Procedures for the use of Speech Sound Severity Rating Scale:
Rationale/Purpose:
The Speech Sound Production Severity Rating Scale is to be used as a tool after a complete
assessment of the student’s sound production performance. The scale is designed to assist the
examiner with interpretation and documentation of the results of assessment findings in terms of
severity or intensity. This is not a diagnostic instrument and should not be used in the absence
of assessment data. In order to be identified as a student with a speech impairment, the
deviation(s) in sound production must be determined to have an “adverse effect on educational
performance.” The rating scale serves the following purposes:
i). to document the absence or presence of a speech sound production deviation and to what
degree (Mild, Moderate or Severe).
Articulation impairment is the “atypical production of speech sounds…that may interfere
with intelligibility” (ASHA, 1993, p. 40). Errors in sound production are generally
classified as motor‐based or cognitive/linguistic‐based (Bernthal and Bankson, 1988).
Motor‐based errors are generally called articulation impairments; cognitive/linguistic‐
based errors are referred to as impairments of phonological processes. While some
practitioners classify phonological process errors as language impairments, for purposes
of these guidelines they are included, along with articulation impairments, under the
category of phonology. An articulation impairment does not exist when: (1) sound errors
are consistent with normal articulation development; (2) articulation differences are due
primarily to unfamiliarity with the English language, dialectal differences, temporary
physical disabilities or environmental, cultural or economic factors; and, (3) the errors do
not interfere with educational performance.
ii.) To indicate the absence or presence of “adverse effect on educational performance.”
“Educational performance” refers to the student’s ability to participate in the educational
process and must include consideration of the student’s social, emotional, academic,
and vocational performance. The presence of any deviation in speech sound production
does not automatically indicate an adverse effect on the student’s ability to function
within the educational setting. The deviation must be shown to interfere with the
student’s ability to perform in the educational setting. The effect on educational
performance is, therefore, best determined through classroom observations, consultation
with school-based and Professional Service Provider teams, and interviews with parents
and the student. Teacher checklists are also useful for determining specifically how the
sound production problem affects educational performance.
Procedure:
1. Use the Communication Scales’ matrices to rate the student’s communication in all areas.
Identify and circle the scores in each row of a scale. Since scores in each row contribute to
the total score, it is necessary to determine a score for each individual subscale. For
example, sound production, formal assessment, stimulability, intelligibility, oral motor
structure and function, and adverse effect on educational performance/communication are
all weighted in importance in the determination of impairment. Do not alter these weighted
scores. For example, do not score intelligibility as a “7” or stimulability as a “2.5”.
No zeros (0) are to be used on these scales. No 2-3 or 3-4 ratings shall be used.
2. All of the individual ratings of the subscales in the matrix should be summed to determine
the final overall severity rating.
Rating Score
Rating of 1 =
Rating of 2 =
Rating of 3 =
Rating of 4 =
Descriptor
Within Normal Limits
Mild
Moderate
Severe
3. The overall rating is used to guide service delivery options and determine a student’s rank
in overall caseload when prioritizing for service delivery. The model of service delivery
should be based on the needs of the student, ensuring the least restrictive environment,
access to the general education curriculum and/or appropriate age‐related activities, and
reasonable educational benefit from services.
4. Variance in Determining the Overall Rating
During the evaluation process the SLP determines the Overall Rating based on assessment
results and the Rating Scales. At the referral intake and review meeting, the SLP, in
collaboration with the Multidisciplinary Team, may use professional judgment to add or
subtract one rating point from the Overall Rating. The Multidisciplinary Team may consider
the following: student attendance, cognition, rate of progress, response to interventions,
cultural and linguistic differences, or other environmental or neurological factors. The use of
the variance should be considered only during the referral meeting so that all team members
are able to discuss the factors involved and the decision can be finalized.
Intervention Definitions:
Tier 1 Intervention – Classroom strategies and activities that are appropriate for whole
group, small group, individual or within peer group settings. May include cues, prompts,
scaffolding ideas, games, resources and explicit instructional lessons. Appropriate for
most students with a speech impairment, especially those that are stimulable for sound
production and working toward “carryover” or generalization of treatment gains. Tier 1 can
and may include classroom-based contact with the SLP/SLPA.
Tier 2 Intervention – Indicates direct treatment from an SLP/SLPA. Majority of
intervention will occur in small group or individual setting. Data collection and progress
monitoring will be consistently and meticulously kept to guide further treatment decisions.
Homework will be provided intermittently and home programming is available upon
request.
Tier 3 Intervention - Indicates direct treatment from an SLP/SLPA. Majority of
intervention will occur in small group or individual setting. May occur in addition to Tier 1 &
Tier 2 interventions (simultaneously). Interventions will be more involved or intense than
Tiers 1 or 2. Service Delivery Variables from Tier 2 intervention that may be
manipulated/increased include: Frequency of intervention, Duration of intervention,
Duration of Session, Continuum of support, and Stakeholders/interventionists involved.
Data collection and progress monitoring will be consistently and meticulously kept to guide
further treatment decisions. Homework will be provided intermittently and home
programming is available upon request.
Minimum Service Requirement – Equates to 1 unit of treatment. 1 unit is equivalent to a
“block” of treatment. Considering a block length of 6 calendar weeks with a schedule of 2
sessions per 6 day cycle, the average student is seen for treatment 9 times within a block.
If treatment is not run on a block schedule, 9 sessions also equates to once per month
based on the school calendar (with September start-up and June wrap-up). Minimum
session length is 20 minutes.
Service Delivery Variables: Factors that may be added or changed to increase the
power of interventions. Service variables include:
i.)
Frequency of contact – daily, bi- weekly, weekly, bi-monthly, monthly
ii.)
Duration of Contact – Session length: 20 minutes, 30 minutes, 40 minutes
iii.)
Duration of Intervention – 6 weeks, 8 weeks, 12 weeks, semester, year
iv.)
Stakeholders/interventionists – SLPA, SLP, Student Support Teacher,
Classroom Teacher, Educational Assistant, Professional Service Providers,
Parents.
v.)
Continuum of Support – Power of intervention, research base of
intervention, level of cueing, prompts, materials and resources, scaffolding
used/needed during intervention.
Speech Sound Treatment Service Delivery Guidelines
Rating:
Descriptor
Service Requirement:
Overall Rating of 1 Within Normal No Direct service delivery;
Limits
Tier 1 activities MAY be recommended.
** Home program MAY be available upon
request for all severity ratings.
Overall Rating of 2: Mild
Tier 1 Intervention: (as above) +
Impairment
Tier 2 Intervention: (Minimum Service
Requirement of 1unit of treatment - 1 block
of Direct service or 9 sessions)
Homework provided for all students
receiving direct service
Overall Rating of 3 Moderate
Tier 1 Intervention +
Impairment
Tier 2 Intervention: (MSR of 1 unit of
treatment – as above) +
Addition of 1 Service Variable. Further
service determined by data & progress
monitoring.
Overall Rating of 4: Severe
Tier 1 Intervention +
Impairment
Tier 2 Intervention: (MSR of 1 unit of
treatment) +
Addition of 2 services variables.
Tier 3 may be necessary (As indicated by
progress monitoring data).