New York State Speech-Language-Hearing Association
Comment Regarding the Proposed Rulemaking for the Early Intervention
Program
May 7, 2010
The New York State Speech-Language-Hearing Association made significant public comment
regarding our concerns about the proposed changes in the regulations governing the Early Intervention
program. We continue to remain very concerned that the proposed criteria for initial and continued
eligibility for communication services will exclude some children with significant delays from receiving
critical EI services. In addition we strongly recommend that the current practice of utilizing personnel
who have only a bachelor’s degree in communication disorders be discontinued because the individuals
do not have any direct clinical experience, professional course work or clinical practice hours in working
with children under the age of three. In addition we remain very concerned that children with feeding
disorders, which may be severe, will not qualify for EI services.
As always our concerns and recommendations on the proposed regulations are intended to ensure
that disabled children receive the EI services they need from the highest qualified providers and that
access to quality services is preserved.
Eligibility for Communication Services
We continue to be concerned that children ages birth to three with speech-language disabilities
are being held to a different standard than children with disabilities in other domains. It appears to be
discriminatory to require a different and a more severe level of disability for children with
communication-only disabilities at a time when the American Speech-Language-Hearing Association is
indicating that current data on “later talkers” shows that these problems do not resolve on their own. The
new research indicates that children with speech impairments are more likely to have reading and social
problems later. “We know the earlier the intervention, the better the brain can reorganize.” (Dr. Diane
Paul-Brown, director of clinical issues, ASHA)
In addition, in the field, it has been the experience of many providers that Early Intervention
Officials and county-employed service coordinators do not accept informed clinical opinion or reference
to the clinical indicators as described in the Clinical Practice Guidelines for Communication Disorders to
assist in determining eligibility, making it a greater concern that children with speech and language
disorders will not have access to needed services. Many service coordinators are not aware of the
enhanced surveillance as outlined in the Clinical Practice Guidelines and will accept children as eligible
or not eligible, losing the opportunity to follow children over a period of time to better assess the need for
communication services.
We also continue to have grave concern for children with feeding and swallowing disorders.
When these children have severe feeding needs but lack other developmental delays the feeding disorder
alone will not create enough of a delay to pull down the motor domain to a level of eligibility. Children
with G-tubes due to previous medical problems and children with food refusal may not have a significant
developmental delay in a domain and they will not qualify for services. Is it the intention of the
Department to have these infants and toddlers be ineligible for EI services? Children with Childhood
Apraxia of Speech , a speech motor disorder the severely impacts a child’s ability to speak will not be
eligible to receive speech therapy services through the Early Intervention Program because it impacts
expressive language and will not meet the eligibility standard. These children generally require many
years of speech therapy services to speak intelligibly and the best progress is for children who receive
therapy to communicate effectively as early as possible. Children with syndromes, such as Prader-Willi,
have an abundance of expressive language but have severe delays in receptive language, thus, making
standardized evaluations invalid.
Continuing Eligibility
A child with a communication disorder at 1 Standard Deviation below the mean would still be
functioning well below the expected level as same aged peers. A child with less than 1 standard deviation
below the mean when a child’s age is counted in months can translate to years when a child’s age is over
3 years of age. This form of criteria is less valid for younger children. To drop a child with a history of a
communication disorder from EI when the child has only partially improved puts them at a high risk for
continued delay as they will not be able to achieve skills in a normal range without continued support.
Some municipalities required formal testing scores every six months (which is not consistent with
practice standards). When children make mild progress they may “test out” of eligibility within a few
months of services being started and this is not a valid criterion for discharge from speech therapy
services. If the EIP has billed the family’s insurance they may have used the entire benefit available for
the family leaving the family with no means to access speech therapy for their child.
Use of TSSLD/TSHH
NYSSLHA continues to oppose the use of individuals who do not hold nor are eligible for a
license in NYS as a speech-language pathologist. The teaching credential issued by NYSED
(TSSLD/TSHH) does not extend to the birth to three population; it only extends to children 3 years of
age. EI is not a school setting as is the intended use of the TSSLD and TSHH credential and has no
validity in the birth to three population. A child who has been identified as having -2 standard deviation
performance in the communication domain is not a child who requires language enrichment but a child
who qualifies for and is in need of speech and language therapy by a qualified speech-language
pathologist (originally PL94-142 stated speech therapy can be delivered only by a speech-language
pathologist). The TSSLD/TSHH has no experience to deal with delays caused by severe medical
conditions such as Cleft Palate, Pierre Robin, Cerebral Palsy, Prader-Willi and Autism Spectrum
Disorders. Providing special instruction is not providing speech and language therapy and the child is
being denied access to the appropriate service by the appropriate professional.
Personnel who have a bachelor’s degree in communication disorders and initial certification have
no EI-related coursework or clinical practicum hours working with children under the age of three.
In fact, the teacher certification program is geared toward preparing students to work in a public school
setting with minimal relevance to treating children age birth to three. Despite the lack of relevant
coursework and clinical experience, they are permitted to provide EI services in the community if
employed by an agency -- even if they are fresh out of undergraduate school. I have submitted charts with
this testimony that compare coursework and clinical requirements at the bachelor and masters level.
NYSSLHA would also like to emphasize that the current EI standards are less restrictive than
the 4410 program regulated by the State Education Department (SED). Under 4410, the TSSLD and
TSHH work as employees and provide services in a school program. They are not allowed, even as an
employee, to provide professional services in a community setting. Again, in the EI program, the TSHH
and TSSLD are providing services to children in the community with no immediate supervision and no
experience or clinical practice hours in providing care to children under age three.
In addition, the American Speech-Language-Hearing Association does not accredit the bachelor’s
level programs and does recognize the TSSLD or TSHH as a viable credential for the practice of speech
and language therapy. New York only recognizes the TSSLD/TSHH credential for the provision of
speech therapy services by employees working in an exempt setting (schools serving children age three to
twenty-one and government employees are the only exempt settings.) However, children from three to
five serviced outside a school setting must be treated by an individual that possesses a NYS
license in speech-language pathology. Under current State Law, any individual who is contracting
to provide services in speech-language pathology must have a New York State license in speechlanguage pathology as required when engaging in private practice and when third party billing
occurs.
There is no rationale for placing new, stringent work experience requirements on the highest
qualified providers, and continuing to allow inexperienced, untrained individuals to provide care to
disabled children.
Referrals Based on Medical/Biological Risk Factors
NYSSLHA is concerned that the language regarding referrals for children with possible hearing
loss continues to not be inclusive enough to insure that children at risk for a hearing loss will be referred
to the Early Intervention program. We recommend that the proposed regulations be modified to read:
Suspected hearing impairment (e.g. delayed speech-language development, suspicion based on gross
screening measures) or risk of hearing loss based on familial history, syndromal presentation, or failure of
new born infant hearing screening for which follow up testing has not yet been conducted.
If you have any questions or would like additional information, please contact the NYSSLHA office at
(518) 786-0947.