Wayne A. Secord, Ph.D. is the Coordinator of School Speech-Language Pathology at The Ohio State University and a Summer Visiting Instructor at Northern Arizona University (NAU). An ASHA Fellow and Honours recipient, Dr. Secord is the author of countless articles, books, tests and intervention programs. He is also a co-author of CELF-5 – a critically acclaimed assessment tool designed to diagnose communication and language disorders, which is widely used by Speech-Language Pathologists in Australia. We sat down with Dr Secord to discuss the practice of speech pathology and the differentiating qualities that make clinicians truly great at what they do.
Speech pathology – a snapshot
The Australian Bureau of Statistics has reported that over one third (37 percent) of children aged 5-14 years have a sensory or speech impairment. This means that hundreds of thousands of school-age students with language-learning difficulties will continue to require the services of speech-language pathologists (SLPs) across the country.
For decades, SLPs (or speechies as they are affectionately known in Australia), have provided clinically based therapeutic services to students with disorders in communication, speech, and language. In the past, practice relied heavily on the ‘pull-out’ model where the student was taken out of class and assessed and treated in isolation within a specialised room.
Researchers have identified a number of issues with the ‘pull-out’ model. The main issue is that practicing therapy solely in isolation means that students cannot generalise their newly learned skills to the classroom where they’re truly needed.
Researchers are increasingly telling us that speech language services in a therapy room simply cannot effectively replicate interactions and activities commonly found in the classroom. Therapy carried out in this way can easily become decontextualised as the student struggles to make connections between what goes on in the therapy room and what needs to occur throughout the rest of the school day.
The aptly termed ‘push-in’ approach has gained more credibility in recent times. This approach is less clinical in nature and more education and curriculum-focused. The SLP works with the classroom teacher to infuse strategies into ongoing classroom instruction so that they are carried over throughout the school day and after the SLP leaves the classroom. This approach is more likely to ensure a carryover of newly learned skills in an educational setting.
What makes a speechie great (and not so great)?
Dr Secord strongly believes that the incorporation of classroom-based practice to therapy is one of the hallmarks of an excellent SLP.
“We did a lot of research on what makes really good clinicians really good and what we found is that when a child is not doing well in school, you have to get into practical, classroom-based assessment. When you do that right, you get a good idea of the things the student can’t do, say, make, or use – and if you can do that then you can gain an understanding of the things a child struggles with in context. The interventions that follow must be curriculum-focused and delivered in such a way that improved classroom performance is the primary target for all participants.“
The flipside to this approach is what Dr Secord and his colleagues call the ‘KC and the Sunshine Band approach’, inspired by the band’s famous sing-along song Get Down Tonight, but adapted to his theory “give a little test, do a little therapy, get down tonight”, where he observes that some clinicians are spending minimal time on therapy. In other words, according to Dr Secord it’s simply not enough to just spend two half hours per week treating a child one-on-one or in small group sessions away from the larger class group – after all, what’s two half hours per week given how many more hours per week there are for the child to stumble? According to Dr Secord, this traditional, isolated approach needs to be reevaluated.
That is not to say that the more clinical, or pull-out-type sessions must be completely eliminated – in fact the argument for the merging of pull-out and push-in approaches is reflected across the literature. Researchers maintain that the idea is not to get rid of the pull-out method, but to restrict these one-on-one group sessions to appropriate cases to best serve students’ needs. In other words, SLPs should tailor their intervention to each student. Dr Secord also backs this approach:
“Clinical measurements and their tests are good for diagnosing communication and language disorders – but the good people will think about how the results translate into what the student struggles to do in school. There needs to be an academic AND clinical endpoint for each and every student that is treated. You need to be doing a combination of therapies. You can’t just have a clinical target - if that’s your only target, the child will not make much progress at all.”
Team-based intervention is another approach Dr Secord holds close to his heart.
“Teamwork, practical goal setting, coaching others - all this stuff that I learnt in sports – these are also the things that make an excellent clinician. A good team of interventionists will focus on a few things at any given time and do them really well. This means the student gets better where it counts.” He said.
Dr. Secord emphasised time and time again, that it’s all about doing a few things, as a team, extremely well – as that’s what wins in sports and in schools.
Speech Pathology Australia’s Chief Executive Officer, Gail Mulcair, echoes the idea of the team-based component of this style of intervention. She maintains that it is crucial that the SLP develops an effective working relationship with the child’s teachers to maximise outcomes.
So what do we have so far? Excellent SLPs will develop an understanding of what a child struggles with in the context of the classroom. They will figure out how to do a few things really well so that the individual student can improve both clinically and academically, and they will do these things in collaboration with teachers and other specialists in schools. But according to Dr Secord, it’s not enough to set these systems up, dust your hands off and walk away.
“Excellence in speech-language pathology demands that you constantly reflect on what you do – not just clinical reflection, but context-based reflection. You need to constantly be asking yourself, are we, as a team, on course? Are things working? Are we making a difference?”
A carpenter is only as good as his tools and the same goes for speechies…
If SLPs are to implement clinical and classroom-based interventions designed to help a student strengthen their system and improve their school-based skills, assessment tools need to provide relevant, practical information for clinicians to work with.
Excellent assessment practices are a passion of Dr Secord’s and together with Dr . Wiig and Dr Semel he’s created a flexible, comprehensive assessment to help SLPs the world over diagnose speech and language disorders.
Clinical Evaluation of Language Fundamentals – Fifth Edition, or CELF-5 – is a comprehensive battery of tests built specifically on a model of school-age performance. The Australian version of CELF-5 was released in June 2017 and provides highly accurate diagnostic information with current Australian and New Zealand normative data, reflecting today’s diverse population. Dr Secord shared some of the practical components of the new assessment tool:
“A well-known college professor by the name of Jack D’Amico once said to me that it’s useless to try to build an idea of a kid based on standardised tests alone because they are based on a hypothetically average kid that doesn’t exist. So there’s a component on CELF-5 called ‘ORS’ (Observational Rating Scale) that is designed for the teacher to fill out the 10 issues they believe the child is experiencing – and that’s exactly where a good SLP will begin - by conducting a practical, classroom-focused teacher interview.”
It’s this section of the test that enables an SLP to hone in on precisely what the child struggles to do, say, make, and use in school. And in this fashion, CELF-5 allows an SLP to put their focus on both academic and clinical endpoints.
The Buros Center for Testing, an independent, non-profit organisation known amongst academics as the world’s premiere test review centre described CELF-5 as being ‘well-constructed’, ‘well normed’ and as possessing ‘strong psychometric properties’. Dr Secord is thrilled with the review, but knowing just how much research and work went into its creation, he is not surprised.
“The data obtained from its standardisation clearly shows how accurate it is in identifying students with disabilities in language and learning. The diagnostic accuracy of the test, or, its sensitivity and specificity, which is reported in the examiner’s manual, is 97%. SLPs love it because it’s easy to use and score, but best of all, it provides a solid picture of a student’s language abilities and clearly helps professionals identify school-age students in need of help.”
Australian speechies have been waiting more than 12 years for CELF-5, so how does it differ to the previous version?
“This is a more robust and targeted assessment – each test is stronger, more reliable and more of a powerful standalone test. We critically evaluated CELF-4 and deleted any tests that didn’t have the impact we wanted. But the biggest overall change is that we’ve put the focus on literacy. We really wanted the spotlight to be on reading and writing. It will do very well in Australia.”
The next generation of SLPs
Dr Secord is currently teaching ‘Language Disorders in School-Age Children and Young Adults,’ and ‘Phonological Development and Disorders’ at Northern Arizona University’s summer program. He says that his students become astute in the use of CELF-5 and skilled at completing practical classroom-based assessments. His main focus is fluency – teaching his students how to think with and in their newfound knowledge.
“I tell my millennials to forget about getting an A. Just because you get an a A, it doesn’t mean you’re going to be any good. I don’t want them to memorise facts. I take them through so many things that they become fluent in combining their test and measurement skills with practical observation, discussion, and interview techniques. We go over numerous case studies and talk them through over and over so that their clinical skills become increasingly automatic.”
According to Dr Secord, this is another pathway to greatness - people become good clinicians when they know what they are doing inside and out. And not just what they are doing, but what their team of interventionists is doing.
“A good SLP has excellent crossover knowledge – they have a knowledge of what they do and what teachers are doing in the curriculum. They know that the time spent with their student will have a result that improves him in school. These are some of the really outstanding points that make people great.”