Interministerial Guidelines for the Provision of Speech and Language Services (as applicable to the Education Act)

September 1988

Ministry of Education
Ministry of Health
Ministry of Community and Social Services

This document supersedes the Guidelines for the Provision of Speech and Language Services, June 1985, and the references to speech and speech pathology/therapy in the document, Policy/Program memorandum No. 81, July 19, 1984.

• Purpose of the Interministerial Guidelines
• Introduction
• I. Basic Principles
• II. Development of a Local Service Delivery Model
• III. Determining Responsibility for Service Delivery
• IV. Conflict Resolution
• V. Service Review

Purpose of the Interministerial Guidelines

The following information is provided as a guide for the use of school boards; local Home Care Programs and Agencies of the Ministry of Health; and, Facilities for the Developmentally Handicapped, Schedule I and II (hereafter referred to as Facilities) and Children's Mental Health Centres (hereafter referred to as Centres) funded by the Ministry of Community and Social Services, in the provision of speech and language services for pupils who are enrolled in and attending publicly-supported schools (hereafter referred to as pupils).

Introduction

Program/Policy Memorandum No. 81, Provision of Health Support Services in School Settings, was issued on July 19, 1984. The interministerial agreement represents the Ontario Government's commitment to ensure that all pupils with special needs receive the support services required to benefit from an educational program.

The agreement represents a sharing of responsibilities by the Ministries of Education, Health, and Community and Social Services. Furthermore, it requires the direct provision of services at the local level by school boards, Home Care Programs, Agencies, Facilities and Centres operating under the aegis of the Ministries of Education, Health, and Community and Social Services, respectively.

In June 1985, Guidelines for the Provision of Speech and Language Services, a further interministerial agreement approved by the Ontario Cabinet, described the sharing of responsibility for the provision of relevant services so that the speech and language needs of all pupils with communication disorders could be addressed through the co-ordinated services of school boards, Home Care Programs, Agencies, Facilities and Centres.

In June 1987, the Interministerial Advisory Committee on Speech and Language Services, including representation from speech and language professionals and associations, was reconvened. The advisory committee reviewed data from various sources, modified the original guidelines and submitted the revised guidelines for approval of the three ministries.

The guidelines are published to assist in decision-making, at the local level, by providing direction to school board, Home Care Program, Agency, Facility and Centre personnel to determine their responsibilities in the provision of speech and language services in a co-operative mode.

The contributions of all who participated in the review process and in the development of the revised guidelines are gratefully acknowledged.

The revised guidelines are approved by the Ministries of Education, Health, and Community and Social Services.

I. Basic Principles

The following basic principles are essential to the understanding of the provision of speech and language services:

1. The responsibility of parents to work together with school boards and other service providers to facilitate the provision of required services is acknowledged.

2. Where a child is receiving speech and language services upon being enrolled in a community school, it is expected that local Home Care Program, Agency, Facility or Centre personnel, in co-operation with the parent(s), will liaise with school-board staff to share information and, where appropriate, to ensure a smooth transition of the speech and language program to the local school setting.

3. The implementation of the guidelines does not preclude the provision of speech and language services by other established sources of service to pupils who are enrolled in schools, for example, hospitals or Children's Treatment Centres.

4. Where speech and language needs have not been assessed prior to school entry and before making a referral to the Home Care Program or to other service providers, it is the responsibility of a school board, within its early identification process, to develop and implement strategies to:
   1. determine a pupil's communication needs and, where appropriate,
   2. make a referral to the local Home Care Program or to other community resources.

5. When addressing the educational needs of pupils with various communication disorders, school boards should provide a comprehensive language and speech program. This program should utilize a spectrum of professional and trained support personnel through a co-operative, interdisciplinary approach.

6. School boards will provide services for pupils with communication disorders, where such services are an appropriate part of the pupil's educational program.

7. School boards may continue to purchase speech and language services from other service providers, for example, other school boards, hospitals, Agencies and Centres.

Co-ordination and monitoring are essential to the complete and efficient provision of speech and language services by the various service providers within local communities. It is expected that school boards will assume leadership to facilitate the development, co-ordination and ongoing monitoring of speech and language services for pupils who are enrolled in their schools.

II. Development of a Local Service Delivery Model

It is expected that school boards, local Home Care Programs and Agencies of the Ministry of Health and Ministry of Community and Social Services Facilities and Centres will:

• be mutually supportive in the provision of speech and language services
• employ or contract appropriately trained staff to provide assessment, treatment and programming
• develop a co-operative model for providing speech and language services within the community, in accordance with the basic principles and proposed service delivery model described herein.

School boards should provide leadership in the development of a local service delivery model by initiating regular meetings with local Home Care Programs, Agencies, Facilities and Centres to co-ordinate and monitor services.

Where it is determined that speech and language services are the responsibility of the Ministry of Health and that these services must be provided within the school setting, such services will be requested by the school principal and provided through the local Home Care Program, in accordance with established procedures. Staff providing services through the Home Care Program shall liaise closely with appropriate school board personnel. Where services are not provided through the Home Care Program, service providers are encouraged to liaise with appropriate school board personnel.

The attached model describes the responsibility of school boards, Home Care Programs and Agencies of the Ministry of Health, and Facilities and Centres of the Ministry of Community and Social Services in developing a local service delivery model. Service providers are encouraged to modify and adapt the model to meet identified local needs.

III. Determining Responsibility for Service Delivery

1. For those pupils who are admitted to treatment programs operated by the Ministry of Health and to Facilities and Centres funded by the Ministry of Community and Social Services, and who attend an educational program offered by a school board in the treatment setting, it is expected that the provision of speech and language services will be the responsibility of the Ministries of Health and Community and Social Services, respectively.

2. For those pupils, who are enrolled in publicly supported schools and who are not admitted to a treatment program identified in paragraph A above, the following information will guide the development of service delivery models at the local level.

   Language Disorders
   Language competence is an integral component of the classroom program. Therefore, school boards should be responsible for the assessment and provision of services for pupils with language disorders. These services are most effective when closely integrated with the classroom program, particularly with language problems associated with a learning disability, autism, intellectual and hearing impairment.

Non-Speech Communication
Assessment for, prescription of, and orientation to augmentative and alternate methods of communication for non-speaking pupils will be provided by the Ministries of Health and Community and Social Services, respectively. However, the ongoing development and use of these methods of communication in the educational setting must be part of the school program and the responsibility of school boards, with the support of Home Care Programs, Agencies, Facilities, and Centres of the Ministries of Health and Community and Social Services, respectively.

Articulation/Speech Sound Production
While it is recognized that articulation/speech sound production problems may be viewed as a dimension of language competence, the large numbers of pupils experiencing varying degrees of such problems make it necessary for local Home Care Programs and Agencies of the Ministry of Health and school boards to provide services, as follows:

1. a) Specialized assessments and programs for pupils with neuromotor speech disorders, such as dyspraxias and dysarthrias, should be the responsibility of the Ministry of Health.
   b) Other motor speech disorders requiring the support of a medical, habilitation or rehabilitation team should be provided by the Ministry of Health.

2. In cases where it is determined that the articulation/speech sound program should be part of the educational program, school boards are responsible.

3. In cases where it is not essential that the speech program be part of the educational program, school board or health staff may provide assistance, as determined locally.

Fluency Disorders
The provision of services for pupils with fluency disorders requires the availability of services and support programs within both the health and education sectors. Therefore, Home Care Programs, Agencies, and school boards should co-operate to develop and deliver diversified services to pupils with fluency disorders.

Where the fluency program is determined to be an integral part of the educational program requiring the support services available in the school setting, the school board should be responsible.

Voice Disorders and Resonance Problems
The need for assessment and monitoring by a medical team requires that pupils with voice disorders and resonance problems be served by Home Care Programs and Agencies of the Ministry of Health. This includes therapy needs associated with cleft lip and palate repair and velopharyngeal insufficiency.

Some pupils may require monitoring through the school program after a period of therapy. Monitoring should be provided by school boards, with the support of Home Care Programs and Agencies of the ministry of Health.

IV. Conflict Resolution

Where a pupil has multiple or complex needs, including speech and language, such as multiple-diagnosis, and there is a lack of agreement regarding which service agent is responsible, a supervisory officer designated by the local school board, the director of the local Home Care Program (or designate) and the area manager of the Ministry of Community and Social Services (or designate) will determine which local service provider will deliver and monitor appropriate speech and language services. Duplication of identical services and the provision of speech-language services by more than one speech-language pathologist to one pupil should be avoided.

Where local officials are not able to determine the respective role for each ministry or are unable to provide the required service, the case, supported by documentation, will be referred by the local school board to the appropriate regional office of the Ministry of Education. In seeking a resolution, the Regional Director of Education is expected to refer the matter to appropriate staff of the Special Education and Provincial Schools Branch, Ministry of Education. A mutually satisfactory resolution will be determined in consultation with officials of the Ministries of Health and Community and Social Services.

V. Service Review

An interministerial committee will monitor the implementation of the Interministerial Guidelines for the Provision of Speech and Language Services, September 1988 and conduct an annual review of service delivery.