzalone (2001), Hanft, Burke, & Swenson-Miller(1996), Humphry & Link (1990), and Schultz-Krohn& Cara (2000) for discussions on the role andpreparation of OTs in early intervention programs.)

Public school is identified by almost 25% ofAOTA members as their primary work setting(AOTA, 2001a). This percentage underscores theneed for school-based practice to be an integral part

of OT professional preparation (Swinth, 2002). In aneducational setting, OT practitioners focus on help-ing students engage in meaningful and purposefuldaily school occupations—the activities that make astudent successful and engaged in school life.School-related outcomes of the primary occupationalareas (i.e., activities of daily living, education, work,play/leisure, and social participation) are describedin Table 1.

OT practitioners assess three interrelated ele-ments that affect participation in goal-directedactivities or occupations in school: (a) individualfunctions, (b) performance skills/patterns, and (c)contextual/activity demands. Each student hasunique physical structures (i.e., sensory, neurologi-cal, emotional, and mental functions) and challengesthat affect successful school-related performance ineducation, self-care, play, and social participation(AOTA, 2002; Hanft, 1999a ,1999b). Both the context(Orr & Schade, 1997) and specific activity demandsaffect how well a student performs a given task orrole. For example, a four-year-old girl with congeni-tal deformities in her forearms, limiting motions ofher hands, is taught to use adapted scissors andheavy construction paper to complete her art pro-jects and classroom lessons. An eight-year-old boywith an attention deficit disorder, who has difficultycompleting assignments and following directions


Occupational Area

Activities of Daily Living (Basic and Instrumental)

Education

Work

Play/Leisure

Social Participation

Educational Outcome

Cares for basic self-needs in school (e.g., eating, toilet, managingshoes and coats); uses transportation system and communica-tion devices to interact with others; develops healthmanagement routines and, when appropriate, home manage-ment skills for independent living (e.g., cleaning, shopping,meal preparation, budgeting, safety and emergency responses).

Achieves in a learning environment including academic (e.g.,math, reading), nonacademic (e.g., lunch, recess), prevocationaland vocational activities (e.g., career and technical education).

Develops interests, habits, and skills necessary for engaging inwork or volunteer activities for transition to community lifeupon graduation from school.

Identifies and engages in age-appropriate toys, games, andleisure experiences; participates in art, music, sports, and after-school activities.

Develops appropriate social relationships (and behavioralstrategies) at school with peers, teachers, and other educationalpersonnel within classroom, extracurricular activities, andpreparation for work activities.

Table 1: School-related occupations addressed during OT assessment and intervention


due to perceptual and sensory motor problems, canbenefit from reorganization of his work space andadditional time to complete assignments. A 15-year-old adolescent with mental retardation and extremesensitivity to sounds and touch, which limits herspeech and social interactions, may benefit fromslow and rhythmic exercise periods just before playand meals to learn sign language to communicatewith peers and family.

Incorporating the dimensions of educational rele-vance into assessment and intervention is a criticalyet complex aspect of school-based practice. OTpractitioners analyze what a student does to partici-pate successfully in a school setting by assessing thecombined influence of individual characteristics,performance skills, performance patterns (i.e., rou-tines, habits, and roles), the educational context, andspecific activity demands. OT intervention isdirected toward helping a student achieve the edu-cational goals and objectives agreed upon by theentire team, including family members (Giangreco,1995). Therapists must assess the student’s functionsin the school environment and describe how theirintervention will improve performance/participa-tion in academic and nonacademic parts of theeducational program (Hanft & Place, 1996).

OT practitioners analyze what a student does to

participate successfully in a school setting by

assessing the combined influence of individual

characteristics, performance skills, performance

patterns (i.e., routines, habits, and roles), the

educational context, and specific activity demands.

Intervention by an OT may include workingwith children individually, coleading small groups inthe classroom, consulting with a teacher about aspecific student, providing inservice for groups ofeducational personnel and/or family members, andserving on a curriculum or other systems-levelcommittee. Service delivery needs to be consideredwithin the total school environment (or home andcommunity environments for Part C and transition).Rather than choosing one model of service delivery,recommended practice emphasizes choosing from acontinuum of service delivery models throughout

the course of intervention, considering student per-formance/participation improvement (Case-Smith &Cable, 1996; Hanft & Place, 1996; AOTA, 1995).

Supply and DemandShortages of school OT practitioners have beenreported to Congress for many decades. In the 2000-2001 accounting, 12,915 OTs were employed inpublic schools, with 12,727 being fully certified. Anadditional 6,395 OTs were employed to serve infantsand toddlers with disabilities. Many contextual fac-tors affect the supply of and demand for OTs. As inspecial education in general, it is difficult to predictthe exact shortages and demands due to the ever-changing environment and the multiple ways dataare collected on state and national surveys (Boyer,2000; Federal Resource Center for Special Education,1999, 2000, 2001). Three critical factors may affectfuture supply and demand of OTs: (a) trends in thehealth care environment, (b) trends in the educa-tional environment, and (c) trends in institutions ofhigher education (IHE).

After the passage of the Balanced BudgetAmendment of 1997, demand for OTs in medical set-tings dropped. This increased the pool of OTsavailable for schools. School OTs increased dramati-cally from 9,561 in 1998-1999 to 12,915 in2000-2001(United States Department of Education[USDOE], 2000). The percentage of fully certifiedOTs increased from 97% in 1998-1999 to 98.5% in2000-2001(USDOE, 2000). These employment trendsare not likely to prove enduring, however, aschanges are on the horizon. With baby boomersaging, employment opportunities for OTs in medicaland nursing facilities are likely to grow.Furthermore, because OT training programs havehad declining enrollments since 1997, fewer newpractitioners will be entering the OT job market. In2007, when master’s degrees will be required forentry to the profession, bachelor’s-level programswill be phased out, and the supply of new practi-tioners will be diminished further.

Salaries. According to the AOTA (2001a), theoverall median full-time annual salary for OTs inschool settings was $42,000 (a median hourly salaryof $23.08). U.S. Bureau of Labor Statistics (USBLS)(2001b) estimated the median annual salary for ther-



apists in elementary and secondary schools to be$45,320. According to AOTA (2001a), occupationaltherapy assistants (OTAs) who work in schools makea median annual salary of $28,000 (a median hourlysalary of $14.90). USBLS (2001c) estimated themedian annual salary for OTAs in general, notschool-based specifically, at $34,340. Because of ques-tions about the economy and reimbursementprocedures, future salary levels are unknown(Salsberg & Martiniano, 2002).

Recruitment and retention. A variety of strategieshave been used to recruit OT practitioners to workin the public schools and to retain them. States likeWashington and Virginia have developed and imple-mented specific programs through their departmentsof education. Table 2 provides examples of educa-tional strategies, incentives, and follow-up supportsthat have been mentioned in the literature. Althoughrecruitment activities (e.g., educational stipends inreturn for years of service, continuing educationsupport for school-based therapists, development of


Educational Strategies Incentives Everyday Supports

Table 2: Possible recruitment and retention strategies for OT practitioners

Note: IHE = institute of higher education; DOE = Department of Education; OT = occupational therapy. Compiled from Hanft & Anzalone, 2001; Peters &Shepherd, 1999; Salsberg, 2001; U. S. Dept. of Health & Human Services, 1999, 2000, 2001.

Partnerships with IHE and state DOE toallocate funds for educating therapists:

Tuition support.

Stipends for living.

Textbook financial support.

Collaborative service learning in the community.

Mentorship prior to leaving the IHE.

Distance education/online courses withflexible scheduling (e.g., a portionof a course, a course, or a sequence ofspecialized courses).

Exposure to field through fieldworkexperiences.

Interdisciplinary training.

Specialized training in school- basedpractice.

Provide professional development thatspecifically links OT and educationalenvironments.

Provide professional development withall stakeholders (e.g., educators and therapists together).

Transition to school practice training for

therapists in other practice settings.

Market the profession at job fairs, careerdevelopment, volunteer experiences.

Increased starting salaries:

Sign-on bonuses.

Payback scholarships or loan-forgivenessprograms.

Community-based discounts (e.g., helpwith banking setup, moving expenses,recreation membership, etc.).

Stipends for critical needs.

Monies for additional training.

Free workshops and materials.

Salary incentives for additional training or coursework.

Specialized training (e.g., assistive technology, state conference, or differenttreatment approaches).

Coresearch or program development with IHEs.

Encourage personal growth.

Professional mentorship, local or long distance, within and outside the OT profession:

Family mentorship programs.

Follow-up support (e.g., telephone calls,e-mail contacts, buddy systems, consultation, or field visits).

Reduce paperwork and help OT personnel be part of the team:

Interdisciplinary learning and service.

Peer reviews.

Journal clubs.

Yearly retreats or state conferences onschool-based practice.

Lending library.

Local special interest club.

Local support group.

Online “chats” to share questions andinformation.


recruitment materials for high school students, andsupport for recruitment at job fairs around the coun-try) are mentioned in the literature, no research thatevaluated the success or effectiveness of these activi-ties could be identified.

Preparation and Education ofOccupational TherapistsFor most of the 20th century, the baccalaureatedegree was the entry-level degree. In the late 1960sand early 1970s, entry-level master’s degree pro-grams were developed to offer professionalpreparation for individuals with bachelor’s degreesin other fields. Such programs offered either aMaster of Occupational Therapy or a Master ofScience degree. By the mid-1980s, professional mas-ter programs were open to students withoutbachelor degrees who had completed 2 to 3 years ofundergraduate education. The ratio of master’sentry-level programs to bachelor’s entry-level pro-grams equalized by the mid-1990s. By January 2007,AOTA will require the master’s degree as the entry-level degree for all OTs.

All preservice educational programs for OTs orOTAs must meet Standards for Accreditation estab-lished by the American Council on OccupationalTherapy Education (ACOTE, 1999). Only graduatesof programs accredited by ACOTE may take theNational Board for Certification in OccupationalTherapy (NBCOT) professional examination, thebasis for entry into the profession in all states. Thestandards define what all entry-level practitionersmust know to be able to work in any service setting.Rather than teach specific expertise in any given set-ting (e.g., schools), the purpose of OT entry-leveleducation is to provide students with a foundationfor working in any setting. It has been reported thatit is not uncommon for OTs working in the schoolsto get an advanced degree in OT or a field related toschool-based therapy to support the development ofexpertise, but no empirical data could be found tosupport this report. One standard specifically men-tions the educational environment, and most OTeducational programs include content related toschool practice in course(s) related to pediatrics. OTprograms can add additional course content notincluded in the standards. Some programs have

received federal grants to add content related to edu-cational practice settings. Thus, a few programs havespecific courses related to school and early interven-tion (Amundson, 1995; Brandenburg-Shasby &Trickey, 2001; Chandler, 1994, 2002; Powell, 1994).

One study addressing preparation of OTs forschool-based practice was found in the literature(Brandenburg-Shasby & Trickey, 2001). This studyincluded therapists with 1959–1999 graduations.Less than 50% of 1990–1999 graduates had com-pleted any fieldwork in a school setting as part oftheir preparation. They reported an average of 81hours of pediatric content, and 19% reported thattheir curriculum had a separate school-based course.The authors concluded that their results “suggestthat a large percentage of entry-level therapists areaccepting positions in school-based practice withminimal to no time spent addressing this practicearea in their preservice education” (p. 1).

Only graduates of programs accredited by ACOTE

may take the National Board for Certification in

Occupational Therapy (NBCOT) professional exami-

nation, the basis for entry into the profession in all

states.

Even though the standards, which have littlecontent specific to school-based practice, do providea knowledge base that is a foundation for practice ineducational settings. The standards require coursework in anatomy, neurology, and lifespan humandevelopment with particular emphasis on occupa-tional development at each stage of life. Content ondisease, disability (including developmental disabil-ity), injury, aging, and environmental causes ofdysfunction is included. The OT process, which par-allels determining eligibility and identifying need forspecially designed instruction in the schools, is amajor component of the preservice curriculum.Course work on the major approaches to interven-tion, such as assistive technology, addresses all agelevels and a variety of occupational dysfunctions.Systems of service provision (e.g., working as ateam, transitioning between settings, communitylinkages, and advocacy) and funding of services areincluded. Finally, the standards emphasize clinical



reasoning and problem solving in most OT curricula.Based on the standards, entry-level OTs should havea strong foundational knowledge that supports prac-tice in school-based settings. The standards alsobring a needed perspective to student perfor-mance/participation in the schools.

Additional credentials for practice in educationor early intervention settings. Some states have alsoestablished additional requirements for OT practi-tioners to work in schools or early interventionprograms. These varying requirements may includeeducation-related classes, an education credential, orearly intervention certification requirements.

Individual practitioners must obtain the relevantstate OT credential before they fulfill any additionalrequirements to provide services in schools or earlyintervention programs.

Competencies. Several states, some authors, andone research study have defined competencies forOTs working in educational settings (Brandenburg-Shasby & Trickey, 2001; Golubock & Chandler, 1998).There is little variation among these sources, indicat-ing a common view of school-based competenciesfor OTs. However, no research establishes the rela-tionship of these competencies to actual practice, orthat a school-based therapist with these competen-


Table 3: Competencies for OTs in school-based practice

School-based Competencies for Occupational Therapists

1. Knowledge of current laws, regulations, and procedures related to the education of children with special needs.

2. Knowledge of the educational system and its critical components (mission, organization, codes, funding, eligibility process).

3. Knowledge of disabling conditions and their effects on sensory, motor, psychosocial, and cognitive development and function.

4. Knowledge of major theories, treatment procedures, and research relevant to providing occupational therapy services for children with special needs.

5. Ability to select and administer appropriate assessment instruments and procedures taking into account age, developmentallevel, disabling condition, and educational placement.

6. Ability to assess functional performance of students with special needs within the school environment.

7. Ability to engage in consensual decision making as part of the IEP process.

8. Ability to interpret assessment results appropriately and use results to develop an intervention plan relevant to the educational environment.

9. Ability to plan, implement, and modify intervention strategies using a continuum of intervention approaches.

10. Ability to communicate effectively (orally and in writing) with education personnel, administrators, parents, students, and community members.

11. Ability to explain the role of occupational therapy within the school settings to education personnel, parents, students, and community members.

12. Ability to document assessment and intervention results in the proper manner for a school setting and relate this information to the educational goals of the student.

13. Ability to schedule, to implement, to evaluate, and to modify service provision to meet the therapeutic as well as educational needs of a full student load in the school environment.

14. Ability to facilitate transitions among agencies, programs, and professionals in service provision changes (early intervention to preschool, preschool to elementary, elementary to middle and high, high school to work and/or adult services or independent living.

15. Ability to supervise occupational therapy assistants and fieldwork students as appropriate.

Note: These are the overarching competencies; the complete document includes 128 additional competencies that further delineate the fifteen overarchingcompetencies (Golubock & Chandler, 1998).


cies is a competent school therapist. Competenciesfor school-based OTs are presented in Table 3.

AOTA and NBCOT also have developed compe-tency programs for OT practitioners, which can beused by the individual practitioner to evaluate his orher own performance. However, there has been noresearch to establish effectiveness of these tools forcompetency development and performance.

Standards of practice. AOTA has establishedstandards of practice through its RepresentativeAssembly of representatives from each state. Thesestandards of practice delineate ethical and practicalprocedures and processes for responding to referrals,evaluation, and determination of need for therapy,treatment intervention, and discharge from services.Designed to be applicable for all practice settings,the practice standards provide a framework for pro-viding OT services. In addition, the code of ethics,which must be taught in all OT educational pro-grams, provides guidance for decision makingthrough the commitment to core values of benefi-cence, veracity, and justice. The language in moststate regulatory laws also provides parameters forlegal and ethical practice. Most state regulatory lawsvest the decision making about initiation, type, anddiscontinuation of OT services with the OT profes-sional. The OT’s decision may be different from thedecision of the Individualized Educational Program(IEP) team in the school setting, placing the OT in anethical dilemma of being required to provide ser-vices to a child who in his or her judgment does notneed the services. Providing unneeded services is aviolation of most state regulatory laws, and this isnot an infrequent occurrence for OT practitioners. Ithas been reported that conflicts like this cause thera-pists to leave the school-based setting; however,empirical data to support this could not be found inthe literature.

The code of ethics, which must be taught in all OT

educational programs, provides guidance for deci-

sion making through the commitment to core

values of beneficence, veracity, and justice.

Certification and LicensureGraduates from an accredited OT educationalprogram are eligible to take the NBCOT registryexamination. OTs who pass this exam may use thecredentials to identify themselves as registeredoccupational therapists. Certification by NBCOT, aprivate organization, and state regulation of practice,both exist to protect the consumer of OT services.Generally, state regulation requires that practitionersbe initially certified by NBCOT to qualify for alicense. Only state regulation of practice carries theforce of law. In addition, NBCOT can impose othersanctions for unprofessional acts, which may eventu-ally lead to the loss of a state permission to practice.OT practice is regulated in all 50 states, the Districtof Columbia, Guam, and Puerto Rico. Each state orjurisdiction details the specific requirements that OTsand OTAs must fulfill before they can practice OT.States vary in the type of regulation provided (e.g.,licensure, mandatory state certification or registra-tion, voluntary state certification or registration, titlecontrol or trademark) and who is covered by the reg-ulation—OTs only; OTs and OTAs; or OTs, OTAs,and OT aides.

States’ OT practice acts are consistent withAOTA’s Standards of Practice (AOTA, 1998) anddefine the legal scope of practice for OT practitionerswithin that state. These laws set professional para-meters and address topics (e.g., scope of practice,continuing competence, supervision, unprofessionalconduct, and licensure requirements). States differ inscope of practice and other details; thus, OT practi-tioners must be familiar with their staterequirements. Responsibility for oversight andenforcement of the OT practice rests with the appro-priate state regulatory agency in each state. Theseagencies may have responsibility for other profes-sions in addition to OT. Most states require OTpractitioners to renew state credentials periodically.Each state defines the criteria an OT practitionermust meet for renewal. One common requirement isthe need to document continuing education or pro-fessional development in the relevant area ofpractice.



SummaryOT personnel issues are complex, particularly forpractitioners working in educational settings. Thereare data addressing the role and work force issues ofOTs, OTAs, and OT in general. However, dataspecific to OT in the schools are limited, and thereis more opinion than research in the literature.Available research pertaining to OT in schoolsaddresses intervention strategies and issues ratherthan personnel issues. Several key considerationsrelevant to leaders within special education seem tohave emerged from this review. First, national datapredict a shortage of OTs within the next 5 years.Data regarding supply and demand in educationalsettings are confusing; some sources indicate a short-age and other sources do not. OT practitionersreceive an education that prepares them to work inany practice setting, but they may not receive all theinformation needed to be successful in educationalsettings as part of their preservice education.

OT personnel issues are complex, particularly for

practitioners working in educational settings.

Competencies and continuing education strate-gies for school-based therapists are identified in theliterature, but many lack a research basis. Finally,most therapy practitioners have a certification orlicense to work in their state. However, these are notspecific to educational settings. A few states havespecialty certification to work in the schools, but wefound no evidence that these certifications made anydifference in job performance.

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U.S. Department of Health and Human Services [USDO-HHS]. (1999). Building the future of allied health: Reportof the implementation task force of the national commissionon allied health. Rockville, MD: U. S. Department ofHealth and Human Services, Public Health Service,Health Resources and Services Administration,Bureau of Health Professions, Division of AssociatedDental and Public Health Professions. RetrievedOctober 6, 2001, from ftp://ftp.hrsa.gov/bhpr/publications/ncahtfsum.pdf.

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About the AuthorsYvonne Swinth, Ph.D., OTR/L, is an associate pro-fessor in the School of Occupational Therapy andPhysical Therapy, University of Puget Sound, 1500N. Warner #1070, Tacoma, WA 98416. E-mail: [email protected].

Barbara Chandler, MOT, OTR, is an associate profes-sor in the Health Science Department at JamesMadison University, HH3109, Harrisonburg, VA22801. E-mail: [email protected].

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Jayne Shepherd, M.S., OTR, is an associate professorin the Department of Occupational Therapy, VirginiaCommonwealth University, Box 980008 MCVStation, Richmond, VA 23298-0088. E-mail: [email protected].



Over the past several decades, speech-languageservices in the schools have undergone profound

fundamental changes in scope and focus.Legislative/regulatory, societal, professional, med-ical, and demographic influences have converged to shape and define practice as we know it today(Whitmire, 2002). The challenges and demandsunique to employment in school settings call for special attention to the issues surrounding thepreparation, supervision, certification, recruitment,and retention of qualified personnel to meet theneeds of students with communication disorders.

Personnel PreparationThe complexities of the caseloads as well as the rolesand responsibilities of school-based speech-languagepathologists (SLPs) have expanded significantly inthe past decade (American Speech-Language-Hearing Association [ASHA], 1999; 2000a; 2001c;2001e; 2002). The setting requires sound knowledgeof assessment and treatment procedures for a broadrange of disorders, from articulation and fluency to

autism, cognitively based communication disorders,and dysphagia, as well as issues associated with cul-tural/linguistic diversity (ASHA, 2000a). In addition,SLPs are now involved in the prevention of literacyproblems as well as the identification, assessment,and remediation of spoken and written languageproblems in preschool, elementary, and secondarystudents (ASHA, 2001c). Furthermore, they mustengage in a wide range of indirect activities to sup-port students’ educational programs and to ensurecompliance with federal, state, and local mandates.Many of these expanded roles were required, orstrongly encouraged, by the 1997 reauthorization ofthe Individuals with Disabilities Education Act, andare consistent with current policy and practice in thefield of communication sciences and disorders.Preparing SLPs to meet the demands of school set-tings is complicated by: (a) graduate program issuesrelated to content and design; and (b) on-the-jobtraining and supervision limitations. These factors,which have devastating long-term implications forquality speech-language services in the schools, arediscussed below.

Personnel Preparation and Credentialing in Speech-Language Pathology

Kathleen A. Whitmire, Ph.D., CCC-SLP Diane L. Eger, Ph.D., CCC-SLP/AAmerican Speech-Language-Hearing Association American Speech-Language-Hearing Association

• The majority of graduate programs in communication sciences and disorders train generalists who may not be prepared for the unique demands of employment in the schools (e.g., curriculum-based assess-ments, classroom-based interventions, collaborative consultation) because the complexities of caseloads and the roles and responsibilities of school-based speech-language pathologists have expanded signifi-cantly in the past decade.

• School districts that do not have an ASHA-certified speech-language pathologist on staff cannot offer therequired supervision to graduates who need to complete a supervised clinical fellowship year.

• Emergency certificates, waivers, and some state teacher requirements result in the hiring of inadequatelytrained personnel who are not equipped to handle the complex caseloads and expanded job responsibili-ties of school-based speech-language pathologists.

• The recruitment and retention of qualified speech-language pathologists is thwarted by rising demands,challenging workplace conditions (e.g., caseloads, paperwork, salaries), lack of reciprocity in certifications,and competing workplace options.

• The critical shortage of culturally and linguistically diverse speech-language pathologists, graduate stu-dents, and faculty has implications for curricula, clinical training, and research, as well as skills andknowledge of practitioners.


Graduate training. The majority of graduateprograms in speech-language pathology are trainingSLPs who are generalists in the field of communica-tion disorders rather than specialists who work inschool settings. This approach provides a solid foun-dation in communication disorders that clinicianscan take into any employment setting. However, itmay lead to gaps in professional preparation for theunique challenges and demands particular to schoolsettings (Eger, Moreau, & Tempalski, 2001).

The majority of graduate programs in speech-

language pathology are training SLPs who are

generalists in the field of communication disorders

rather than specialists who work in school settings.

A specific area of concern is service deliveryoptions, with significant discrepancies apparentamong recommended practice, reported practice,and graduate training. Despite 20 years of policyand practice guidelines encouraging an integratedand comprehensive approach to service delivery thatcombines direct and indirect delivery models tomeet the individual needs of students (Frasinelli,Superior, & Myers, 1983; Nieptupski, Scheutz, &Ockwood, 1980; Eger, 1992; ASHA, 1993; Blosser &Kratcoski, 1997), data from the schools indicate askewed use of service delivery options. Data fromthe 1995 ASHA Survey of Speech-LanguagePathology Services in School-Based Settings (Peters-Johnson, 1998) strongly demonstrate that, with theexception of the birth-to-two-year age group, the tra-ditional pullout model is used most frequently. Infact, in the 6–11 year age group and in the 12–17 yearage group, it was used 78% and 65% of the time.This pattern was repeated five years later in theASHA 2000 Schools Survey (ASHA, 2001a) wherethe traditional pullout model continued to bereported as the most commonly used model of service delivery in the school setting. Furthermore,respondents to this same survey (ASHA, 2001a) indicated that in 87% of the cases, the clinician isresponsible for determining the type of service delivery model. This is significant in terms of thepersonnel preparation of SLPs. In a survey of schoolclinicians rating graduate student clinicians (Eger et.

al., 2001), the data suggest that graduate students areprimarily trained to utilize the pullout model of ser-vice delivery. While 86% of these student clinicianswere rated adequately to well prepared to apply aca-demic information to the school setting in the area ofindividual or small group (pullout) therapy, onlyabout 35% of these same student clinicians couldadequately apply academic information to the schoolsetting in the area of classroom (push-in) therapy orconsultation with the education team. None wasrated as well prepared in these two service deliverymodels.

Personnel preparation for SLPs must alsoinclude: (a) knowledge of curriculum and instruc-tion, (b) skills in professional collaboration inplanning and providing services, (c) training instrategies and techniques for working in educationalsettings, and (d) supervised experiences in generaleducation settings (since traditional university-basedclinics do not provide adequate experience with cur-rent service delivery models and collaboration in thedevelopment and implementation of assessment andintervention plans). Unfortunately, this is often notthe case in communication sciences and disordersprograms.

Supervision for on-the-job training. Althoughon-the-job training is not unique to school-basedsettings (Rosenfeld and Kocher, 1999), three factorsrelated to the schools have long-term impacts on thequality of school speech and language services. Thefirst issue is that most graduate education programsdo not include specific content on school-relatedroles and tasks. This includes: (a) curriculum-basedassessment, (b) development and implementation ofeducationally relevant intervention plans, and (c)implementation of specially designed instruction toremediate or circumvent severe language problemsin the classroom. These skills must be learned on thejob.

The second issue is that the difficulties associatedwith on-the-job training in school-specific skills areexacerbated by the fact that many school systemshave professionals from other fields supervisingSLPs. Only 23% of respondents to ASHA’s 2000Schools Survey reported being supervised by aspeech-language pathology supervisor; the remain-der were supervised by a special educationcoordinator or school principal (ASHA, 2001b).



When there is no speech-language supervisor toassist with proper mentoring of a new staff member,the content information specific to the school isnever learned.

The third issue that has long-term impact on thequality of school speech-language services is thatmany school systems, especially smaller districts, do not have a supervisor or peer with ASHA’sCertificate of Clinical Competence in Speech-Language Pathology (CCC-SLP). This means thatsuch school systems cannot and should not hireentry-level graduates who need to complete a clini-cal fellowship year under the direct supervision ofan ASHA-certified SLP in order to obtain ASHA cer-tification. This limits the pool of qualifiedcandidates.

Only 23% of respondents to ASHA’s 2000 Schools

Survey reported being supervised by a speech-

language pathology supervisor; the remainder

were supervised by a special education coordinator

or school principal.

Certification and LicensureThe credentials held by speech-language cliniciansworking in the schools vary according to staterequirements. Possible credentials include ASHA’sCertificate of Clinical Competence, a state license,and a state teacher certificate. This variability hascreated concerns regarding the qualifications ofschool personnel.

ASHA’s Certificate of Clinical Competence.ASHA’s Certificate of Clinical Competence inSpeech-Language Pathology (CCC-SLP) sets thestandard for entry-level requirements for the practiceof that profession. Requirements for ASHA’s CCC-SLP include the following: (a) a graduate degree; (b)21 graduate semester hours and a total of 350practicum hours, with at least 250 practicum hoursobtained in a graduate program accredited by theASHA Council for Academic Accreditation (CAA);(c) a passing grade on the Praxis examination inspeech-language pathology; and (d) successful com-

pletion of a clinical fellowship under the supervisionof an ASHA-certified SLP.

State licensure and teaching certification. Somestates have what is known as universal licensure.This is a state license that is required to practice inall settings, including schools, and is typically issuedand administered by the state’s department of pro-fessional regulation. In other states, schoolpractitioners are exempt from the state licensing lawbut must meet a separate set of requirements estab-lished by the state’s department of education inorder to obtain teacher certification. A few statesrequire state licensure and teacher certification orstate licensure plus education-specific courseworkand examinations (ASHA, 2001e).

Requirements for state licenses are, for the mostpart, similar or equivalent to those for ASHA’s CCC-SLP. In fact, some states will automatically grantlicensure if the applicant holds the CCC-SLP. Teachercertification, on the other hand, varies across statesin terms of requirements for the master’s degree (i.e.,may be a degree in a field related to communicationdisorders), clinical practicum (i.e., must includeexperience in a school setting), coursework (e.g.,courses in pedagogy and child development), andexaminations (e.g., a passing grade on a state teach-ers exam).

In 36 states, an individual entering the publicschool system must have at least a master’s degreeto work as a SLP (ASHA, 2001e). Of those 36 states,seven require the practitioner to be state licensed orto meet requirements over and above a master’sdegree. Even in states that require incoming person-nel to have at least a master’s degree, there are stillindividuals who entered the school system with onlya bachelor’s degree. Many states have set dates bywhich these personnel must receive a master’sdegree. Approximately 14 states allow bachelor’s-level personnel to start work in public schools asSLPs. However, several of these states require thatthe individual be enrolled in a master’s degree pro-gram and complete that program within a certaintime frame. A few of these states will only allowsuch individuals to work under emergency certifica-tion or when a qualified master’s-level individualcannot be located.

The requirements for ASHA’s CCC-SLP weredetermined to be those needed to establish the




minimum skills required for entry into the field ofspeech-language pathology. Individuals who holdstate teaching certificates with requirements less rig-orous than ASHA’s CCC-SLP are at risk of lackingthe basic skills and knowledge needed to carry outthe responsibilities of a SLP. Individuals at the bach-elor’s degree level and/or with emergencycertification are clearly not prepared for thedemands of the broad range of job responsibilities or the diverse school speech-language caseload.

The credentials held by speech-language clinicians

working in the schools vary according to state

requirements. Possible credentials include ASHA’s

Certificate of Clinical Competence, a state license,

and a state teacher certificate.

Qualified Providers: Supply and DemandTeacher quality and its relationship to studentachievement are top priorities in our nation’seducation agenda. This same goal applies to thehiring of SLPs, who play a key role in helpingchildren succeed in school. SLPs’ knowledge of thelanguage-learning-literacy connection equips themto analyze the linguistic demands of the schoolcurriculum and to contribute to students’ masteryof that curriculum. However, the recruitment andretention of qualified SLPs in the schools is thwartedby rising demands, challenging workplaceconditions, and competing workplace options.

Studies on availability and need. Studiesconducted at both the state and national levels havedocumented existing difficulties in hiring qualifiedSLPs (American Association for Employment inEducation [AAEE], 2000; ASHA, 2001b; LegislativeOffice of Education Oversight, 1999; U.S Bureau ofLabor Statistics, 2001) with projections of increasedneeds. Fifty-one percent of respondents to ASHA’s2000 Schools Survey indicated a shortage of quali-fied SLPs in their school district (ASHA, 2001a) withgreater shortages in rural and urban areas comparedto suburban settings. Reported effects of thesevacancies include: (a) increased caseloads, (b) less

opportunity for networking and collaborating, (c)decreased opportunities for individual services, (d)decreased quality of services, (e) increased numberof staff without ASHA certification/master’s leveltraining, (f) reduced duration or frequency of ser-vices, and (g) denial of services to children who needthem (ASHA, 2001b; Legislative Office of EducationOversight, 1999).

The Study of Personnel Needs in Special Education(SPeNSE, 2002), conducted by the U.S. Departmentof Education’s Office of Special Education Programs,reported 11,148 job openings for SLPs in school set-tings for the 1999–2000 academic year. The greatestbarrier to recruiting SLPs was the shortage of quali-fied applicants, with 59% of respondents reportingthis factor as having the greatest impact on shortages.

The American Association for Employment inEducation (2000) lists SLPs as ranking third in thenation in 1998 for number of vacancies compared to other areas in the teaching field. Of the 11 geo-graphic regions surveyed, seven fell in theconsiderable shortage category; no region placed in thebalanced or surplus areas in terms of supply of SLPs.

Teacher quality and its relationship to student

achievement are top priorities in our nation’s

education agenda.

According to the U.S. Bureau of Labor Statistics(BLS) (2001), the employment of SLPs is expected to grow much faster than the average for all occupa-tions through the year 2010. In their estimates,speech-language pathology ranks 25th out of the 700occupations and 11th out of the 68 health-relatedoccupations in terms of growth. According to theBLS, more than 34,000 additional SLPs will beneeded to fill the demand between 2000 and 2011—a 39% increase in job openings. A total of 57,000 jobopenings for SLPs are projected between 2000 and2010 due to growth and net replacements.

Although the U.S. is the most demographicallydiverse nation in the world (Deal-Williams, 2002),that diversity is not reflected among practitioners,graduate student populations, or program faculty.According to the 2000 US Census, 77.5% of the U.S.population is white; in contrast, membership counts


indicate that 95% of ASHA members are white. Data from the Council of Academic Programs inCommunication Sciences and Disorders shows that93% of faculty in communication sciences and disor-ders are white, while 89% of master’s-level studentsare white. Furthermore, anecdotal reports suggestthat many minority students do not remain in thoseprograms through graduation (Deal-Williams, 2002).These data suggest a continuation of the current crit-ical shortage for bilingual SLPs. Ninety-eight percentof ASHA members report that they are monolingualEnglish speakers. Although 10.5% of the U.S. popu-lation speaks Spanish in the home, only .6% ofASHA members report that they speak Spanish(Deal-Williams, 2002). The lack of diversity in ourgraduate programs’ students and faculty also raisesquestions regarding the preparation of all studentsto work with diverse populations. Such a disparitysuggests weaknesses in (a) exposure to diverse pop-ulations, (b) curricula and clinical training regardingdiversity, and (c) research on culturally and linguisti-cally diverse populations.

According to the U.S. Bureau of Labor Statistics, the

employment of SLPs is expected to grow much

faster than the average for all occupations through

the year 2010.

Challenges to working in school settings.Workforce studies documenting vacancies haveincluded information on reported challenges facingschool-based speech-language pathologists as a pos-sible explanation for the difficulty in recruiting andretaining qualified applicants (ASHA, 2000b; ASHA,2001b; Legislative Office of Education Oversight,1999). These challenges include the following: (a)excessive paperwork, (b) lack of time for planning,collaboration, and meeting with teachers and par-ents, (c) high caseloads, (d) extensive travelingbetween buildings or sites, (e) little or no clericalassistance, (f) lack of parental involvement and sup-port, (g) low salaries, (h) inadequate work space andfacilities, (i) limited access to technology, (j) lack oftraining for special populations, and (k) lack ofadministrative support.

One of the greatest barriers to maintainingqualified and experienced clinicians in the schools is the lack of portability across school systems andwork settings. Schools seldom give new employeescredit for their experience. In contrast, SLPs inmedical settings or private practice are typically paid for previous experience. In addition to salaryportability issues, pension portability issues forschool-based SLPs are similar to the ones noted bySindelar et al. (2003) for teachers. When frustratedby these barriers to providing quality services tochildren, SLPs have the option to seek employmentin other settings, such as hospitals, long-term healthcare, private practice, and higher education.

Recruitment and retention of qualified personnel.Recent studies have focused on a variety of strate-gies that school districts have implemented to recruitand retain qualified personnel (e.g., Bergeson,Douglas, & Griffin, 2000; Darling-Hammond, 2001;Urban Teacher Collaborative Report, 2000). In addi-tion to strategies that attract classroom teachers,there are specific strategies that school districts canuse to recruit and retain qualified SLPs. Theseinclude: (a) salaries commensurate with the level oftraining required for the profession, (b) higher salaryschedules, (c) salary supplements similar to those forNational Board Certification, (d) clerical assistanceand computers, (e) reasonable and manageable case-loads to allow services to be delivered based on theindividual needs of the child and to allow time forthe full range of responsibilities required of the SLP,(f) better facilities for intervention and office work,(g) streamlined paperwork, particularly for docu-menting therapy treatment for Medicaidreimbursements, (h) travel time between assignedschools, (i) time to meet with teachers to consult andplan collaborative services, (j) recruitment at collegesand universities with communication disordersdepartments, (k) recruitment through national ads(e.g., ASHA’s online career web site), (l) reimburse-ment for professional dues, and (m) release time andfunding for profession-specific staff development.

SummaryThe demands placed upon SLPs working in today’sschools are affected by a number of legislative, societal, professional, medical, and demographic



influences. Preparing, recruiting, supporting, andretaining personnel qualified to meet these demandsrequires consideration of such diverse factors asprofessional preparation program focus, supervision,certification and licensure, and working conditions.Assuring that children with communicationdisorders receive the highest quality services fromadequately prepared personnel can be fostered bypartnerships among university programs, publicschools, and funding agencies, and commitments oftime and effort, as well as financial resources andsupport. Only then will training programs produceschool-based SLPs who are equipped to respond tothe needs of diverse caseloads and who choose toseek and maintain employment in the school setting.

Preparing, recruiting, supporting, and retaining per-

sonnel qualified to meet these demands requires

consideration of such diverse factors as profes-

sional preparation program focus, supervision,

certification and licensure, and working conditions.

ReferencesAmerican Association for Employment in Education

[AAEE]. (2000). Educator supply and demand in theUnited States: 1999 Research report. Washington, DC:Author.

American Speech-Language-Hearing Association [ASHA].(1993). Caseload size and speech-language servicedelivery in the school. American Speech-Language-Hearing Association [ASHA], 35 (Suppl. 10), 33–39.

American Speech-Language-Hearing Association [ASHA].(1999). Guidelines for the roles and responsibilities of theschool-based speech-language pathologist. Rockville, MD:Author.

American Speech-Language-Hearing Association [ASHA].(2000a). Omnibus survey: Caseload report. Rockville,MD: Author.

American Speech-Language-Hearing Association [ASHA].(2000b). Omnibus survey: Salary report. Rockville, MD:Author.

American Speech-Language-Hearing Association [ASHA].(2001a). 2000 schools survey special report: Service deliv-ery. Rockville, MD: Author.

American Speech-Language-Hearing Association [ASHA].(2001b). 2000 schools survey special report: Working con-ditions. Rockville, MD: Author.

American Speech-Language-Hearing Association [ASHA].(2001c). Roles and responsibilities of speech-languagepathologists with respect to reading and writing in childrenand adolescents. Rockville, MD: Author.

American Speech-Language-Hearing Association [ASHA].(2001d). Scope of practice in speech-language pathology.Rockville, MD: Author.

American Speech-Language-Hearing Association [ASHA].(2001e). State teacher requirements for audiology andspeech-language pathology. Rockville, MD: Author.

American Speech-Language-Hearing Association [ASHA].(2002). A workload analysis approach for establishingspeech-language caseload standards in the schools.Rockville, MD: Author.

Bergeson, T., Douglas, L., & Griffin, A. (2000). Educatorsupply and demand. In Washington, 2000 ExecutiveSummary. Washington State Department of Education.

Blosser, J. L., & Kratcoski, A. (1997, April). PACs: A frame-work for determining appropriate service deliveryoptions. Language, Speech and Hearing Services inSchools, 28, 99–107.

Darling-Hammond, L. (2001). The challenge of staffingour schools. Educational Leadership, 58(8), 12–17.

Deal-Williams, V. (2002). Addressing and enhancing diversityin academic programs: Cultural, racial and linguistic diver-sity. Presentation at the Council of AcademicPrograms in Communication Sciences and DisordersAnnual Meeting, Palm Springs, CA.

Eger, D. L., (1992). Why now? Changing school speech-language service delivery, ASHA, 34, 40–41.

Eger, D. L., Moreau, V. K., & Tempalski, K. (2001). Schoolspeech-language services have changed: Why haven’t theuniversities? Presentation at the 2001 ASHAConvention, New Orleans, LA.

Frasinelli, L., Superior, K., & Myers, J. (1983). A consulta-tion model for speech and language intervention,ASHA, 25, 25–30.

Legislative Office of Education Oversight. (1999).Availability of therapists to work in Ohio schools.Columbus, OH: Author.

Nieptupski, J., Scheutz, G., & Ockwood, L. (1980). Thedelivery of communication therapy services toseverely handicapped students: A plan for change.Journal of Association of Severely Handicapped, 45(1),13–23.

Peters-Johnson, C. (1998, April). Survey of speech-language pathology services in school-based settings-national study final report. Language, Speech andHearing Services in Schools, 29, 120–126.




Rosenfeld, M., & Kocher, G. G., (1999, July). The practice ofspeech-language pathology—A study of clinical activitiesand knowledge areas for the certified speech-languagepathologist. Princeton, NJ: Education Testing Service,Education Policy Research.

Sindelar, P. T., Bishop, A. G., Gregoire, M., Connelly, V., &Rosenberg, M. S. (2003). Getting teachers where they’reneeded most: The case for licensure reciprocity.Gainesville, FL: University of Florida, Center onPersonnel Studies in Special Education. Available:www.copsse.org.

SPaNSE. (2002). Study of personnel needs in special education.Washington DC: U.S. Department of Education.

Urban Teacher Collaborative Report. (2000). The urbanteacher challenge: Teacher demand and supply in the greatcity schools. Belmont, MA: Recruiting New Teachers,Inc.

U.S. Bureau of Labor Statistics. (2001, November).November 2001 Monthly Labor Review. Washington DC:Author.

Whitmire, K. (2002). The evolution of school-basedspeech-language services: A half century of changeand a new century of practice. CommunicationDisorders Quarterly, 23(2), 68–76.

About the AuthorsKathleen A. Whitmire, Ph.D., CCC-SLP, Director ofSchool Services, and Diane L. Eger, Ph.D., CCC-SLP/A, represent the AmericanSpeech-Language-Hearing Association, 10801Rockville Pike, Rockville, MD 20852. E-mails: [email protected] and [email protected].


The American Speech-Language-HearingAssociation (ASHA) is the professional, scientific,

and credentialing association for more than 109,000audiologists, speech-language pathologists, andspeech, language, and hearing scientists. ASHA’smission is to ensure that all people with speech, lan-guage, and hearing disorders have access to qualityservices to help them communicate more effectively.

ASHA is a professional association that advo-cates for and serves the needs of the approximately28 million Americans who have some degree ofhearing loss. Many are children who receive audiol-ogy services in the schools. Audiologists providingservices in and for schools, often termed “educa-tional audiologists,” typically have extensiveexperience with pediatric populations, and compre-hensive knowledge of the effects that hearing lossand (central) auditory processing disorders[(C)APDs] can have on communication, academicperformance, and psychosocial development.Educational audiologists also have a unique under-standing of legislation related to audiology serviceprovision to children, birth to 21 years, and theprocesses of state education agencies (SEAs) andlocal education agencies (LEAs). This paper willaddress issues related to professional preparation,certification and licensure, and supply and demandthat are of critical importance to audiologists and thechildren, SEAs, and LEAs they serve.

Professional Preparation forAudiologists in the SchoolsChanges in Professional Preparation in Audiology

Audiology services in the schools are affected by thechanges occurring in the field of audiology. Thesechanges began in the late 1990s, when audiologistsrecognized that, in the 21st century, there would be agreater need for academic and clinical training tokeep up with the advancements in knowledge, tech-niques, and technology within the field of audiologyand to ensure provision of the highest-quality ser-vice to consumers. To broaden the knowledge baseof audiologists, and facilitate high-quality serviceprovision changes to audiology, preservice trainingand certification requirements are being instituted.

Transition to the Doctorate

Recognizing the need for audiologists to acquireadvanced post-baccalaureate study that emphasizesclinical practice, the audiology profession worked todevelop and implement a specialized doctoral pro-gram of study. Before January 1, 2001, it was theresponsibility of the Council on ProfessionalStandards in Speech-Language Pathology andAudiology (Standards Council) of ASHA to developstandards for clinical certification and to monitorthose standards in the context of changes in thescope of practice of the professions. The StandardsCouncil developed an action plan to identify the“academic, clinical practicum and other require-

Audiology Services in the SchoolsSusan J. Brannen, M.A., CCC-A Nancy P. Huffman, M.S. Ed., CCC-A/SLPMonroe 2 – Orleans BOCES Churchville, NY

Joan Marttila, M.A., CCC-A Evelyn J. Williams, M.S., CCC-AMississippi Bend Area Education Agency American Speech-Language-Hearing Association (ASHA)

• The role of the audiologist in the schools is critical, mandated public law and should be recognized as apermanent and integral part of the educational processes.

• The field is moving toward a doctoral-level degree requirement for certification.

• States have varying credential and licensure requirements. Determining which credentials are needed is the audiologist’s responsibility.

ments for the acquisition of critical knowledge andskills necessary for entry-level, independent practiceof audiology” (ASHA, n.d.-b). As a part of that plan,the Educational Testing Service was commissionedby ASHA to conduct a skills validation study for theprofession of audiology. Following a review of thedata provided by the skills validation study, prac-tice-specific literature, feasibility studies, and otherpertinent information, in October 1996, theStandards Council published proposed standards forwidespread peer review. Significant modificationswere made to the document, and it was thenreleased for a second round of widespread peerreview in July 1997. Additionally, ASHA commis-sioned an independent research firm to conduct atelephone poll of academic programs in an attemptto gather information from 124 academic programchairs. Responses were obtained from 91 programsthrough the use of this technique. The proposedstandards were modified on the basis of the secondround of peer review and adopted by the StandardsCouncil at its meeting in September 1997, and are tobe implemented in 2007.

The 1997 Standards for the Certificate of ClinicalCompetence in Audiology are intended to make thescope and level of professional education in audiol-ogy consistent with the scope of practice of theprofession. They address the significant discrepan-cies between the level of preparation andrequirements for practice that were identified in theskills validation study.

Salient features of the new standards include thefollowing:1. Applicants for the certificate of clinical compe-

tence must complete a minimum of 75 semestercredit hours of post-baccalaureate study thatculminates in a doctoral or other recognizedacademic degree.

2. The requirement for 75 post-baccalaureate semes-ter credit hours becomes effective for personswho apply for certification after December 31,2006. The requirement for a doctoral degree ismandated for persons who apply for certificationafter December 31, 2011.

3. The graduate education in audiology must beinitiated and completed in a program accreditedby the Council on Academic Accreditation inAudiology and Speech-Language Pathology

(CAA) of the American Speech-Language-Hearing Association.

4. The program of study must include a practicumexperience that is equivalent to a minimum of 12months of full-time, supervised experience.

5. The applicant will be required to demonstrate thatthe acquisition of knowledge and skills wasassessed by the educational program that grantsthe post-baccalaureate degree.

6. The standards include maintenance of certificationrequirements (Standard VI) that went into effecton January 1, 2003. Requirements for mainte-nance of certification can be met through avariety of professional development activities oracademic coursework (ASHA, 2001b).

The profession is in a time of transition. Not onlyis ASHA requiring a doctorate, the AmericanAcademy of Audiology (AAA) also has doctoral-level requirements for certification (AAA, n.d.).Audiologists in all practice settings are evaluatingwhether or not they will obtain a doctoral degree,and individuals entering or currently enrolled intraining programs are evaluating their doctoraldegree options in order to meet certification require-ments. At the time the new standards go into effect,audiologists holding ASHA certification will not berequired to obtain a doctoral degree as long as theircertification remains current. To facilitate the acquisi-tion of doctoral degrees, especially the clinicalDoctor of Audiology (Au.D.) degree, distance-learn-ing programs have been established to meet theacademic and clinical needs for practicing audiolo-gists. Once a significant number of universities haveaudiology doctoral programs in place, distance-learning programs may be phased out.

The profession is in a time of transition. Not only is

ASHA requiring a doctorate, the American

Academy of Audiology (AAA) also has doctoral-

level requirements for certification.

In addition to establishing the new audiologydoctoral programs, academic programs are in theprocess of phasing out their master’s degree pro-grams in audiology. Some universities are ready tobring new students into doctoral programs, whereas


Audiology Services in the Schools

others have not been able to meet doctoral degreestandards or are unable to obtain university fundingto move to the doctorate.

Necessity of Continuing EducationStandard VI requires audiologists wishing to main-tain their ASHA Certificate of Clinical Competence(CCC-A) to obtain and document continuing profes-sional development. This mandate began on January1, 2003, and will be phased in according to initialcertification dates. The renewal period will be threeyears. This standard will apply to all certificate hold-ers, regardless of the date of initial certification(ASHA, 2001b). For audiologists with a master’sdegree who already possess their ASHA CCC-A,continuing education is essential in order to continuepracticing audiology and to have a certificate that isportable across work sites and state boundaries. Foraudiologists who have obtained their doctorate,either through distance-learning programs or thenewly established on-campus doctoral programs,continuing education is essential as they continuallyimprove their knowledge and practical skills.

According to Standard VI, professional develop-ment is defined as “any activity that relates to thescience of and contemporary practice in audiology,speech-language pathology, or speech, language, andhearing sciences, and results in the acquisition ofnew knowledge and skills or the enhancement ofcurrent knowledge and skills. Professional develop-ment activities should be planned in advance andbased on an assessment of knowledge, skills, andcompetencies of the individual and/or an assess-ment of knowledge, skills, and competenciesrequired for the independent practice of any area ofthe professions” (ASHA, 2001b). Audiologists maydemonstrate continued professional developmentthrough continuing education (CE) providersapproved by ASHA; from a provider authorized bythe International Association for ContinuingEducation and Training (IACET); from a college oruniversity that holds regional accreditation oraccreditation from an equivalent nationally recog-nized or governmental accreditation authority; orfrom employer-sponsored in-service or other contin-uing education activities that contribute toprofessional development (ASHA, 2001b).

Impact of Changes in Audiology StandardsAt the present time, the long-term impact of thechanging standards on the profession of audiologyand specifically audiology in the schools isunknown, but the two major areas that are likely to be impacted are financing and knowledge.

One of the basic tenets of advocates for the Au.D.and other doctoral-level degrees is that audiologistswho possess a doctorate can expect to see improve-ments in their salaries. For audiologists practicing inschool settings, this may actually be realized, asmany salary schedules in educational settings arebased on academic degree. Individuals with variousadvanced degrees (e.g., master’s, education special-ist, doctorate) frequently start out on progressivelyhigher salary schedules. In addition, most educatorsare able to better themselves financially by obtainingadvanced degrees after being hired by a LEA. Foraudiologists with master’s degrees who are cur-rently practicing in the schools, it is anticipated thatthese individuals would move into higher salaryschedules if they obtain their doctorate.

At the present time, the long-term impact of the

changing standards on the profession of audiology

and specifically audiology in the schools is

unknown, but the two major areas that are likely

to be impacted are financing and knowledge.

On the other hand, the increased salary demandsof doctoral-level audiologists may result in adecreasing number of audiologists directlyemployed by LEAs and increased use of audiologysupport personnel, such as technicians, in order tooffset the costs of employing audiologists. For LEAsthat contract with audiologists in private practice,hospital, clinical, or university settings, the cost ofobtaining equivalent contracted services willincrease.

Knowledge ImpactThe audiology doctorate will broaden the knowl-edge base and the clinical skills of audiologists. Theaudiology doctorate can meet the needs of audiolo-gists providing services in the schools if one or more





of the components of the doctoral program focuseson audiology practice issues specific to educationalsettings. It is absolutely critical that advocates forand experts in audiology service provision in theschools participate in the development of audiologydoctoral programs in order to assure that course-work and clinical experience are relevant topediatric populations and educational settings. Thenext few years will be an opportunity to shape newaudiology doctoral programs to meet the needs ofaudiologists providing services in schools.

The audiology doctorate can meet the needs of

audiologists providing services in the schools if one

or more of the components of the doctoral pro-

gram focuses on audiology practice issues specific

to educational settings.

The need for continuing education will also affectaudiologists in the schools. Educators have tradition-ally used academic coursework at the graduate levelas a way to enhance their knowledge base andimprove their salaries. Although graduate creditclasses can meet the continuing education require-ments of ASHA if they result “in the acquisition ofnew knowledge and skills or the enhancement ofcurrent knowledge and skills” in audiology orrelated communication sciences (ASHA, 2001b),other activities can also be used to meet the continu-ing education requirement. LEAs will need either toprovide graduate courses or continuing professionaldevelopment programs that are relevant to the prac-tice of audiology or provide adequate release timeand financial support for their audiologists to obtainnecessary continuing education through other mech-anisms outside of the school setting.

Professional Preparation Needs ofAudiology Practitioners in the SchoolsVarious professional organizations have helpeddefine the role of the audiologist in the schools.Most recently, the Guidelines for Audiology ServiceProvision in and for Schools (ASHA, 2002b) haveprovided information about the legal mandates andthe critical components of audiology service deliv-

ery in the schools. The document includes informa-tion about the need to be able to provide audiologicassessment, audiologic (re)habilitation, educationmanagement, education training, counseling, class-room acoustics measurements and recommendations,and integration with early hearing detection pro-grams. The Educational Audiology Association(EAA), developed the document MinimumCompetencies for Educational Audiologists (EAA, 1994)that describes the knowledge that is necessary forpractitioners to work in the school setting.Preservice competencies such as service deliverymodels, overviews of educational theory of curricu-lum and instruction, speech and languageacquisition, and the psychological aspects of hearingloss in children and its impact on the family areincluded in the EAA document. The RecommendedProfessional Practices for Educational Audiology (EAA,1997) also describes skills that the competent schoolpractitioner needs in the areas of identification andassessment, amplification, hearing loss manage-ment, conservation and consultation, programmanagement, and professional leadership anddevelopment.

ASHA’s new Audiology Standards addressknowledge, skills, and attitudes pertinent to educa-tional audiology practice. Clearly, the intent of thenew Audiology Standards is to prepare audiologiststo provide competent, comprehensive services in allsettings, including school-based audiology programs.

What Needs to Be DoneThe impetus for the audiology doctorate sprangfrom the needs of audiologists working in privatepractice and hospital settings to have increasedautonomy and an expanded knowledge base.Indeed, the vast majority of audiologists areemployed in hospitals or private practice settings(ASHA, 2001c). Audiology services in the schoolshave always been provided by a relatively smallnumber of audiologists, and as audiology doctorateprograms are developed, it is critical that the needsof the school practitioner be incorporated into thedoctoral program. This will take dedication and per-severance because the majority of audiologydoctoral graduates will be employed in other prac-tice settings. The mandate for the doctoral degree


becoming the entry-level credential for audiologistsand for continuing education provides proponentsfor audiology services in and for the schools theopportunity to advocate for better preparation ofindividuals who choose to practice in this setting.

Certification and Licensing for Audiologists Practicing in the Schools

National CredentialsAudiology, like many other education and health-related professions, has national certificationavailable that is often required for employment,reimbursement, and career advancement. ASHA’sCertificate of Clinical Competence in Audiology(CCC-A) is the national credential held by mostaudiologists seeking national-level recognition.Approximately 13,000 audiologists currently holdthis credential (ASHA, n.d.- a). The American Boardof Audiology (ABA), an affiliate of the AAA, has anational credential that is held by approximately 700audiologists (Phil Darrin, personal communication,April 9, 2003).

State CredentialsLicensure is required for the practice of audiology inmost states. Forty-seven states regulate audiologists,44 through licensure and 3 through registration orcertification (ASHA, 2002c). To date, licensure cre-dentials have been modeled on ASHA’s CCCrequirements. Licensure boards are discussing howto modify their licensure laws to accommodate theimpending change in educational preparation.Consistent with national trends, many licensureboards require continuing education/competence forrenewal. However, not all employment in the publicschool sector requires state audiology licensure.Only 21 of the states that require licensure for thepractice of audiology use this as the credentialrequired in the public schools. Another 20 stateshave a special audiology credential for the practiceof audiology in the schools. A review of these cre-dentials suggests that they are also based onequivalent requirements found with the CCC-A andadditional pedagogy courses or tests. Within the reg-

ulations for most of the states, the title “audiologist”is protected and reserved for individuals who holdstate licensure or registration regardless of practicesetting.

In addition, many states also require registrationor licensing that allows otherwise licensed or regis-tered audiologists to dispense hearing aids. Thisoften includes the fitting and dispensing of hearingassistive technology as it relates to classroom educa-tional amplification (e.g., FM systems). Typically,continuing education requirements are tied to thiscredential, allowing audiologists to fit and dispensehearing aids and other hearing assistive technology.Some school districts prefer that the audiologist alsohold a teaching credential.

Issues Facing the Credentialing AgenciesCredentials required for audiologists employed inthe public school sector vary from state to state.Although most of the entry-level credentials appearto be based on the national certification, ASHA’sCCC-A, there are differences. As mentioned earlier,the continuing education/competence requirementfor audiologists has been instituted in many states.Continuing education is also now a requirement formaintaining national certification. Credentialingagencies within states as well as national certifyingagencies have their own unique requirements.Although some of these might “overlap,” they donot all require the same type, format, or amount ofprofessional development for audiologists practicingin the schools.

The new requirements for continuing profes-sional development and a doctorate as the entrydegree for practice as an audiologist will affect thesecredentialing bodies. As college and university pro-grams that offer the master’s degree in audiologyclose (a trend already in evidence), audiologistsseeking positions in all settings will hold a doctoral-level degree. Credentialing bodies will need todetermine if their credential will reflect the newstandard and, if not, how to resolve the difference.

Issues Facing the State and Local Education AgenciesSEAs, LEAs, and administrators will need to care-fully examine job descriptions, supervisionrequirements, and budgetary issues as they relate to


audiologists. Although some LEAs may have doc-toral-level staff, it is not the common degree.Attracting and retaining these professionals in thepublic school arena to provide service to childrenwith a variety of significant needs will be a chal-lenge. Salaries, equipment and material resources,autonomy, and respect are hurdles LEAs and SEAswill face. Additionally, collective bargaining unitswill need to examine their contracts carefully to bestrepresent the needs of this small, but important, cat-egory of professionals.

A question often posed is which credential is bestsuited for the types of responsibilities an audiologisthas in the public schools. To date, it does not appearthat one single credential suffices, but the prevailingcredentials would suggest that the CCC-A does pro-vide the basic clinical, rehabilitation, and counselingrequirements needed. It becomes incumbent, how-ever, on the state to clearly define the credentialsnecessary for practice in the schools. In doing so,consideration must be given to IDEA, ADA, andSection 504 provisions and Medicaid requirements asthey pertain to reimbursement and school practices.LEAs also need guidance from the state to assureproper credentialing of independently contractedaudiology providers. As mentioned earlier, creden-tials currently include, for some, a teachingcertificate, a license, and/or a registration for dis-pensing. This discussion alone can causeadministrators to look at current staff to fulfill thefunctions of an audiologist. The myriad of creden-tialing requirements may cause confusion foradministrators resulting in the inappropriate assign-ment of the functions of an audiologist to anotherstaff member.

Issues Facing the AudiologistSurveys, membership information, and other datasuggest that there are fewer than 1,300 audiologistsworking in the schools in some capacity nationwide.This reflects a much smaller number of audiologiststhan is needed and is a small percentage of the pro-fessional staff employed in this sector. This fact canlead to professional isolation, an overextension ofresponsibilities, and a tendency to be underappreci-ated or undersupported by the administration.

The issue of what credentials are needed is alsothe responsibility of the audiologist who chooses to

work in the schools. Gathering this information canbe formidable as often the various required creden-tials are managed by different governmental bodiesor divisions. Fees associated with obtaining andmaintaining multiple credentials as well as the fre-quent need to affiliate with a collective bargainingunit becomes an additional cost for the audiologistworking in the schools. Additionally, representationwithin a collective bargaining unit can be difficult asaudiologists often have a “nontraditional” rolewithin the school setting. Gaining representationmight present another challenge to the audiologistwho chooses to practice within school settings andaffiliate with collective bargaining units.

Surveys, membership information, and other data

suggest that there are fewer than 1,300 audiolo-

gists working in the schools in some capacity

nationwide.

Continuing professional development willbecome an overwhelming activity for the busy audi-ologist employed in the LEA. Release time as well asfinancial support are concerns. Meeting and reconcil-ing the variety of requirements to maintain themultiple credentials is indeed both an issue and achallenge.

Audiologists are faced with rapidly changingtechnology, new research, and advanced and expen-sive instrumentation. Children in schools haveincreased listening and hearing needs. Schools haveshrinking budgets. Providing quality services in orfor schools will demand that audiologists work withLEAs to carefully manage the way in which audiol-ogy services are provided, programs are developed,and contracts are made.

Audiology services are clearly delineated inIDEA. However, many parents and teachers do notknow of their availability. Often they are delivered ina non-traditional manner relative to service provi-sion in the schools. Advocacy at all levels is requiredto allow audiologists to provide services to our chil-dren in the schools. Organization of this effort andquality information continues to be a challenge forthe audiologist working in the schools.



With all of its challenges, the role the audiologistplays in the schools is critical and is mandated bypublic law. The issues, hurdles, and challenges men-tioned above will be met with success if SEAs, LEAs,audiologists, administrators and other professionals,and bargaining units understand and recognize theimportance of including the credentialed audiologistas a permanent and integral part of the educationalteam.

Audiologist Supply and DemandNeeds EstimatesEstimating the number of students in schools requir-ing educational audiology services is a difficult task.Some LEAs may elect to provide services only tostudents who qualify under IDEA, Section 504, andADA. Others may choose to make certain audiologicservices available to all students, depending on thesize and depth of the program. LEAs may currentlychoose to provide educational audiology services tochildren from birth to age 21 or may serve childrenfrom ages 3 to 21. Yet others may only serve studentsfrom ages 5 to 21. LEAs, often by state law, are typi-cally required to conduct audiologic screenings andhearing conservation programs for all children.Universal newborn screening programs have beenhelpful in the early identification of hearing loss andbetter delineation of their hearing needs by schoolage. Also with the increased number of childrenreceiving cochlear implants, it is anticipated thatthese children will attend their neighborhoodschools rather than being placed in special or self-contained classrooms or schools. LEA-basedaudiologists are involved in many of the programsand services directed toward children with hearingloss and/or auditory disorders. Thus, depending onthe depth and breadth of the services required andoffered, estimating the numbers of students requir-ing audiology services can be complicated.

One source of information on the number of chil-dren who might potentially require or benefit fromthe services of an audiologist is the Twenty-ThirdAnnual Report to Congress on the Implementation of theIndividuals with Disabilities Education Act (U.S.Department of Education, 2001). In Table AF1 of thatreport, the total resident population of children 3 to21 years old in 1999–2000 was estimated to be

74,453,695. Table AF2 shows the birth to age 2 resi-dent population to be 11,334,677. One could thendeduce that there are approximately 86 million chil-dren in the United States in need of audiologyservices of some nature.

If one simply looks at students identified with“Hearing Impairments,” Table AA2 in the reportshows that in the 1999–2000 school year, 71,539 stu-dents from 6 to 21 years old were served. If one addsstudents with Deaf-Blindness, Table AA2 wouldshow an additional 1,840 students 6 to 21 years oldwho were served. It is reasonable to assume thatthese children require audiology services.

...there are approximately 86 million children in

the United States in need of audiology services of

some nature.

Knowing that hearing loss and/or auditory pro-cessing problems can coexist with all of the disablingconditions identified under IDEA, one can look atTable AA1 and see that during the 1999–2000 schoolyear, 6,253,853 students with disabilities from 3 to 21years old were served under IDEA. Thus, one couldextrapolate and suggest that the numbers of childrenfrom 3 to 21 years old in need of educational audiol-ogy services is over 6 million.

Beyond looking at the report to Congress (whichfocuses only on services to students served underIDEA), one can look at data dealing with the preva-lence and incidence of hearing loss in children. Forexample, in the document Healthy People 2000, theU.S. Public Health Service makes several statementsabout hearing loss in children. • Over one million children in the United

States have a hearing loss.• Five percent (5%) of children 18 years old

and under have a hearing loss.• Approximately 83 of every 1,000 children in

the United States have what is termed an educationally significant hearing loss (U.S. Public Health Service, 1990).

Additionally, the U.S. Department of Health andHuman Services reports that 2 to 3 out of every 1000live births result in a baby with a congenital hearingloss and that approximately 15% of all children have



a hearing loss (U.S. Department of Health andHuman Services, 2000).

Berg (1985) states that “among every 1000school-age students in the U.S., 7 have bilateral and16–19 have unilateral hearing losses that may signifi-cantly interfere with their education.” More recentresearch has found the number to be between 11.3%and 14.9%—an average of 131 of every 1,000 school-age children have some degree of hearing loss thataffects learning and development (Bess, Dodd-Murphy, & Parker, 1998; Niskar, Kieszak, Holmes,Esteban, Rubin, & Brody, 1998).

While audiologists are very much involved inthe assessment, intervention, and management ofchildren with (C)APD, it is difficult to provide anestimate of the number of children who may haveauditory processing problems. Factors that compli-cate obtaining demographic data include the varyingdefinitions of (C)APD and the fact that (C)APD isnot a category of disability under IDEA. These chil-dren are often classified under IDEA as having alearning disability and/or a speech-language impair-ment. Chermack and Musiek (1997) estimate that 2%to 3% of all children have a (C)APD. Based on thisestimate, given the resident population of children3–21 years old as 74,453,685 (U.S. Department ofEducation, 2001), one could propose that there areapproximately 1,489,073 to 2,233,611 children in theU.S. with an auditory processing disorder.

Estimates of the number of audiologists cur-rently employed in schools. Again, the Twenty-ThirdAnnual Report to Congress on the Implementation of theIndividuals with Disabilities Education Act (U.S.Department of Education, 2001) cites data on full-time equivalent (FTE) audiologists employed duringthe 1998–1999 school year (the only year reported) toprovide special education and related services forchildren and youth with disabilities. In 1998–1999(Table AC3), 1,051 fully-certified audiologists wereemployed. In addition, there were 175 audiologistsemployed who were not fully certified as audiolo-gists. This represents an increase in employment of122 not fully certified as audiologists in comparisonto the 22nd Annual Report (U.S. Department ofEducation, 2000). Data are not available in the 23rdAnnual Report regarding vacant positions. However,the previous report noted that there were 36 FTEpositions vacant. The presence of vacant funded

positions and the dramatic increase in the employ-ment of individuals not fully certified suggests ashortage of educational audiologists. Using the totalresident population figure for 1999–2000 of children3 to 21 years, 74,453,685, there is approximately oneeducational audiologist for every 70,840 students inthe United States.

ASHA reports that 12,650 audiologists hold theCertificate of Clinical Competence in Audiology inthe document “Highlights and Trends: AnnualCounts of the ASHA Membership and Affiliation,2002.” Further, Table 6 of that report, “DemographicProfile of the ASHA Member and NonmemberCertificate Holders Certified in Audiology Only forJanuary 1 through December 31, 2002,” indicates thatof those who identified a primary employment facil-ity (n = 10,095), 9.5%, or 959 certificate holders,indicated they were employed in a school (ASHA,n.d.-a).

The presence of vacant funded positions and the

dramatic increase in the employment of individuals

not fully certified suggests a shortage of educa-

tional audiologists.

Current and suggested ratios of educationalaudiologists per number of children. To adequatelyserve the needs of children in educational settings,one full-time equivalent audiologist for every 10,000children age birth through 21 years old served by aLEA is recommended (Colorado Department ofEducation Special Education Unit, 1998). ASHA, inits “Guidelines for Audiology Service Provision inand for Schools” (2002b), recommends one FTEaudiologist for every 10,000 children as well.However, the guidelines state that “when audiolo-gists provide time-intensive services (e.g., directmanagement/intervention, service to infants andtoddlers) and one or more of the factors listed belowis present, a caseload ratio of 1:10,000 will be unrea-sonable and must be reduced.” The following is alist of factors that will affect and influence caseloadsize:• Itinerancy/excessive travel time.• Number of schools and LEAs served.• Student placements with an LEA.



• The number of children with hearing loss and/or(C)APD.

• The number and age of children with other dis-abilities requiring audiologic assessment andintervention services.

• The number of hearing aids, cochlear implants,and HATs (hearing assistive technology systems)in use.

• The quantity of tests provided, including audi-tory test batteries.

• The number and age of students receiving direct,ongoing audiologic intervention services.

• The number of infants and preschoolers receiv-ing assessment and intervention services.

• EHDI (early hearing detection and intervention)program responsibilities.

• Hearing loss identification/prevention/conser-vation program responsibilities.

• The scope of audiologic services provided (e.g.,assessment, intervention, hearing aid dispensing).

• The extent of supervisory and administrativeresponsibilities.

• The number of multidisciplinary team meetingsand reporting requirements.

• In-service training and counseling responsibilities.

• Other duties assigned that are outside the audiologist’s scope of service delivery (ASHA, 2002b).

In ASHA’s Audiology Survey 2000 Edition: FinalReport (2000), 71.8% of audiologists working inschools report that they participate “frequently” to“very frequently” on Individual EducationalProgram (IEP) development teams. More thantwenty-seven percent report that they participate onIndividualized Family Service Plan (IFSP) develop-ment teams.

Based on the number of students with hearingloss identified and served under IDEA, and thenumber of children with hearing loss and/or audi-tory disorders that are receiving or are in need of oraudiology services under mandates such as Section504, ADA, and/or other federal, state, and/or localinitiatives, it is clear that the need for LEA-based orcontracted audiology services will not diminish inthe near future. Additionally, with the advent of uni-versal newborn and infant hearing screening,

hearing loss in children will be identified early, inter-vention programs will be instituted early, andaudiologists in educational settings should and willbe involved, in increasing numbers, in assessment,intervention, and management of these children. It isclear that educational audiologists provide compre-hensive services in and for LEAs. Roles haveexpanded and continue to expand, which suggeststhat the recommended ratio of one FTE audiologistfor every 10,000 students may be inadequate andshould be improved.

Additionally, with the advent of universal newborn

and infant hearing screening, hearing loss in chil-

dren will be identified early, intervention programs

will be instituted early, and audiologists in educa-

tional settings should and will be involved, in

increasing numbers, in assessment, intervention,

and management of these children.

Factors Influencing the Demand forEducational AudiologistsLegislative mandates. Mandates such as IDEA,Section 504, and the ADA all have requirements fordetermining eligibility, assessment and evaluation,re-evaluation, and program implementation andmonitoring that require the services of an audiolo-gist. IDEA’s requirements for assistive technologyand the assurance of proper functioning of hearingaids also require the expertise of an audiologist.

Health care regulations. Recently enacted legisla-tion for universal newborn hearing screening willplace identified children into early intervention pro-grams sooner. In those states where the lead agencyfor “Child Find” and early identification and inter-vention programs is the SEA or LEA, educationalaudiologists have and will continue to have a majorrole in program development, management, andimplementation.• Unique hearing and listening disabilities of children

in schools that require specialized and frequent audiol-ogy services and technology. Some examples ofsituations requiring specialized and frequentaudiology services are coordination of services




for children with cochlear implants, use of hear-ing assistive technology (such as FM systemsand classroom amplification), monitoring of fluc-tuating hearing loss in students (especially withotitis media) and the accommodation required toassure a student’s accessibility to the acousticinstructional environment, providing direct inter-vention services to students with hearing loss or(C)APDs.

New federal initiatives in education. Legislationsuch as the No Child Left Behind Act (NCLB),Reading First, and other initiatives in the generaleducation arena have involved audiologists in pro-grams in listening skills development and phonemicawareness skills development for children who havenot been classified as having disabilities.

Expanded roles of audiologists in schools beyondthose associated with hearing loss. Examples ofexpanded roles of educational audiologists are:• Consulting with teachers as they employ strate-

gies for meeting state standards dealing withlistening skills.

• Consulting with teachers and administrators onreducing the effects of damaging noise on hear-ing that occurs in instructional environments,particularly in career and vocational education.

• Assisting schools in implementing standards forclassroom acoustics including analysis of classroom noise and acoustics, making recom-mendations for improving the listeningenvironment, facilitating acoustic accessibility to instruction. (Acoustical Society of America[ASA], 2000, 2002; ASHA, 1995, 2002a, 2002b).

• Working with teachers and administrators toassure appropriate classroom acoustics forinstruction (creating an environment with appro-priate signal to noise ratios and reverberationtimes) (ASA, 2000, 2002; ASHA, 2002a, 2002b).

• Providing assessments for children who failaudiologic screening as well as children with dis-orders other than peripheral hearing loss (e.g.,(C)APDs, attention deficit disorders, learningdisabilities, autism) and children served underSection 504 plans.

• Providing for and monitoring of hearing assis-tive technology such as personal and sound fieldamplification systems to improve listening capa-bility for students with hearing loss, (C)APDs

and other disorders such as attention deficit dis-orders.

Value placed on audiology services by a schooldistrict in the absence of mandates. Although allschool districts must comply with state and federalmandates, some districts have come to value theexpertise of the educational audiologist and involvethe educational audiologist throughout their pro-grams and services. Educational audiologists havean understanding of curricula, the variety of settingsand contexts of instruction (natural environments,hospitals, distance learning), and instructionaldynamics (coteaching, using teacher aides, one-on-one aides for individual students, instructioninvolving related service providers) (Huffman,1997).

Factors Influencing the Supply ofEducational AudiologistsDesire to work in a public school. Audiologists workin a number of employment settings includinghealth care (hospitals, nursing homes, home health,private physician’s offices), clinics and agencies(speech and hearing centers), colleges and universi-ties, private practice, industry, and schools (specialschools, preschools, elementary and secondaryschools, and intermediate units) (ASHA, 2001a).Given the roles and responsibilities and the knowl-edge and skills required for educational audiologyservices, some audiologists may choose not to workin schools. On the other hand, the working condi-tions, roles and responsibilities, and prestige in theschool setting may be highly appealing for others.

Availability of employment. Regarding demand,small school districts may not necessarily hire audi-ologists. They may use intermediate educationagencies or cooperatives to provide audiology ser-vices or contract with a local agency, clinic,university, or private practice for specified audiologyservices. Regarding supply, there may be geographi-cal “pockets” where universities in close proximityproduce audiology candidates for certification,resulting in an over-supply of available audiologists.In other geographical regions, such as rural areas,there may be an undersupply.

Until recent changes to the audiology standardswere made, the number of audiology students seek-ing doctoral-level degrees was on the decline.



Therefore, as audiology programs make the transi-tion to the doctoral degree, they are faced with ashortage of doctoral-level faculty, thus limiting thenumber of students who can be admitted to pro-grams. This may ultimately lead to an initialreduction in the number of audiologists entering theprofession and a need for LEAs to increase recruit-ment and retention efforts.

Salary. The ASHA 2001 Omnibus Survey: SalaryReport (2001d) reports median academic year salariesin school settings as $42,600 per year for audiolo-gists. Median calendar year salaries for audiologistsin private practice are $50,000. Audiologists workingin LEAs are often covered by collectively bargainedsalary and benefits packages that may have immedi-ate and long-term appeal. On the other hand, asaudiologists begin to command higher salaries basedon their doctoral degrees, salaries offered by LEAsmay not be appealing or will have to be negotiateddifferently or outside of collective bargaining units.

The ASHA 2001 Omnibus Survey: Salary Report

reports median academic year salaries in school

settings as $42,600 per year for audiologists.

Credentialing requirements. As discussed else-where in this paper, credentialing requirements arein transition. Many audiologists, including thosewho are currently employed in schools, are in theprocess of obtaining an AuD or other doctoraldegree. Individual states have requirements forlicensing and teacher certification, which may ormay not include a doctorate requirement in order tobe employed in schools. For example, with a transi-tion to a doctoral degree, fewer audiologists maygraduate, those who do graduate may be attracted toprivate practice where more attractive salaries areperceived, and schools with collective bargainingagreements may not offer salaries that persons hold-ing doctoral degrees find attractive. Nonetheless, itremains to be seen what the impact will be on thesupply of educational audiologists.

Critical Questions

When studying issues of supply and demand foraudiologists in the schools, there are several criticalquestions to be answered.• Given the unique needs of children with hearing

and listening disabilities in today’s schools, howdo professional preparation requirements foraudiologists influence the supply and demand ofaudiologists (i.e., educational audiologists) whowish to work in school settings?

• How can certification requirements and licensurerequirements promote easily accessible and high-quality services for students in schools?

• Given changing credentialing requirements, howcan the supply of qualified audiologists beincreased to meet recommend needs, that is, oneaudiologist per 10,000 students?

• Given the date of the 23rd Annual Report toCongress, what accounts for the significantincrease in the number of personnel employedwho are not fully certified as audiologists?

• Given legislative mandates and the limited fund-ing resources of LEAs, how can educationalaudiology services be made readily available tostudents in need?

• What will the audiologist’s role be in federal ini-tiatives targeting children who are not identifiedas disabled but who must be provided servicessuch as those required in the No Child LeftBehind Act, Reading First, and other initiativesundertaken as a result of presidential commis-sion panels?

• How can educational audiologists demonstrateefficacy? Given the current climate and intereston outcomes, how can audiologists better defineand educate others about the value of their services?

• How can audiologists increase the visibility oftheir services and promote the provision of ser-vices when they are not mandated? If states andLEAs are not mandated to provide services, theyare not likely to do so. If parents are not aware oftheir rights to services, they will not requestthem. If name recognition is increased, willdemand for services increase?



ConclusionResearch continues to document the high incidenceof hearing loss in children of all ages and the poten-tially negative consequences hearing loss and/or(C)APD can have on communication, academic per-formance, and psychosocial development. Theeffects of hearing loss and/or (C)APD are variable,depending on several factors, including the natureand degree of loss or disorder. Thus it is essentialthat children with hearing loss and/or (C)APDreceive comprehensive audiologic services to reducethe possible negative effects of the loss or disorderand to maximize their auditory learning and com-munication skills. Furthermore, all children ineducational settings can benefit from audiologic ser-vices in terms of the development of listening skills,instruction in prevention of hearing loss, and theprovision of accessible acoustic environments. It isclear that the preparation of audiologists that pro-vide services in educational settings will beimpacted by the changes in audiology standardsfacilitating a need for SEAs and LEAs to evaluateand modify the way in which they access and pro-vide audiology services in the schools andcontinuing professional development for LEA-basedaudiologists. As national credentialing standardschange, it is imperative that states, SEAs, and LEAsexamine their licensure, registration, and/or certifi-cation requirements and, perhaps, modify them toaccommodate provisions of the new audiology stan-dards. In addition, as audiologists obtain and/orenter the profession with doctoral degrees, SEAs andLEAs will need to make fiscal modifications toaccommodate the increased salary demands of LEA-based audiologists as well as increased fees forcontracted services. LEAs will also need to imple-ment or modify recruitment and retention efforts toattract audiologists with doctoral degrees to schoolsettings.

It is essential that children with hearing loss and/or

(C)APD receive comprehensive audiologic services

to reduce the possible negative effects of the loss

or disorder and to maximize their auditory learning

and communication skills.

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Huffman, N. (1997). Audiology services in the educationalsetting. In P. O’Connell (Ed.), Speech, Language, andHearing Programs in Schools: A Guide for Students andPractitioners, pp. 73–103. Gaithersburg, MD: AspenPublishers.

Individuals with Disabilities Education Act — Re-autho-rization 1997 (20 USC §§ 1400 et seq.)

Niskar, A. S., Kieszak, S. M., Holmes, A., Esteban, E.,Rubin, C., & Brody, D. J. (1998). Prevalence of hearingloss among children 6 to 19 years of age: The thirdnational health and nutrition examination survey.Journal of the American Medical Association, 279(14), pp.1071–1075.

U.S. Department of Education (2000). Twenty-second annualreport to congress on the implementation of the Individualswith Disabilities Act, Washington, DC: Author.

U.S. Department of Education (2001). Twenty-third annualreport to congress on the implementation of the Individualswith Disabilities Act, Washington, DC: Author.

U.S. Department of Health and Human Services. (2000)Healthy people 2010. 2nd ed. Washington, DC: U.S.Government Printing Office.

U.S. Public Health Service (1990). Healthy people 2000.Washington, DC: U.S. Government Printing Office,Superintendent of Documents.

About the AuthorsSusan J. Brannen, M.A., CCC-A, is chair of theDepartment of Audiology for Monroe 2 – OrleansBOCES, 3599 Big Ridge Road, Spencerport, NY14459. E-mail: [email protected].

Nancy P. Huffman, M.S. Ed., CCC-A/SLP, is anaudiologist, 590 Stearns Road, Churchville, NY14428-9530. E-mail: [email protected].

Joan Marttila, M.A., CCC-A, is the coordinator forAudiology, Vision, Assistive Technology for theMississippi Bend Area Education Agency, 729 21stStreet, Bettendorf, IA 52722-5086. E-mail: [email protected].

Evelyn J. Williams, M.S., CCC-A, is the director ofAudiology Practice in Schools, American Speech-Language-Hearing Association (ASHA), 10801Rockville Pike, Rockville, MD 20852. E-mail: [email protected].



While reliance on paraprofessionals has increasedin virtually all settings, advancement opportu-

nities, systematic training and preparation, andsupervision have not (Boomer, 1982). The number ofparaeducators reported in the 1999–2000 survey hasexpanded by a minimum of 50,000 since results of asimilar survey conducted in 1996…[yet] there hasbeen very little progress in finding viable solutionsto the problems connected with the employment,preparation, and supervision of paraeducators(Pickett, Likins, & Wallace, 2002).

In the past 20 years, from Boomer in 1982 toPickett and her colleagues in 2002, paraprofessionalshave been evolving as critical members of instruc-tional teams providing services to students withspecial needs; however, the infrastructure to supportthem has not substantially improved. The role ofparaprofessionals has evolved over the past 50 years,moving increasingly from primarily assisting withclerical tasks to assisting with instructional tasks.Their changing role reflects changes in educationalpractices, evolution of teachers’ roles, shifting in leg-islation and policy, and shortages in the number ofqualified teachers. These changes require the devel-opment of (a) standards for paraprofessional rolesand competencies, (b) infrastructures to prepareparaprofessionals for their new roles, and (c) admin-istrative systems to support instructional teams atthe school level. The active involvement of many dif-ferent constituents—policymakers in federal and

state governments, administrators in state and localeducation agencies, personnel developers in two-and four-year institutions of higher education,researchers, professional organizations and others—is required. Quite clearly, although solutions arepossible, the evolution of the paraprofessional role isnot without its issues. Solutions require that theactions of the constituents listed above be alignedand coordinated.

For the purposes of this paper, Pickett’s defini-tion will be used to define “paraprofessional,” as herdefinition emphasizes the role of the paraprofes-sional as one who assists with the delivery ofservices under the direction of licensed staff:

Paraeducators are school employees: 1) who work underthe supervision of teachers or other licensed/certificatedprofessionals who have responsibility for a) identifyinglearner needs, b) developing and implementing pro-grams to meet learners needs, c) assessing learnerperformance, and d) evaluating the effectiveness of edu-cation programs and related services, and 2) who assistwith the delivery of instructional and other direct ser-vices as assigned and developed by certified/licensedprofessional practitioners (Pickett et al., 2002).

This paper will provide a brief history of theparaprofessional position and a review of the currentliterature addressing three topics: (a) supply anddemand, (b) preparation and training, and (c) certifi-cation and licensure. A summary of the issues andimplications for further research will also be addressed.

Paraprofessionals in SchoolsTopics For Administrators

Teri Wallace, Ph.D.University of Minnesota

• The role of paraprofessionals in education has evolved over the past 50 years from assistance with clericaltasks toward more instructional tasks.

• The contemporary role reflects changes in educational practices, evolution of teachers’ roles, shifts in legislation and policy, and shortages of qualified teachers.

• There are varying levels required for certification of paraprofessionals, often dependent on specific jobresponsibilities.

• Despite recognition of the importance of training, many local and state education agencies do not providesufficient preservice or inservice training opportunities.

Evolution of the Paraprofessional RoleHistorical SummaryThe role of paraprofessionals as instructional sup-ports and key members of educational teams doesnot have a long history. Although they number morethan 500,000 today (NCES, 2000), as recently as 1965,there were fewer than 10,000 (Green & Barnes, 1989).As their numbers have increased, their roles haveexpanded. In 1997, Pickett and Gerlach identifiedseveral events and trends relevant today that havecaused policymakers, educators, and others toreassess the role of the paraprofessional workforce.These include: (a) continuing efforts to include youthwith disabilities in the general education classroomand their communities (Blalock, 1991; Hales &Carlson, 1992; Hofmeister, 1993; Morehouse &Albright, 1991; Pickett, 1996); (b) a growing need foroccupational and physical therapy and speech-lan-guage pathology services for children and youth ofall ages (Fenichel & Eggbeer, 1990); (c) increasingnumbers of students who come from ethnic and lan-guage minority heritages in school systemsnationwide (Ebenstein & Gooler, 1993; Haselkorn &Fiedeler, 1996; OSERS, 1993); (d) ongoing shortagesof teachers and related services personnel (NationalCenter for Education Statistics [NCES], 1993; OSERS,1993); and (e) changing and expanding roles ofschool professionals as classroom and program man-agers (French & Pickett, 1997; Pickett, Vasa, &Steckelberg, 1993; Putnam, 1993; Snodgrass, 1991).

It is these and other developments that have hada significant impact on the emerging role of parapro-fessionals in special education at the time theyoccurred, and a current review will show their rele-vance today. In describing the evolving role of thisworkforce, the most logical framework is to movefrom a review of the past, to an overview of the pre-sent, and finally to an anticipation of the future.

1950s and 1960sThere are examples of paraprofessionals working ineducation and human service programs as far backas the early 1900s. However, it was not until the mid1950s that recognition of the value of paraprofession-als began to emerge. This attention to the

employment of paraprofessionals was due to thepostwar shortage of teachers that demanded localschool boards look for alternative service providers.Paraprofessionals were recruited to perform clericalfunctions to free the teachers to spend more timeproviding instruction to students (Frith, 1982;Lindsey, 1983; Morehouse & Albright, 1991; Pickett,1996).

During this time the Ford Foundation funded theBay City Project (Michigan Schools), which recruitedand trained paraprofessionals to complete clericalduties and various administrative tasks to enableteachers to provide more direct instruction to stu-dents in general education programs (Gartner &Reissman, 1974; Pickett, 1994). Although the employ-ment of paraprofessionals began to occur across thecountry based on the outcomes of this effort, theapproach was not without its critics. In fact, manyindividuals were concerned that paraprofessionalswould be used as cheap labor to replace teachers, orthat their presence would justify increased class size.

In fact, many individuals were concerned that para-

professionals would be used as cheap labor to

replace teachers, or that their presence would jus-

tify increased class size.

Another equally significant project was beingimplemented in special education while the effectsof the Bay City Project were being realized in generaleducation. Cruickshank and Haring (1957) initiatedthe first demonstration project to investigate theresponsibilities of paraprofessionals in special educa-tion. They found that the primary responsibilities ofparaprofessionals were the same regardless of theeducational setting in which they worked.Cruickshank and Haring examined paraprofession-als in three settings, including: (a) a regularkindergarten that included students with blindness,(b) another classroom that included students whowere labeled gifted, and (c) six different types ofself-contained special education classrooms. The pri-mary responsibilities reported in each of the settingsincluded noninstructional tasks such as playgroundsupervision, housekeeping in the classroom, materialpreparation, and record keeping. In summarizing


Paraprofessionals in Schools



their work, Cruickshank and Haring indicated thatthe use of paraprofessionals provided an opportu-nity for the professionally trained teacher to useother skills. They stated that their study providedfurther support for the assumption that teacherassistants can be effectively utilized in the enrich-ment of the instructional program.

Many events throughout the 1960s served tochange the roles of paraprofessionals in education.The growth of the civil rights movement, efforts toimprove equality for women, and the beginning ofthe campaign to secure entitlement for children andadults with disabilities all led to expanded programsacross education and human services (Gartner &Riessman, 1974; Pickett, 1994). In fact, the verynature of schools began to look different. Thesesocial changes took on a new emphasis and alongwith them came increased societal expectations,which placed so many new demands on schools thatthe status quo was no longer good enough.Compensatory education for disadvantaged stu-dents, individualized education for students withdisabilities, specialized programs for students fromvarious cultural backgrounds, and an increase ingovernmental infrastructure to support the deliveryof special services stimulated the employment ofparaprofessionals (Green & Barnes, 1989). Thesechanges led to teachers needing instructional assis-tance in addition to clerical support.

The growth of the civil rights movement, efforts to

improve equality for women, and the beginning of

the campaign to secure entitlement for children

and adults with disabilities all led to expanded pro-

grams across education and human services.

Similarly, an increase in public attention to theinequities in educational opportunities for studentsfrom minority groups led to a growing lack of confi-dence by parents and policymakers in the ability ofteachers to meet the needs of students from diversecultural backgrounds (Gartner & Reissman, 1974;Pickett, 1994). This led to the employment of para-professionals from local communities in whichstudents and their families resided. These parapro-fessionals were called upon to serve as liaisons

between home and school. For the first time,paraprofessionals provided instructional support tostudents and their parents (Green & Barnes, 1989).

During this time of evolution in the role of theparaprofessional in education, there was an increasein theory and position papers that discussed the pos-sibility of using paraprofessionals in instructionalpositions (Doyle, 1995). Many projects and reportsthat came out of general education, for example,Headstart and Title I of P.L. 89-10, suggested that aparaprofessional in a classroom could relieve theteacher of several tasks and facilitate the professionalresponsibilities of the instructor (Blessing, 1967).Although Blessing found that paraprofessionalsworking in Title I programs performed mostly non-instructional tasks, Ebenson (1966), and Blessingboth agreed that, given appropriate supervision,paraprofessionals could perform instructional activi-ties, and that an increased and expanded use ofparaprofessionals could impact the increasing short-age of teachers.

At the same time the utilization of paraprofes-sionals gained momentum, recognition of theimportance of improving opportunities for peoplefrom varied cultural backgrounds, women, andindividuals with disabilities to achieve professionalstatus began to emerge. In 1965, a book entitled NewCareers for the Poor described an approach for highereducation to use to develop programs for parapro-fessionals, which would encourage them to enter theprofessional ranks (Pearl & Riessman, 1965; Pickett,1986). This also served as a catalyst to provide theexpanding movement with a new name—NewCareers. This evolution in the preparation of para-professionals reflected the current political andsocial climate at the time, which promoted moreopportunities for a greater number of people.

1970s and 1980sThe federal government played an active role in theNew Careers Movement through legislative actions,funding, and administrative guidelines (Pickett,1986). For example, the U.S. Department ofEducation supported the Career OpportunitiesProgram (COP), a training effort instituted in 1971,which involved 20,000 individuals in careeradvancement programs (Pickett, 1986). COP pro-grams were developed jointly by school districts and



teacher education programs to support paraprofes-sionals who wanted to become teachers.

The federal government played an active role in the

New Careers Movement through legislative actions,

funding, and administrative guidelines.

At the same time that higher education wasrecruiting paraprofessionals into teacher educationprograms, states were developing certification proce-dures, identifying duties of paraprofessionals,mandating the use of paraprofessionals in some pro-grams, and addressing training and career mobilityfor paraprofessionals wanting to remain in their cur-rent roles. In 1977, although COP ended withpositive reactions from all involved, few local educa-tion agencies or universities that originallyparticipated in COP continued to offer opportunitiesfor career development based on the COP model(Pickett, 1994). Additionally, Pickett states that, asfederal funding for all education programs wasreduced during the 1980s, interest and concern aboutimproving the performance of paraprofessionalslessened as their use increased. Lindsey (1983) statesthat the double-digit inflation, shrinking tax basesand other economic factors of the time were respon-sible for reducing funds for education. He alsosuggests that one variable that permitted state edu-cation agencies (SEAs) and local education agencies(LEAs) to continue to provide services in a morecost-effective way was hiring and integrating para-professionals into existing organizational andadministrative structures. At the same time, practicesassociated with the deployment, management, andtraining of paraprofessionals became more unstruc-tured and, many times, non-existent.

1990s, 2000, and 2001These years have brought with them changes in fed-eral legislation regarding the preparation ofparaprofessionals, changes in teacher roles, need forclarification regarding the appropriate roles for para-professionals, and new attention to educationalreform and accountability.

The role of paraprofessionals has changed sub-stantially during the past 50 years, and the role is

still evolving. Educational reform efforts are promot-ing new roles for teachers as managers andinstructional team leaders. Specifically, teachers havegreater responsibility for program and classroommanagement, participation in school site decision-making, and implementation of accountabilitysystems and measures. These changes in teachers’roles have implications for the roles of paraprofes-sionals (Pickett, 2000; Pickett et al., 2002). Inaddition, provisions in federal legislation requirethat all personnel should be adequately prepared fortheir roles and responsibilities. Such legislationincludes the 1997 Amendments to the Individualswith Disabilities Education Act (IDEA), theElementary and Secondary Education Act (ESEA) of1994, the School-to-Work Opportunities Act of 1994,and the No Child Left Behind Act (NCLB) of 2002.

Two specific pieces of legislation described haveimportant implications for the role and preparationof paraprofessionals: the amendments to IDEA (P.L.105-17) and NCLB (P.L. 107-110). Both of the lawsrefer to preparation and supervision requirementsneeded for paraprofessionals to provide specific ser-vices. The 1997 Amendments to IDEA, as quotedbelow, require training and supervision when para-professionals are to assist in the provision of specialeducation services.

A State may allow paraprofessionals and assistants whoare appropriately trained and supervised, in accordancewith State law, regulations, or written policy, in meet-ing the requirements of this part to be used to assist inthe provision of special education and related services tochildren with disabilities under Part B of the Act. [34CFR §300.136(f)]

In addition, the NCLB act established parapro-fessional training requirements for new para-professionals (anyone hired on or after January 8,2002); NCLB also provides 4 years from enactment(January 8, 2006) for currently employed paraprofes-sionals to meet one of the following requirements:(a) completed at least 2 years of study at an institu-tion of higher education; (b) obtained an associate’s(or higher) degree; or (c) met a rigorous standard ofquality and can demonstrate, through a formal stateor local academic assessment, knowledge of, and theability to assist in instructing, reading, writing, andmathematics; or knowledge of, and the ability toassist in instructing, reading readiness, writing

readiness, and mathematics readiness, as appropri-ate [Title I, Section 1119/b]. These requirementsapply to any paraprofessional whose position isdirectly funded by Title I and who provides instruc-tional support services. In a Title I school-wideprogram, any paraprofessional providing instruc-tional support services will have to meet theserequirements, including paraprofessionals providingspecial education services that are instructional innature. In addition, the regulations state that a para-professional must work under the direct supervisionof a teacher, which means that the teacher plans theparaprofessional’s instructional activities and evalu-ates the students with whom the paraprofessionalworks. In addition, the paraprofessional must workin close proximity to the teacher. Paraprofessionalswho do not have instructional duties are notincluded in the definition of “paraprofessional.”

These requirements have prompted a renewedinterest in competencies and standards, credentialingsystems, and infrastructures to support preparationand ongoing development. In addition, there hasbeen an increase in the amount of research in thisarea regarding the training needs, supervision,appropriate use, and efficacy of paraprofessionals,which will be reviewed in the next section of thispaper. This research provides the basis for the resultsand recommendations of this issue brief.

A Review of Current Literature Supply and DemandAttempting to establish a clear understanding of thenumber of paraprofessionals working in schoolsacross the nation is a huge challenge. There is a lackof data available to assist various constituents intheir decision-making regarding this workforce. It isimportant to note that because data collected by fed-eral agencies is based in part on informationreported by SEAs or is in some cases self-reportedby individuals, it is at best incomplete and may pro-vide an inadequate picture of paraprofessionalemployment. In addition, data are often not reportedin a timely fashion, which provides a delay in under-standing the current employment situation.

Given these cautions and issues, three mecha-nisms are discussed that exist to secure informationabout the paraprofessional workforce. None of the

three methods captures the entire paraprofessionalworkforce and aggregating the results is not appro-priate. For example, the Occupational OutlookHandbook (2000–2001) reported approximately 1.2million teaching aides/assistants employed in publicand private schools and early childhood and daycare centers (U.S. Bureau of Labor Statistics, 2000).While the handbook suggests that a large number ofthese individuals work in special education, no spe-cific breakdown is given. Other approaches delineatethe sub-groups a bit more. Specifically, the Schoolsand Staffing Survey (SASS) of the National Center forEducational Statistics (NCES) has been gatheringdata on non-professional staff since 1987–88, but itwasn’t until their most recent report in 2000 thatthey published information about them. While theSASS figures are based on a sample of schools, eachyear the NCES Common Core of Data (CCD) pro-gram gathers staffing information from all localeducation agencies in the United States.

Attempting to establish a clear understanding of

the number of paraprofessionals working in schools

across the nation is a huge challenge.

Pickett et al. (2002) state that there are approxi-mately 550,000 paraprofessionals currentlyemployed in full-time equivalent positions across thenation. The number was generated from a 1999–2000survey of chief state school officers in the 50 states,the territories of the U.S., the District of Columbia,the Bureau of Indian Affairs, and the Department ofDefense conducted by the National Resource Centerfor Paraprofessionals (NRCP). This number repre-sents an increase of 50,000 paraprofessionals (10%)since a similar NRCP survey conducted in 1996.Also, Pickett et al. state that of the 550,000 parapro-fessionals, approximately 290,000 work withchildren and youth with disabilities, and 130,000 ormore work with multilingual learners, Title I, andother remedial education programs. Approximately130,000 work as library and media pareducators,computer assistants, and more. In addition to theincrease in paraprofessionals, the NCES reported a48% increase in instructional paraprofessionalemployment compared to a 13% increase in studentenrollment and an 18% increase in teacher employ-



ment between the years 1990 and 1998 (NCES, 2000).These differences in growth are noteworthy andshould be analyzed to determine their meaning.Gerber, Finn, Achilles, and Boyd-Zaharias (2001)suggest that the rapid increase in the numbers ofparaprofessionals has to do with the expansion ofspecial education and Title I programs, the percep-tion that the use of paraprofessionals is a low-costalternative to small classes, and the perceived suc-cess of paraprofessionals in affecting studentengagement and achievement as well as other positive classroom contributions.

Pickett et al. (2002) state that there are approxi-

mately 550,000 paraprofessionals currently

employed in full-time equivalent positions across

the nation.

Pickett (1994) stated that at the time the largestrecorded use of paraprofessionals in schools was due to federal legislation such as Chapter I of theImproving America’s Schools Act (IASA) and theIndividuals with Disabilities Education Act (IDEA)passed in 1990. The legislation emphasized the inclu-sion of students with disabilities into the generaleducation and community environments andincreased the need for and use of paraprofessionals.Not unlike the changes evidenced in the 1990s, theincreased demands on teachers to address the indi-vidual needs of students resulted in a reliance on theparaprofessional workforce.

Clearly, the numbers of paraprofessionals continueto increase, and as they do, recruitment strategiesmust also increase and improve. Most of the litera-ture speaks to the recruitment of paraprofessionalsinto the teaching profession. Paraprofessional-to-teacher programs exist (Blalock, Rivera, Anderson, & Kottler, 1992; Epanchin & Wooley-Brown, 1993;National Teacher Recruitment Clearinghouse, 2001)and are often used to increase the teaching work-force especially related to the high need for bilingualcertified teachers and an increasing need for under-standing unique cultural differences (Genzuk, 1997;Miramontes, 1990; Villegas & Clewell, 1998).However, there is also a literature supporting theneed to recruit and retain paraprofessionals in ruralareas, transition programs, schools serving students

who are linguistically diverse, and programs servingstudents who are autistic or who need positivebehavioral supports (Boomer, 1994; Harper, 1994;Miramontes, 1990; Morehouse & Albright, 1991;Nittoli & Giloth, 1997; NCPSE, 2000; Palma, 1994;Rogan & Held, 1999; Rueda & DeNeve, 1999). Forexample, Passaro, Pickett, Latham, and HongBo(1994) report a shortage of paraprofessionals in thethree rural states they studied. Respondents reportedthe following as reasons for attrition: (a) lack ofopportunity to advance, (b) poor salary, (c) lack ofadministrative support, and (d) lack of respect.These experiences are somewhat characteristic of theparaprofessional workforce and have been reportedby many authors as summarized by Jones andBender (1993).

Clearly, the numbers of paraprofessionals continue

to increase, and as they do, recruitment strategies

must also increase and improve.

Not surprisingly, Riggs and Mueller (2001) foundthat the retention of paraprofessionals was mostoften threatened by other positions that offeredhigher salaries or greater career advancement. Inaddition, they found that paraprofessionals reportedthe following as factors affecting self-esteem: (a)being invited to team meetings centered on the stu-dents with whom they work; (b) being providedwith adequate break time, (c) having adequate sub-stitute coverage, and (d) being perceived as a “teammember” working “along side of” the teacher. In astudy of general educators, special educators, para-professionals, and administrators, Giangreco,Edelman, and Broer (2001) uncovered six majorthemes associated with respect, appreciation, andacknowledgement of paraprofessionals. Theyinclude: (a) nonmonetary signs and symbols ofappreciation, (b) compensation, (c) being entrustedwith important responsibilities, (d) noninstructionalresponsibilities, (e) wanting to be listened to, and (f) orientation and support. In order to address theneed for paraprofessionals who can best serve individuals with disabilities, Blalock (1991) recom-mends strategies for hiring paraprofessionals thatinclude a suggested hiring process, vocationalassessments, and interview questions. Clearly,




schools must review the strategies they use to recruitand hire paraprofessionals, and create meaningfulways to support them once hired. In addition, stateand federal agencies must identify and implementefficient, accurate methods of capturing the numbersof paraprofessionals working in K–12 educationtoday, and identify the program funds used to support their position.

Preparation and Training ofParaprofessionalsAccording to Guskey and Huberman (1995), profes-sional development is a crucial component foreducational improvement. Many individuals activein this area have likened the “paraprofessional” or“paraeducator” to a “paralegal” or a “paramedic,”but there is a huge difference. Although similar inthe role they might have in their “profession”, theyare quite different in the amount of preservice prepa-ration and ongoing development that is required ofthem to work in their respective fields. This sectionwill review the literature regarding the training andpreparation of paraprofessionals.

Many individuals active in this area have likened

the “paraprofessional” or “paraeducator” to a

“paralegal” or a “paramedic,” but there is a huge

difference.

In 1974, after reviewing the literature, Reid andReid classified the duties of paraprofessionals work-ing in special education classrooms with studentswith mild disabilities as being clerical, housekeep-ing, noninstructional, and instructional. May andMarozas (1981) stated that “the implications of thetasks delineated under these categories are that theteachers teach and paraprofessionals prepare materi-als and manage the behavior of children” (p. 228).The Study of Personnel Needs in Special Education(SPeNSE, 2001) found that, while there were differ-ences by region and district regarding the types ofservices paraprofessionals provided, the majority of special education paraprofessionals, nationwide,spend at least 10% of their time on each of thefollowing activities: (a) providing instructionalsupport in small groups; (b) providing one-on-one

instruction; (c) modifying materials; (d) implement-ing behavior management plans; (e) monitoringhallways, study hall, other; (f) meeting with teach-ers; (g) collecting data on students; and (h) pro-viding personal care assistance (SPeNSE, 2001).

Other studies found similar results (Downing,Ryndack, & Clark, 2000; French, 1998; Lamont &Hill, 1991; Minondo, Meyer, & Xin, 2001; Pickett & Gerlach, 1997; Pickett, 2000; Wallace, Stahl, &MacMillan, 2000). In some studies, paraprofessionalsreported being responsible for a student’s instruc-tional program when that is the responsibility of the teacher (Giangreco, Edelman, Luiselli, &MacFarland, 1997; Marks, Schrader, & Levine, 1999;Wallace, Stahl, & MacMillan, 2000). Downing,Ryndak, and Clark (2000) found that paraprofession-als reported a high level of responsibility in theirjobs, and that they made decisions regarding adapta-tions, provided behavioral support, and interactedwith team members, including parents. This is ahuge concern pointing to a need for training andpreparation not only of the paraprofessionals butalso of those who supervise and direct their work.Katsiyannis, Hodge, and Lanford (2000) conducted a review of due-process hearings, Office of CivilRights (OCR) rulings, OSEP memorandums, andcourt rulings from 1990–1999 regarding the legalparameters associated with the use of paraprofes-sionals in special education. Four important findingsabout the role and appropriate use of paraprofes-sionals to provide special education services include:(a) public schools must supply services provided byparaprofessionals if these services are necessary for astudent to receive a free appropriate public educa-tion (FAPE); (b) paraprofessionals must be qualifiedto perform assigned services as indicated in the IEP,and public schools must have broad discretionarypower regarding personnel; (c) paraprofessionalswho lack appropriate training may not directly pro-vide special education services in either public orprivate schools; and (d) appropriately trained para-professionals may assist in the provision of specialeducation services only if certified special educationpersonnel supervise them (Katsiyannis, Hodge, &Lanford, 2000).

As noted earlier, both the amendments to IDEAand the NCLB act require that paraprofessionalsmust receive supervision by licensed staff in order to


provide instructional support and special educationservices. This supervision appears critical for a num-ber of reasons. For example, many studies havefound that paraprofessionals often report not havingjob descriptions, formal orientations, or annual per-formance reviews (Gerber et al, 2001; Wallace et al.,2000). In addition, Wallace et al. (2000) reported that58% of the nearly 3,600 paraprofessionals surveyeddid not have planning time with the teachers whodirected their work. Coupled with findings thatparaprofessionals are reporting more responsibilitythan what is appropriate for their roles, these find-ings suggest that paraprofessionals may not bereceiving adequate guidance or preparation for theirroles. It becomes critical that teachers and othersresponsible for supervision of paraprofessionals provide the needed supervision to ensure that para-professionals know what their roles are and how todo them.

There is agreement in the literature that teachersshould assign tasks, design instructional plans, pro-vide on-the-job training, conduct planning sessions,and monitor the paraprofessional’s day-to-day activ-ities (Doyle, 1997; French, 2001; Morgan & Ashbaker,2000; National Joint Committee on LearningDisabilities [NJCLD], 1999; Pickett & Gerlach, 1997;Wallace et al, 2001). There is also agreement thatteachers are unlikely to receive the knowledge andskills required for paraprofessional supervision dur-ing either their preservice teacher preparation orlater during professional development opportunities.Although this topic of paraprofessional supervisionappears to be more of an issue related to teachers, ithas a huge and fundamental impact on the successof paraprofessional and teacher teams.

Studies have found that paraprofessionals whoreport receiving more inservice training or preser-vice preparation report feeling better prepared tofulfill their job responsibilities (SPeNSE, 2001;Wallace, Stahl, & MacMillan, 2000). Numerous recentstudies and opinion pieces indicate that there is ageneral scarcity of training available for paraprofes-sionals (IDEA Partnerships, 2001; Downing et al.,2000; French & Chopra, 1999; Hilton & Gerlach, 1997;French & Pickett, 1997; Pickett, 2000; Wallace, et al.,2000).

Studies have found that paraprofessionals who

report receiving more inservice training or preser-

vice preparation report feeling better prepared to

fulfill their job responsibilities.

A number of researchers have reported a differ-ence in perceptions among teachers, para-professionals, and administrators on the need forparaprofessional training. For example, Wallace,Shin, Bartholomay, and Stahl (2001) reported a statis-tically significant difference among administrators,teachers, and paraprofessionals regarding the per-ceived need for training. Paraprofessionals reportedthe greatest need, while teachers and administratorsdid not perceive the need for paraprofessional train-ing to be nearly as great. Still others report that evenwhere training exists, paraprofessionals report need-ing more or different training opportunities.Specifically, Whitaker (2000) found that half of theschool districts surveyed (43) employed paraprofes-sionals to work with students with disabilities inoccupational education classes. Although 33% of thedistricts that employed paraprofessionals providedtraining, 94% of the coordinators and 93% of theparaprofessionals reported that more training wasstill needed. The coordinators and paraprofessionalsrated highly the need for training in job coaching,behavior management, and knowledge of studentswith disabilities. Often times, districts may offertraining, but it is not the information needed byparaprofessionals. It is important to provide profes-sional development opportunities that aremeaningful and that provide an authentic opportu-nity for paraprofessionals to gain knowledge andskills specific to their jobs and the students withwhom they work.

Some states have established a career ladderapproach to the recruitment, preparation, and ongoing development of paraprofessionals. The ideais to recruit high school students into two-year pro-grams leading to paraprofessional preparationand/or continued development ultimately leadingto a teaching certificate. A person might work on acertificate of competence, a specified diploma, a two-year degree, then matriculate to a 4-year programand pursue a teaching certificate. The recruitment of




paraprofessionals into the teaching profession mighthave a substantial impact on the current and futureteaching shortage, but strategies for recruiting para-professionals are important in their own right andmust be identified. The paraprofessional workforceis a legitimate educational employee group thatmust be prepared for its changing and growingresponsibilities. The career ladder model provides apotentially sustainable infrastructure for paraprofes-sional preparation.

The recruitment of paraprofessionals into the

teaching profession might have a substantial

impact on the current and future teaching short-

age, but strategies for recruiting paraprofessionals

are important in their own right and must be

identified.

There are a number of guiding principles thatmight be used in designing preservice and inservicetraining for paraprofessionals. For example, the fol-lowing might be considered as individuals developparaprofessional preparation and training opportu-nities: (a) The training should be aligned with a setof competencies and standards of performance; (b)training can take on many formats, and some aremore important than others for teaching certainskills; (c) training should be comprehensive in itsapproach, allowing for various types of opportuni-ties and including specific instruction regarding theneeds of the students with whom the paraprofes-sional works; (d) training opportunities should bebuilt into a sustainable infrastructure to allow forongoing paraprofessional development; (e) an initialorientation to the school and its procedures and pro-grams must be followed with opportunities forongoing, targeted training and supervision; (f) train-ing teacher/paraprofessional teaming together onnew strategies offers the opportunity to discussappropriate implementation roles while learning thesame content at the same time; (g) when paraprofes-sionals have received specific skill training, it isimportant to follow-up and ensure that they imple-ment the skill correctly. Positive feedback is importantto ensure appropriate utilization of the skill.

Again, training and preparation is important,and it must be aligned with appropriate role expec-tations and day-to-day supervision.

Certification and Licensure There is substantial agreement that paraprofession-als play an important role in educating studentswith disabilities (French & Pickett, 1997; Giangreco,Edelman, & Broer, 2001; Hilton & Gerlach, 1997;Jones & Bender, 1993; National Joint Committee onLearning Disabilities, 1999; Pickett, 2000; Pickett &Gerlach, 1997; Wadsworth & Knight, 1996; Wallace,et al., 2001; Wolery, Werts, Caldwell, Snyder, &Liskowski, 1995). Regardless of paraprofessionals’backgrounds and roles, training is a critical elementin effective employment and retention (Frith &Lindsey, 1982; Pickett, 2000; Pickett et al., 1993; Riggs& Mueller, 2001; Wallace et al., 2000). However,despite agreement on the need for paraprofessionaltraining, many local and state education agencies donot provide significant preservice or inservice train-ing (Blalock, 1991; Pickett, 2000; Rubin & Long, 1994;Riggs & Mueller, 2001; Wallace et al., 2000). Since the1997 Amendments to IDEA, a renewed interest indeveloping standards and certification has emerged.Several associations [Council for ExceptionalChildren (CEC), the American Speech, Languageand Hearing Association (ASHA), AmericanPhysical Therapy Association (APTA), and theAmerican Occupational Therapy Association(AOTA)] have established knowledge and skill com-petencies. CEC has competencies set for para-professionals and some states also have identifiedcompetencies or standards for paraprofessionals.Mullins, Morris, and Reinoehl (1997) report that sixstates have procedures for using paraprofessionals.

Currently ASHA, APTA, and AOTA require com-munity college AA degrees for certified therapyassistants. Nationwide, 249 community colleges offerAA degrees to OT assistants and PT assistants. In1997, ASHA recognized an AA degree for SLPassistants. In response to this recognition, there arealready 10 accredited programs and another 50 nearcompletion. Still others are in the developmentalstage. A review of NRCP records indicates that thereare approximately 198 community colleges that offereither two-year AA degrees or one-year certificateprograms to paraprofessionals working in inclusive



special and general education, bilingual/ESL, Title I,and early childhood programs. However, half of thestates, the District of Columbia, the Territories, TheBureau of Indian Affairs, and the Department ofDefense have not established standards and/orregulatory procedures for paraprofessional roles and responsibilities, preparation, and supervision(Pickett et al., 2002). Thirteen states have credential-ing systems, ranging from multilevel licensure/cer-tification credentials that define roles, training, andcareer advancement criteria, to one-dimensionalsystems, that do not specify role or training require-ments. Pickett et al. also report that 11 have chosento establish standards for paraprofessional roles.

A review of NRCP records indicates that there are

approximately 198 community colleges that offer

either two-year AA degrees or one-year certificate

programs to paraprofessionals working in inclusive

special and general education, bilingual/ESL, Title I,

and early childhood programs.

New legislative requirements will have animpact on certification and licensure across ournation. It is critical that constituents, includingpolicymakers in federal and state governments,administrators in state and local education agencies,personnel developers in two- and four-yearinstitutions of higher education, researchers,professional organizations, and others, align theirefforts to ensure an efficient and effective systemof preparation.

A Summary of Current IssuesThis section will summarize the issues alreadyaddressed as well as those not yet raised within theprevious sections. There are two remaining issuesthat must be acknowledged: supervision of parapro-fessionals and the efficacy of their work.

There has been increasing dialogue regardingwhether or not paraprofessionals have a positiveimpact on student achievement. This is a difficultquestion to answer because of the variables associ-ated with it. For example, in the highly publicizedSTAR (Student/Teacher Achievement Ratio) study,

investigators concluded that paraprofessionals didnot contribute to the students’ academic achieve-ment in the classroom. However, Finn (1998) alsoreported that the duties of the paraeductors were leftto the discretion of the teacher, who had received nospecial instructions. The STAR and many other stud-ies did not isolate and control for issues of trainingand supervision. Gerber, Finn, Achilles and Boyd-Zaharias (2001) used the STAR data to examinefurther the role of paraprofessionals—they use theterm “teacher aides”—and their impact on studentachievement. The authors, in general, found consis-tent achievement advantages associated with smallclasses compared to regular size class with a para-professional. However, these results must becarefully reviewed as the study looked at theachievement of the class in its entirety. Because paraprofessionals often work with individuals orsmall groups, the authors themselves state that it is a possibility that paraprofessionals may provideimportant attention and support to specific students,which could be reflected in their achievement data,but the effect of this support is lost when aggregatedwith the rest of the class. In addition, many parapro-fessionals reported not having job descriptions,orientation, or training. There are many variablesinvolved with the appropriate use and supervisionof paraprofessionals, and making statements aboutefficacy when these elements are left unclear seems abit unfair.

It is critical to carefully consider studies of para-professionals’ effectiveness. Satisfaction studies exist,but well-designed studies examining the relationshipbetween the role of paraprofessionals and studentachievement do not (Jones & Bender, 1993; Rubin &Long, 1994). In a review of the literature, Giangreco,Edelman, Broer, and Doyle (2001) concluded that lit-tle is known about the impact of paraprofessionalservices on students with disabilities, at least in partbecause more work is needed on the identification ofservice delivery models (e.g., program-based sup-ports and one-on-one support) that meet students’needs. Furthermore, extant research is often contra-dictory. For example, in a qualitative study ofone-aide-to-one-child service delivery, Giangreco,Edelman, Luiselli, and McFarland (1997) found thatthe aide’s continuous proximity to the child some-times diminished the benefits of one-to-one


attention. The authors suggested that attention begiven to the design and development of models ofservice delivery that do not focus solely on matchinga student with a paraprofessional. On the otherhand, Werts, Zigmond, and Looper (2001) found thatparaprofessionals’ proximity had a positive impacton the academic engagement of primary-aged stu-dents in inclusive settings.

Associated with the efficacy of paraprofessionalsand the appropriateness of service delivery is theissue of supervision. Wallace et al. (2001) found thatparaprofessionals most often reported a differencebetween the person responsible for hiring and evalu-ating their performance (an administrator) and theperson directing their day-to-day work with stu-dents (an educator). However, there is confusion inmany schools that leads to inappropriate expecta-tions and assignments, lack of communication, andlittle planning between educators and paraprofes-sionals. Several studies and opinion pieces haveaddressed the importance of supervision from asearly as that work of Ebenson (1966) and Blessing(1967), who both agreed that, given appropriatesupervision, paraprofessionals could performinstructional activities. Currently, legislation exists tosupport the need for supervision, and now teachersmust learn strategies for supervising paraprofession-als beginning in their teacher preparation programs(French, 2001; French & Pickett, 1997; Salzberg &Morgan, 1995; Wallace et al., 2001). In addition,administrators must promote effective instructionalsupervisory relationships and create infrastructuresthat reward teams.

The key issues are well summarized in a reportto the Office of Special Education Programs (OSEP),the IDEA Partnerships Paraprofessional Initiative (2001).In this report six overarching themes were identifiedby a cross-partnership (IDEA Partnerships, includingASPIIRE, FAPE, ILIAD and PMP) forum of 35 representatives of professional associations; highereducation; federal, state, and local agencies and special projects; and individual professional practi-tioners, paraprofessionals/assistants, and families.These individuals identified broad issues associatedwith the roles, supervision, and preparation ofinstructional and service teams in relation to the1997 Amendments to IDEA. The six issues include(a) confusion and misunderstanding about roles,

responsibilities and supervision of paraprofessionalsby teachers, administrators, and families; (b) lack ofclear federal, state, and local policies and standards;(c) need for consensus about who a paraprofessionalis and what a paraprofessional does; (d) inadequatetraining for administrators, teachers, and paraprofes-sionals regarding appropriate roles, responsibilities,and supervision; (e) inadequate opportunities forinstructional teams to plan, collaborate, and supportone another’s efforts; and (f) need for systematicinfrastructures and administrative support for train-ing, team collaboration/planning, and utilization ofappropriate practice. These six broad issues, coupledwith the need for identifying the efficacy of the para-professional role, represent the key issues supportedby the literature as well as by a national forum ofexperienced and informed individuals.

There is confusion in many schools that leads to

inappropriate expectations and assignments, lack

of communication, and little planning between

educators and paraprofessionals.

Implications for Research While the list of current issues surrounding the paraprofessional workforce is not short, it has a cor-responding list of possible solutions. These solutionswill come about through a variety of avenues. Thefollowing research and development ideas will facili-tate improvement: (a) efficient and accurate systemsfor identifying information about the paraprofessionalworkforce must be designed and implemented; (b)well-designed research must examine the relation-ship between paraprofessional behaviors and theacademic engagement and achievement of students;(c) models of paraprofessional support that demon-strate alignment among standards for roles,preparation, and supervision must be developed andevaluated; (d) research must occur to understand thefactors associated with the successful collaborationand coordination among general educators, specialeducators, and paraprofessionals in the support ofstudents in inclusive educational settings; (e) exami-nation of recruitment and retention strategies must




be undertaken to identify those that lead to success-ful paraprofessionals; (f) appropriate examination ofthe factors (training, supervision, duties, planningtime) associated with the successful use of parapro-fessionals must occur; (g) examination of howteachers work with paraprofessionals in terms ofadministrative, instructional, and noninstructionaltasks must occur; (h) infrastructure to support thepreparation and ongoing development of parapro-fessionals (including preservice and inservicetraining, career ladders, etc.) must be evaluated foreffectiveness; (i) knowledge and skill competencies,and corresponding training approaches must beevaluated to determine those leading to competentparaprofessionals; and (j) models must be developedthat lead to the preparation of administrators andteachers who effectively supervise and direct thework of paraprofessionals. The importance of theparaprofessional workforce, the issues surroundingthis group, and the research and development activi-ties needed to develop solutions might best besummarized in the words of Daniels and McBride(2001):

In the final analysis, schools cannot adequately functionwithout paraprofessionals, and paraprofessionals cannotadequately function in schools that lack an infrastruc-ture that supports and respects them as viable andcontributing members of instructional teams.

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Storey, K., Smith, D. J., & Strain, P. S. (1993). Use of class-room assistants and peer-mediated intervention toincrease integration in preschool settings.Exceptionality, 4, 1–16.

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U.S. Department of Education, Office of Special Educationand Related Services. (1997). Nineteenth annual reportto Congress on the implementation of the Individuals withDisabilities Education Act. Washington, DC: Author.

U.S. Department of Education (1997). Roles of educationparaprofessionals in effective schools: An idea book.Washington, DC: Author.

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Wallace, T., Bernhardt, J., & Utermarck, J. (1999).Minnesota paraprofessional guide. Minneapolis, MN:Institute on Community Integration, University ofMinnesota.

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Wallace, T., Stahl, B. J., & McMillan, W. B. (2000). Statusreport: Preparation and supervision of paraprofessionals inMinnesota. St. Paul: Minnesota Department ofChildren, Families, & Learning.

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About the AuthorTeri Wallace, Ph.D., is the Director of the NationalResource Center for Paraprofessionals Institute onCommunity Integration, College of Education andHuman Development, University of Minnesota,111A Pattee Hall, 150 Pillsbury Drive, SE,Minneapolis, MN 55455. E-mail: [email protected].


CASE IN POINT:Related Service Personnel Are ImportantEducation Team Members

Bill East, Ed.D.National Association of State Directors of Special Education


The highly qualified teacher language in the NoChild Left Behind (NCLB) amendments to the

Elementary and Secondary Education Act of 1965has elevated the discussion of the importance ofhighly qualified teachers in the teaching/learningprocess to a new level. No one would argue that aquality teacher makes a difference. In special educa-tion, other service providers can have a significantimpact on the quality of the education provided andthe results achieved as well. Related service person-nel are key to the individual success of students withdisabilities and to the overall success of school, dis-trict, and state accountability for results. Relatedservice personnel are important, not just becausethey are required by the Individuals with DisabilitiesEducation Act (IDEA), but because these servicescan reduce and sometimes eliminate academic andnonacademic barriers to learning. Education admin-istrators, teachers, and parents must be aware of theconnection these services have to learning, and valuethe related service provider as an important part ofthe teaching/learning team in the schools.

Related service personnel are key to the individual

success of students with disabilities and to the

overall success of school, district, and state

accountability for results.

The paramount concern for the nation’s educa-tion system is the provision of quality serviceproviders in every educational environment. It’s notgood enough to accept anything less, because allchildren are important and all of them can learn tohigh standards. With that said, what about relatedservice providers? Should not excellence be thenorm for them as well? Should not sufficient num-

bers of these professionals be available too? Ofcourse, the answer is yes, but many barriers chal-lenge states and local communities in ensuring thatsufficient numbers of personnel are recruited,trained, employed, supported, and rewarded. Theauthors providing articles for this issue of the Journaladdress many of these barriers and challenges.Whether the service is audiology, occupational ther-apy, physical therapy, speech-language pathology, orthe paraprofessional, the needs are great, the chal-lenges are many, but the solutions to providing goodschool-based services are similar. Rapport andWilliamson provide an excellent summary in thisissue of what the researchers are telling us aboutschool-based services. Policymakers and administra-tors should listen and take action. The followingrecommendations are a partial list of suggestions toconsider in the provision of school-based related services:• Some, but not all, related service personnel

should have adequate preparation for providingschool-based services and services for veryyoung children. Preparation programs thatinclude coursework and practicum experiencesin working with young children will better pre-pare related service professionals for work inschool and clinical settings.

• Exercising the same vigilance with related ser-vice personnel used when recruiting and hiringteachers will guarantee that all staff are highlyqualified.

• To attract qualified applicants, schools shouldconsider hiring bonuses, higher salaries, andother incentives consistent with conditions in theprivate sector.

• Taking full advantage of the multidimensionaltraining and abilities of related service personnel


will produce positive educational outcomes forstudents and instructional support for teachers.

• Providing environments conducive to learning isessential. Related service personnel, with neces-sary supports, can help teams effectively bridgeacademic and non-academic areas, enhancing theeducational results of all students.

• Because there is often no critical mass of peerswith whom to interact, it is important to provideopportunities for related service personnel toreceive appropriate on-going professional development.

• Paraprofessionals will feel valued as key educa-tional team members when they are supportedwith higher salaries, appropriate training, andadvancement opportunities such as career ladderprograms.

• Sometimes services such as audiology, speechtherapy, OT and PT are seen as “special” to par-ents when compared to the classroom instructionevery child receives. Consideration should begiven to using related service personnel to facili-tate greater parent participation in planningservices for their child with special needs.

• As related service fields consider increasing cre-dentialing requirements for the entry point totheir professions, it is important for policymak-

ers and school-based administrators to beincluded in the discussion. While strengtheningcredentials is important and desirable, the avail-ability of school-based services must be in reachof students who require them.

As you read the articles on related services inthis journal, consider how the appropriate use ofrelated service personnel can enhance the educa-tional results of students with special needs. As thesolutions to students’ needs are addressed by NoChild Left Behind and IDEA, the most importantanswer is the provision of highly qualified and sup-ported personnel. While the focus at this time is onteachers, consider that other members of the educa-tion team are extremely important for students withspecial needs. Related service personnel deserve ourattention and our support.

About the Author Bill East, Ed.D, is the executive director for theNational Association of State Directors of SpecialEducation (NASDSE), 1800 Diagonal Road, Suite320, Alexandria, Virginia 22314. E-mail: [email protected]

Related Service Personnel Are Important Education Team Members


Manuscript Guidelines and Editorial PoliciesThe Journal of Special Education Leadership, publishedby the Council for Administrators of SpecialEducation, seeks articles that capture an administra-tor’s attention by providing useful information thatstimulates new ways of thinking about managingand leading. Only articles that have been validatedand accompanied by accepted theory, research, orpractice are sought.

The Journal of Special Education Leadership’s goals are:1. To provide fresh ideas and perspectives,

grounded in recent advances in administrativetheory and research, on contemporary issues thatadministrators must face.

2. To become a primary source of useful ideas forthose who seek to educate present and futureadministrators of special education programs.

3. To become a forum through which practicingadministrators of special education programscan challenge the meaningfulness of translationsof administrative theory and research.

Contributors to each issue will include practicingadministrators, researchers, policymakers, or othersinterested in special education administration. Thepurpose of this arrangement is to encourage interac-tion among individuals within those roles in devel-oping articles. Interactions may include any of thefollowing: a jointly authored manuscript, an inter-view preceded or followed by commentary writtenby the interviewer, and a follow-up article that isspecifically linked to the theory and/or research article that provides examples from the field andimplications for administrators in similar situations.

A typical article might begin with a brief caseillustrating the primary theme or posing certainquestions and issues that special education adminis-trators need to address. A typical article will alsosatisfy the academic reader who seeks more thanjust opinions and wants to see a serious effort atconnecting ideas to accepted theory and research.

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Call for Papers


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67Journal of Special Education Leadership 16(2) • November 2003

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Volume 17, Number 1April 2004

Journal of

SpecialEducation

LeadershipThe Journal of the Council of Administrators of Special Education

A Division of the Council for Exceptional Children

What Do We Know and What Do We Want to Know About RelatedServices Personnel?........................................................................................................3—Mary Jane K. Rapport, PT, Ph.D., and Pamela Williamson, M.A.

Personnel Issues in School-Based Therapy: A Look at Supply and Demand,Professional Preparation, Licensure, and Certification ................................................7—Mary Jane K. Rapport, PT, Ph.D., and Susan K. Effgen, PT, Ph.D.

Occupational Therapy in School-Based Settings ........................................................16—Yvonne Swinth, Ph.D., OTR/L, Barbara Chandler, MOT, OTR, Barbara Hanft, M.A., OTR, FAOTA, Leslie Jackson, M.Ed., OT, and Jayne Shepherd, M.S., OTR

Personnel Preparation and Credentialing in Speech-Language Pathology ................26—Kathleen A. Whitmire, Ph.D., CCC-SLP, and Diane L. Eger, Ph.D., CCC-SLP/A

Audiology Services in the Schools ..............................................................................33—Susan J. Brannen, M.A., CCC-A, Nancy P. Huffman, M.S. Ed., CCC-A/SLPJoan Marttila, M.A., CCC-A, and Evelyn J. Williams, M.S., CCC-A

Paraprofessionals in Schools: Topics For Administrators............................................46—Teri Wallace, Ph.D.

CASE IN POINT: Related Service Personnel Are Important EducationTeam Members..............................................................................................................62—Bill East, Ed.D

Articles