Section One

Module 4: Standards and Requirements in Healthcare and Education

  • How can requirements for specific settings help my work in any setting?

  • After working with the material in this module, readers will be able to

    • recite from memory several key phrases from the National CLAS Standards (Office of Minority Health, n.d.)

    • recite from memory several key phrases from the Every Student Succeeds Act (ESSA, 2015)

    • explain the primary legal requirements for healthcare and education settings, with respect to the provision of equitable care and opportunities for all people

    • use the legal and professional requirements described in this module to evaluate professional behaviors related to culture, language, and identity in speech-language pathology

Module 3 addressed several universally applicable national requirements for the practice of speech-language pathology in the U.S., including federal civil rights law, ASHA’s Code of Ethics, and ASHA’s Issues in Ethics statement about cultural and linguistic diversity. Here in Module 4, we will consider two additional sets of requirements, one intended for healthcare settings and one intended for educational settings. Regardless of your usual work setting, you might find that the issues raised for healthcare and for the public schools can help you think about how you will choose to provide client-centered, culturally and individually appropriate care for all clients in all settings.

Culturally and Linguistically Appropriate Services in Healthcare: The National CLAS Standards

Speech-language pathologists and other professionals in healthcare settings follow the National Standards for Culturally and Linguistically Appropriate Services, or National CLAS Standards (Office of Minority Health, n.d.; Office of Minority Health, 2013), which were developed by the U.S. Department of Health and Human Services as a response to known inequities in healthcare and health outcomes for different groups of people in the U.S. (see Module 10).  

The original version of the National CLAS Standards, published in 2001, differentiated among its 14 standards by describing some standards as requirements, some as recommendations, and some as guidelines. After a comprehensive review and updating process completed during 2010-2012, the Office of Minority Health reiterated that the standards form a cohesive whole and that all standards are necessary, while also accepting that it was not feasible to require that all standards be met immediately in all healthcare settings. Thus, the current National CLAS Standards are presented officially as guidelines, not as regulatory requirements (Gracia, 2013; Office of Minority Health, 2013), but with an emphasis that all health, health-business, and health-care organizations should follow them and work toward them.

In many other ways, however, parts of the National CLAS standards are legally required in many healthcare settings. Federally funded healthcare facilities (e.g., Veterans Administration hospitals and all units administered by the Indian Health Services), for example, and all facilities and companies that receive Medicare, Medicaid, or other federal funds, must demonstrate their compliance with the concepts described in CLAS Standards 5 through 8, because of the overlap between these standards and the current implementation language and regulations related to the Civil Rights Act of 1964 (Gracia, 2013). Similarly, the Affordable Care Act (the ACA, the law often referred to informally as “Obamacare”) requires through its Section 1557 that all healthcare provided or funded by federal agencies in the U.S. must adhere to the comprehensive nondiscrimination provisions of current civil rights law and policy (see https://www.hhs.gov/civil-rights/for-individuals/section-1557/index.html). The Americans with Disabilities Act (the ADA), similarly, in its Title III, requires most public-facing entities, whether privately owned or publicly funded, to provide equal reasonable access to all persons, regardless of physical or mental ability; the “professional office of a health care provider” is explicitly included as covered under Title III. Requirements similar to many of the National CLAS Standards are also part of The Joint Commission’s current accreditation standards for healthcare facilities and providers (see The Joint Commission’s extended Requirement, Rationale, and Reference Report from 2022). In practice, therefore, given this comprehensive web of related laws, you may find your healthcare workplace referring to some or all of the National CLAS Standards as regulatory requirements or as requirements in your organization.

The current National CLAS Standards include 15 statements that are described briefly as “action steps” (Office of Minority Health, n.d.) and described more comprehensively as a “blueprint for health and health care organizations to implement culturally and linguistically appropriate services that will advance health equity, improve quality, and help eliminate health care disparities” (Office of Minority Health, 2013, p. 21). The Principal Standard (the first of the 15) provides a general guiding principle. The remaining 14 standards are divided into three groups, referred to as “themes”: Governance, Leadership, and Workforce; Communication and Language Assistance; and Engagement, Continuous Improvement, and Accountability. You may notice as you read about the standards in the next several paragraphs that the National CLAS Standards are short but not simple; they combine many concepts into efficient long-term goals. As you read, try thinking about the Standards as immediate requirements and also as aspirational and continually expanding goals for organizations and for individual practitioners.

The First Half of the CLAS Principal Standard: Effective, Equitable, Understandable, and Respectful

The first of the 15 National CLAS standards, referred to as the Principal Standard, sets multiple expectations for all organizations and all practitioners:

“Provide effective, equitable, understandable, and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy, and other communication needs.” (Office of Minority Health, n.d.)

Spend a minute trying to unpack this dense, efficient directive. What is “effective, equitable, understandable, and respectful” care? What does it mean for our work to be “responsive to diverse cultural health beliefs and practices, preferred languages…and other communication needs”? What is “health literacy”? Try writing down your own definitions before you read the next paragraphs. Can you link any of these terms to ideas from Modules 1 or 2, to the civil rights law we addressed in Module 3, or to ASHA’s requirements?

Ready for some possible answers? Let’s see what we can do.

Effective refers to meeting the goals we set with clients, assuming that the goals were well-formed, client-centered goals that addressed the clients’ needs. Effective therapy works to improve something that the client wanted improved, in the client’s real-life setting.

Equitable, as we addressed in Modules 1 and 3, refers to whether our work is as effective for clients from some backgrounds as it is for clients from other backgrounds. Equity, in this sense, might also be defined as providing fair opportunities; we cannot guarantee that any client will improve, but our work is equitable if people from all backgrounds can access our care and if our care is provided in a way that makes it equally likely that people from all backgrounds will improve.

Understandable adds another dimension to the requirements. The care we provide is understandable if clients can know how to find us, know what we are suggesting, know why we are suggesting it, comprehend our instructions and explanations, and make informed decisions with us as they work with us. The requirement that care should be understandable overlaps in many ways with the construct of health literacy, which we will address separately below.

Finally, we have used the word respectful already, including within our overall definition that client-centered culturally and individually appropriate care must recognize, respect, and respond to each client’s characteristics, identities, and needs (from the end of Module 1). Hofstede’s (2011) model of group dimensions and Morgan’s (1996) model of individual identities, also from Module 1, help here, too: Respectful care occurs when we remember that people can fall anywhere along many group and individual continua, that all places along the many defining continua are equally reasonable, and that all people deserve to be approached with the same recognition of their fundamental worth and dignity.

Effective, equitable, understandable, and respectful: The combination of these four words in the CLAS Principal Standard emphasizes that all clients deserve the care that the best-served client would receive, or that “dignity and quality of care are rights of all and not the privileges of a few” (Office of Minority Health, “What is CLAS?”). The CLAS Principal Standard requires healthcare organizations and practitioners, including speech-language pathologists, to provide care that all clients can access, that all clients can understand, and that is designed to meet each client’s needs in the context of their own lives. The words also support each other: Beginning from the mindset that we will respect all people’s lives, needs, choices, and journeys, for example, allows us to fight our human tendency to prefer the familiar or to rank differences as better or worse when they are merely different (see Module 2). From that starting point, it becomes obvious that of course we would seek to make care accessible to all people, understandable to them, and resulting in equitably effective outcomes for them, because choosing not to do so essentially ranks some people as more or less worthy of receiving high-quality care.

Reflecting on the CLAS Principal Standard might even lead us to view ASHA’s (2017, 2023) requirements or basic civil rights law in a slightly different light: We hold clients’ welfare paramount and provide competent services to all populations not because ASHA requires us to, or because the federal government requires us to, but because we cannot imagine any reason to do otherwise.

The Second Half of the CLAS Principal Standard: Health Beliefs, Health Practices, and Health Literacy

Did you also unpack the rest of the CLAS Principal Standard? In addition to being effective, equitable, understandable, and respectful, the care and services we provide must be “responsive to diverse cultural health beliefs and practices, preferred languages, health literacy, and other communication needs” (Office of Minority Health, n.d.). These terms are straightforward at one level, but they also deserve some thoughtful reflection.

“Health beliefs” and “health practices” are intertwined continua that encompass such issues as

  • beliefs about which foods, activities, and routines are considered healthy for people of different ages or genders;

  • beliefs about the causes of illnesses, accidents, and developmental and acquired conditions;

  • beliefs about how, when, why, and whether people should seek to change any illness or other condition; and

  • practices or behaviors through which people seek to act on their beliefs or to address their health or another person’s health.

Sometimes it is difficult to be fully respectful of healthcare beliefs and practices that differ from our own, in part because these beliefs and practices are often linked to the assumptions we absorbed from our own families. Depending on “who” you are from and “what” you are from (see the 16 Questions matrix, in Module 2), for example, you might know that the oldest people in a family have earned the right to be protected from the complexities of their health problems, and that the middle-aged members of the family have an accompanying responsibility to guard their elderly parents from traumatic information. If so, you might find it difficult to understand why a family would want their elderly parent to hear all of the details about what is happening and be part of making the decisions about their own care.

We also often find it difficult to fully accept other people’s health beliefs and health practices because of what we consider to be essential knowledge from religion, science, or both. If you are “from” or “in” (again see the 16 Questions matrix, Module 2) people who know that epilepsy marks a child as having special spiritual gifts, you will have a difficult time understanding the choices of people who see it as a neurological problem (spend a weekend reading Fadiman, 1997, if you don’t recognize this example). At perhaps less dramatic levels, we all make many smaller and larger decisions every day about how to care for our bodies, our minds, our children, and our elders. Our choices reflect our answers to all 16 Questions and reflect everything we believe to be healthy, as we define health for ourselves and the people we care about. Equally, we all seek the kind of medical, spiritual, physical, emotional, or social assistance that we believe to be appropriate for any particular issue, or as we believe fits the nature of that issue.

The requirement that we as clinicians are to be “responsive to diverse cultural health beliefs and practices” challenges us, in other words, to become aware of the health beliefs and practices that we have assumed or encountered along our own journeys. It challenges us to remember that our beliefs, practices, and ensuing decisions reflect only one point on a much broader continuum of possibilities (as we first considered in Modules 1 and 2 and will address throughout this website), and it challenges us to be able to consider the complexity of someone else’s answers to the 16 Questions.

Finally, the CLAS Principal Standard requires us to provide services that respect other people’s “preferred languages, health literacy, and other communication needs” (Office of Minority Health, n.d.). This phrase is related to the prohibitions against discriminating on the basis of race, ethnicity, or national origin, from civil rights law (see Module 3), and we will focus on questions of language and communication throughout these modules (including as we consider the Communication and Language Assistance theme of the National CLAS Standards later in this module). The concept of “health literacy” is also much larger than asking about a client’s languages or providing translated materials. Health literacy refers, broadly, to the abilities and systems that allow people to access, understand, interpret, and use health-related information to make decisions about their own health and healthcare in ways that maximize positive and equitable outcomes (see Brach et al., 2012; Nutbeam, 2008; Rudd, 2015).

Personal health literacy includes, as core elements, a person’s ability to read or to read any specific language. More importantly, however, the overall construct of health literacy recognizes that even people who read well cannot read, understand, or use information that is functionally inaccessible to them (Rudd, 2015). The client who finds a prescription leaflet dense with small print and complex terminology at the bottom of the pharmacy bag might be able to decode most of the words, but such texts do not constitute accessible, comprehensible information for most people. Sometimes people know most of the words but not the few critical professional terms; sometimes they interpret words related to possibilities or risks in different ways than the professional author intended (Franic & Pathak, 2000); often they simply do not have, and cannot reasonably be expected to have, the background knowledge or the ability to combine details that the professional has.

Organizational health literacy recognizes, therefore, that the responsibility falls to us, as the experts and the providers, to manage not only the language but also the complexity of the information and materials we provide to clients. Remember that, at best, only about half of adults in the U.S. read at an approximately middle-grades level or higher. Physically, many adults may not be able to see the fine print. Few of your clients have completed the same level of highly verbal education you have completed, much less completed the specialized training about speech-language pathology you have completed. Most clients approach healthcare information while they are fearful, anxious, or in physical or emotional pain, all states that will interfere with their ability to process complex information. And in speech-language pathology in particular, many of our clients are known to have difficulties with expressive or receptive language; that’s why they are seeking our assistance in the first place.

Responding appropriately to clients’ health literacy and communication needs, therefore, requires us to evaluate our own communication assumptions; draw on our skills as multimodal, creative, and empathetic communicators; assess clients’ health literacy abilities and scaffold their learning about all aspects of their options and their care, as we would scaffold their learning toward any specific clinical goal; and also evaluate the influence of any corporate-level or facility-level policies that might be influencing how we provide information to clients or support their decision-making (Rudd, 2015). In short, the CLAS Principal Standard’s focus on health literacy reminds us that we are responsible for ensuring that all clients receive and can use the information they need, as part of our overall responsibility to provide them with effective, equitable, understandable, and respectful quality care and services.

Your Turn

The CLAS Principal Standard requires us to provide “effective, equitable, understandable, and respectful” care. Which other adjectives belong in this territory and are also part of providing effective, equitable, understandable, and respectful care? (One of my key words tends to be “kindness.” What are your key words?)

Use the 16 Questions matrix from Module 2 to consider your decision-making for any health issue that you perceive as a serious medical concern. Then try to complete the matrix from any other point of view. How might a person whose life experiences differ from yours approach the necessary decision-making for this health issue?

Try searching online for information about the healthcare beliefs and practices of two or three cultural groups that you think of as different from yours. How would you need to change your clinical routines, if you were trying to provide effective, equitable, understandable, and respectful quality care and services for a child or an elderly person from that group?

National CLAS Standards 2 through 15

The remaining National CLAS Standards include 14 specific standards, action steps, or goals. Organized into three “themes,” these standards are intended to clarify the requirements of the Principal Standard.

The Governance, Leadership, and Workforce theme addresses culturally and individually appropriate care as a “systemic responsibility, requiring the endorsement and investment of leadership, and the support and training of all individuals within an organization” (Office of Minority Health, 2013, p. 12). As we will emphasize in Module 16 (based on Cross et al.’s 1989 models for healthcare agencies), organizations that seek to provide culturally and individually appropriate care must actively “promote CLAS” and emphasize health equity throughout all levels of the organization, from the leadership to all workers and including through “policy, practices, and allocated resources” (Standard 2). Organizations must also “recruit, promote, and support” both culturally and linguistically diverse workers and also culturally and linguistically diverse leaders (Standard 3). Standard 3 might remind you of the phrase “Nothing about us without us,” which is commonly used in the disability rights community and captures the essence of the need to include people from a wide range of backgrounds at all levels of the organizations that will provide their healthcare or other services (see Charlton, 2000).

The National CLAS Standards’ second theme, Communication and Language Assistance, expands on the notion of health literacy from the Principal Standard. The four standards grouped under this theme are the standards that overlap with civil rights law, the ACA, and the ADA, as mentioned briefly above. Federal law prohibits any organization that receives federal funds, and any business that provides healthcare services to the public, from discriminating against persons on the basis of their national origin, which the law interprets as prohibiting inequities that arise from people’s languages or from their proficiency in English. Healthcare organizations must therefore take reasonable steps to provide meaningful access to their programs for persons with limited English proficiency; in essence, current federal law requires healthcare organizations to recognize that we are very much a multilingual country (as Module 6 will address in detail). Thus, to ensure that all clients and families receive information about their health in accessible and understandable ways, standards under the Communication and Language Assistance theme require organizations to offer language assistance, offer printed materials in the clients’ preferred languages, ensure the competence of interpreters and the accuracy of translations, and provide simple-to-read materials and multimedia signage, including in ways that take into account the needs of people who communicate using sign language, braille, or other methods of communication.

The National CLAS Standards’ third theme, finally, includes seven standards and requires the organization’s Engagement, Continuous Improvement, and Accountability. The standards under this theme require the organization to “conduct regular assessments of community health assets and needs” and then to work with its community to attempt to meet those needs. To be able to do so, organizations are required to establish culturally and linguistically appropriate goals and policies for all aspects of the organization’s internal and community-facing work, including employee support, grievance resolution (see Kirkland & Hyman, 2021), and ongoing measurement of health outcomes in the community.

Perhaps most importantly, Standard 10, under the Engagement, Continuous Improvement, and Accountability theme, requires “ongoing assessments of the organization's CLAS-related activities” and requires the organization to “integrate CLAS-related measures into…continuous quality improvement activities” (Office of Minority Health, n.d.). As we will emphasize throughout this website, the ability to provide client-centered, culturally and linguistically appropriate services is an ever-expanding opportunity, not a goal to be achieved and checked off. Fully culturally proficient organizations, in Cross et al.’s (1989) words, not only value their communities’ and clients’ diversity but also use continual quality improvement systems to assess themselves as organizations, prepare for and respond to the dynamic situations that cultural diversities create, focus on continual learning and improvement for their workforce and their leaders at every level, and recognize that their actions will need to be continually adapted as circumstances change (see Cross et al., 1989, Chapter III, and see this website’s Module 16).

Your Turn

The National CLAS Standards themselves are only about a page long (much shorter than my longwinded explanations!). As of this writing, they are readily available online at the Department of Health and Human Services’ website (https://thinkculturalhealth.hhs.gov/clas). Find them and read them. (If they are no longer available, as you read, what is in their place? Why?) If you work or will work in a healthcare setting, how can you as an individual attempt to meet these standards? If you work in another setting, how could or should these concepts influence your work? (Notice that links to translations of the Standards document into five of the most common languages other than English used in the U.S. are prominent on the webpage, an example of a federal agency taking the legally required reasonable steps to ensure that people from all backgrounds can access this material.)

The National CLAS Standards’ website also provides (or provided) a much longer Blueprint document, a briefer Implementation Checklist, and many other supporting resources. Try to find the Blueprint document and read any part of it, if possible. If your approach to change is incremental, do you recognize one change that you might suggest to your workgroup? If your approach to change is radical, do you recognize one large leap that your workgroup might need to take? (Then try it in reverse: If your approach to change tends to be incremental, what large leap do you recognize that your organization might need to take? If your approach tends to be radical, what single small step might you recognize as at least a useful start?)

Regulations in Educational Settings: Success for Every Student

Speech-language pathologists in public schools (and all other employees, volunteers, families, and students) follow requirements laid out in a complex and still evolving web of civil rights law and other cultural and identity-based regulations. Written to accompany the Civil Rights Act of 1964 and the Voting Rights Act of 1965, among other legislation from the time, the original Elementary and Secondary Education Act (ESEA, 1965) and the original Education for All Handicapped Children Act (EAHCA, 1975) were civil rights laws. The ESEA and the EAHCA have both been updated several times, but their basic goal has not changed. As phrased in the current Every Student Succeeds Act (ESSA), from 2015, states and schools are required to “provide all children significant opportunity to receive a fair, equitable, and high-quality education, and to close educational achievement gaps” (ESSA Title I, Part A, Section 1001).

This recognition of existing “educational achievement gaps” mirrors the recognitions that led the Department of Health and Human Services to develop the National CLAS Standards for healthcare. It also creates important requirements that shape our work in the public schools, in part because these “gaps” reflect differences based on many aspects of children’s cultures, backgrounds, languages, identities, and individual (dis)abilities (as we will revisit in later modules). As of this writing, speech-pathologists and other professionals in schools are therefore required by the ESSA to measure and report educational and related outcomes for all children; to use those data to attempt to reduce any inequities in opportunities or outcomes for relevant groups of children; and to focus actively on increasing the opportunities available to historically under-served students. Schools-based professionals use many frameworks and techniques to attempt to satisfy these requirements, and if you work in a public school you might spend considerable amounts of time in relevant in-services or other trainings about your district’s systems. Three of the most widely applicable requirements are not only critical for schools but also can be useful as we think about culturally and individually appropriate services for any setting: 504 Plans to address institutional assumptions and contexts, multi-tiered student support (MTSS) systems to match all clients’ dynamic needs, and Individualized Education Programs (IEPs) for people who need specific individual assistance.

504 Plans

The documents typically referred to in schools as 504 Plans, first of all, reflect the requirement of Section 504 of the Rehabilitation Act of 1973, as updated in 2024 (Federal Register, July 2024), that no person should be denied the ability to fully participate in any public activity because of a physical, neurocognitive, emotional, or other disability. A 504 Plan is required in schools for every child who has, had, or is considered to have any disability that limits their ability to participate in daily life, including the ability to participate in a typical way in all academic and non-academic aspects of the school day. 504 Plans focus on the context and the assumptions, typically by specifying a few easily achievable changes, or accommodations, to settings or routines that will allow the child equitable access to the academic curriculum and other school-based activities. (504 Plans can also include modifications to the curriculum itself, but children who qualify for curriculum modifications, or for altered or additional goals at school, typically qualify for an Individualized Education Program, discussed below.) Thus, a 504 Plan might ensure that a child with low vision receives large-print books or an electronic tablet that can magnify assigned texts, as one example, instead of being given the same books that most children receive. Similarly, a child with asthma might be allowed to keep an inhaler with them at all times, as an exception to the general rule that students must not have medications with them at school, or a child with an attention disorder might be allowed to take tests alone in a quiet room, as an exception to the general routine that all students will take tests together in their classrooms. In these and many other ways, 504 Plans specify changes to infrastructure or assumed routines that can be described as relatively simple, straightforward, “reasonable accommodations” for a student’s individual needs, intended to allow each student to access material and demonstrate their knowledge in ways that are not limited by their disability.

504 Plans are not difficult, but they do require the adults to think about their assumptions and think about whether those assumptions are appropriate for every child (e.g., that each child should receive a physical copy of the same book, that no child should be allowed to carry medications at school, or that all children should take the test in the same room at the same time). Because the answer about our assumptions and routines is often no, they are not appropriate for every child after all, then the adults need to take the additional steps of recognizing, respecting, and responding to each child’s specific needs. The thought process required to develop a 504 Plan lends itself to use in many other settings, in part because it reflects the heart of client centered, culturally appropriate, or individually appropriate care. Are we assuming that our clients or students will all benefit from the same thing? If that assumption is not warranted, what simple changes could we make in the larger contexts of our work to recognize each client’s individual needs?

Notice that 504 Plans are not focused on wholesale changes for the entire group, on teaching the client something special or different, or on removing or adding curricular requirements for the child. Instead, 504 Plans apply civil rights concepts by identifying the simple changes to infrastructure or context that will allow a child equitable access to the existing goods, services, and other benefits of society. 504 Plans start from the assumption that all children can learn; that all children deserve equitable access to opportunities in school; and that the necessary changes might be in the structure, context, or assumptions that society has accepted. This thought process can easily be adapted as we think about how to meet the needs of any client in any setting.

Multi-Tiered Student Support Systems

Current laws and regulations for schools also rely on a tiered system of appropriate scaffolding and supports for all children, known generally as multi-tiered student support (MTSS) systems. Within an MTSS system, multiple levels (tiers) of assistance are available to all children at all times, organized and provided in a dynamic way that provides every child with the support they need to be successful. For many children, the necessary support comes in what many systems refer to as “Tier One” support for their learning, which might include large-group presentations from a teacher, individual or small-group classroom work, and occasional personal input from a teacher. Other children need more or different help to be successful with some skills or topics, sometimes in the form of small-group or targeted assistance that presents or explains some material in different ways (often known as “Tier Two support”). A few children, including those with diagnosed disorders or disabilities, may need specific one-on-one intervention to address related goals, as a third or occasionally fourth tier of support, if they are to have equitable access to the curriculum and to the benefits of education.

The three or four tiers that characterize an MTSS system, importantly, are not labels for children or for school programs. The tiers refer to levels, styles, or intensities of the dynamic, child-centered supports that are provided in dynamic combinations to all children by the team of professionals. In order to determine which kinds of supports which children need when, school-based professionals, including speech-language pathologists, engage routinely in collaborative screening, progress monitoring, and data-based decision-making about each child’s needs in each area of the curriculum. Effective MTSS systems emphasize that every child needs different support for different topics, on different days, and as different variables change.

MTSS systems in schools tend to be viewed as part of providing services for children with disabilities, but they need not and should not be limited to that context. Notice that a comprehensive and thoughtfully implemented MTSS system gathers data routinely about each child’s progress and then provides that child with the supports they need to be able to continue to progress toward well-chosen goals. At their best, therefore, MTSS systems support individuals and support the entire group, in individually and culturally responsive, supporting, and sustaining ways (see Alim & Paris, 2017). MTSS systems, in other words, allow professionals in schools to think broadly about the full range of supports and approaches that can lead to broadly defined success for all children and for each child, from all cultures and backgrounds and with all identities. Whether you work in a public school or not, any team in any setting could adapt an MTSS-type system as part of their efforts to provide dynamic, individualized, continually evolving, client centered, and personally and culturally appropriate services for all clients.

Individualized Education Programs

An Individualized Education Program (IEP), finally, is required under federal law for every child who has been appropriately diagnosed with one or more specific named medical, physical, cognitive, or other conditions and who therefore requires specific assistance or modifications to the school’s typical programs to be able to be successful. In many ways, IEPs represent the purest expression of basic civil rights law: If all people deserve equitable opportunities to access the goods, services, and other benefits of a society, including public education, then each child deserves for each school to provide the specific help they need to access education.

Federally-mandated and state-managed IEP processes in schools require speech-language pathologists to collaborate with students, families, and other professionals in complex and specific ways using implementation details that differ slightly from school to school. Across all schools, however, most IEPs that involve a speech-language pathologist will involve the provision of specialized and collaborative services that help a child who has a known speech or language disorder to develop the speech, language, voice, or other communication skills they must acquire if they are to be successful in school. In some instances, the child’s educational goals or curricular requirements themselves can be modified, but such modifications, like all other elements of an IEP, must be data-based, individualized, and conducted within a framework that assumes that all children deserve access to the full benefit of the entire educational program. Thus, the IEP process, in a general sense, again provides an excellent framework for client-centered, culturally appropriate, and appropriately individualized clinical services in any setting. We start by assuming that all individuals from all populations deserve the best possible services and the best possible outcomes, regardless of their cultural, linguistic, or individual backgrounds and identities, and we then seek to plan and modify our services based on each individual’s needs.

Your Turn

If you are not familiar with the issues raised by the complexities of trying to educate all children in the U.S. public schools, you might want to try an article or a book outside your comfort zone. Try hooks (2004), Kozol (2012), Lutz (2017), Overstreet and Chafouleas (2016), or Paris and Alim (2017).

I tend not to emphasize rote memorization as a learning tool, but this material is an exception. You might want to memorize the following phrasing, from the Every Student Succeeds Act of 2015:

·      “all children” deserve the “opportunity to receive a fair, equitable, and high-quality education”

Highlight Questions for Module 4

This module emphasized memorizing some specific wording. Can you complete and recite from memory all of the following phrases? Why does it matter in some situations to know the precise wording of any rule? Why does it matter in some situations to understand the underlying spirit of any rule?

  • from the first part of the CLAS Principal Standard: that all clients should receive “effective…” quality care and services.

  • from the Every Student Succeeds Act of 2015: “all children” deserve the “opportunity to receive a…”

As we mentioned at the end of Module 3, different individuals from different groups might respond to the kinds of requirements described here in Module 4 in different ways. Given your journeys so far in your life, do you find yourself embracing, championing, or resisting any specific parts of the National CLAS Standards or the civil-rights-based requirements for public schools? Can the 16 Questions matrix from Module 2 help you think about why you are responding as you are? How are our initial reactions as persons related to our ultimate actions as professionals?

This module recognized the possibility that the laws or other guidance in place as you are reading might differ from those in place as I am writing. Did you find any such differences? If so, what has changed, what has not changed, and what bedrock values or principles support your current practice?