SLP Interview: Crystal Sanford

Date: September 18, 2019

Original Questions

1. Can you explain a bit about yourself and your role in the public school as an SLP?

2. What is your experience with students on the spectrum?

3. How many student (or what percentage of students) would you say you work with who
are on the spectrum?

4. How do you assess for diagnosis of ASD?

5. How do you monitor the progress on communication and language goals for individuals
on the spectrum?

6. Do you have any advice for how, as a SPED teacher, I can best collaborate with the SLP
in assessing individuals on the spectrum?
 Transcript

Can you explain a bit about yourself and your role in the public school as an SLP?
I’ve worked in multiple settings. For the past 8 years I’ve worked in middle school. My
role in a public school is to ID if students continue or initially demonstrate communication
challenges that adversely affect their academic performance. There may be students
who are impacted on the milder side, but my role is to work with those who are really
impacted at school.

My role is to provide assessment or therapy services. That includes stuttering, sound

production.

What does that mean, sound production?

Challenges those who can’t produce specific sounds, mainly s/r/l, and lang
comprehension and expression and social language skills.

You have a lot on your plate!

We are the mistresses of many and the masters of none. We are trained on the medical
side to work with patients who have had strokes, swallowing, as well as trained for all
things to do with kids in a school settings. And within that you can have kids with all
kinds of challenges there as well.

You want to be able to hone in and provide excellent services in all of those areas, but
its hard to high quality services in any one area.

You had mentioned that you do a lot of assessments and also provide treatments.
Would you say that your time is split evenly? How balanced is your load?
Assessments and treatment and also the consultation part which comes up when
someone needs you to work with a student right away to create a social story or fix
someone’s communication board and then the lunch bunch.

So, where does that all fit… maybe 15% is consultation the rest is 50/50 treatment and
assessment, although we all get into the business because we want to do the treatment.

How many students do you see?

Our caseload mandates 11 max per day. I work 4 days so I can have a max of 44 kids.

Are there other SLPs at Lewis with you?

This is the first year I have a SLPA. Only because I have some students who need make
up services.
Why? Is that because a student misses their services because they weren’t there for the
day?
Yes

What happens when someone assesses a student and they determine that they need
services but there is no room in your case load for another student? What happens if a
student is deemed as needing speech and language services but you’re maxed out? Do
you have room for more kids?

I have room for 3 more kids. The new thing for speech is that if you max out you’re able
to call a “Principal’s Case Load” until they find someone else to provide the make up
services. Like, we just inherited a kid from an elementary school who was on the
principal’s case load so he has 24 hours of services to make up all from last year.

So you have to squeeze those in in addition to the services he gets this year?
Right. So he has to be pulled out a lot. His IEP is coming up, and we are going to talk to
parents to say, “do you want this?” They can say no or yes but if they want it they just
have to be aware that he is going to miss a lot of class.

Can you explain the pull out services?

They’re always with a group. Except there are a handful of kids, mostly out of due
process, who are seen on an individual basis. Kids who are more significantly impacted.
They have ipads to communicate and due process requires them to be one-on-one.

So you communicate with these kids who have iPads how?

It’s not typing. It’s an iPad that has a program on it that is called Touch Chat. It’s like an
image board and it’s all on an ipad. They use that with different layers of pix to
communicate. The first layer has basic words like “I, want, like” and then there’s a page
that will take them from that front page to another page that’s all about them. When they
push a button it spits out words.

That is amazing. It’s giving voice to those who don’t have one.
Exactly. The most significantly impacted ones are those who have autism.

What is your experience with students on the spectrum?

Work with them since I’ve been an SLP for 21 years. Most recently - caseload has
increased as the identification of autism has increased. I’ve worked in public schools in
pre-k through transition at age 22. I have worked with non speaking, minimally speaking
all thru kids who are in general ed and seminar classes.

Grouped by levels?
Yes, so my kids who have more significant needs, I see them altogether. And I push into
their classroom. The kids who are mod/severe classroom, I push in to do a lesson
2x/week. It’s nice because teachers and aides see what they’re doing and can reinforce
what we’re doing.

Are there any other instances where you push in?

Yes, I push into the Applied English classroom where they use collaborative methods.
7th and 8th grade kiddos are more moderately impacted so it’s an adapted curriculum for
English. It’s a slower pace. It’s the same skills but they use different text at a lower
reading level. I help around the language piece, not the social piece, collaborative
conversation in how to support them around abstract thinking like character thoughts
and perspective sharing. I probably stay 30-40 minutes.

How many student (or what percentage of students) would you say you work with who
are on the spectrum?
About 50%

Why do you think it’s so high? There aren’t 50% of kids in the population with Autism, so
why are so many on your caseload?
Because more kids who have special education services have an autism diagnosis.

Would you say that 50% of kids receiving SPED services are on the spectrum?
That’s a good question. I don’t know! Mine is 40% on paper because only 40% have a
school based diagnosis as their primary primary eligibility diagnosis. But there’s another
10% who have it privately and haven’t turned in their paperwork, or they don’t have it on
paper at the school but it’s apparent. Maybe the team didn’t say Autism on the
paperwork in Elementary School and they put SLD or OHI with secondary speech, but
their tri is coming up and we are looking at changing that.

We’ve only had two cases where we were sure a student had ASD and then they were
assessed and we decided that it was not ASD but other issues like OCD or extreme
ADHD.

One student in particular was extremely defiant. Michelle Garcia Winner who created the
protocols of social challenge created a category called “resistant social communicator”
that’s someone who argues, resists help. That’s one of the hardest categories to reach
because it’s hard to find a carrot. They don’t care what you think or they don’t think they
need to change. You’re supposed to see these kids one-on-one, try to pull in their
interests, and craft a way to fit in your work. But then they ask you, “why are you being
patronizing”? It’s hard!

How do you assess for diagnosis of ASD?

Ethically, as SLPs, we don’t assess for autism.

We assess for social, and language deficits that are typically related to autism.
It requires a pediatrician or a developmental psychiatrist who are on board with making
the assessment.

So you do not make the diagnosis at school?

No. We can. I can eyeball it, but we can’t make the diagnosis. There is some talk about
changing that because parents are hard pressed to get the private diagnosis or their
insurance won’t pay for it.

But why can’t the school psych do that?

The psych does it in the school setting. But I’m only on board to say that they have a
speech issue related to autism.

But if you recognize it, wouldn’t you then refer them to the school psych to get the
diagnosis?
Yes, I would, in the school setting and hopefully she would have space in her work load
to assess. But I can’t make that diagnosis.

When you do assessments, is there a particular tool that you use?

There are two pieces. Our kids on the spectrum are going to have specific language and
social challenges.

I rely heavily heavily on observations in at least 2 or more settings. Classroom or at

lunch. Parent and teacher reports. Is it seen consistently across all settings.

I have created structured language probes for the language piece. I will bring in a test
like the CASL which is the Comprehensive Assessment of Spoken Language. But the
trick with that is if a kid is average/high average and on the spectrum, they’re gonna
breeze thru that and get standard scores of at least 100. However, they might have other
challenges because of the social piece like perseveration particular topics or inability to
stay on topic, or their difficulty with initiating a conversation. They may be geniuses, and
they would look that way on a test, but socially they would be impacted. That’s why you
can’t only look at those tests. You have to look at other stuff.

The biggest thing I use is Michelle Garcia Winner’s social language protocol. It’s a
structured social probe that looks at 5 subtests.

I didn’t realize that it’s a standardized thing that is being used. I knew it was a curriculum
but not a test.
I’s not a standardized test, but it is a structured social probe. It’s a thing. It’s an
assessment piece.

Is that specific to you or SDUSD?

 It’s international! She’s not even a doctorate! She just started seeing these needs in her
classroom and created this curriculum around these needs and that started to spread to
more people and it just exploded because everyone was looking for something to use
with kids who were not super low. There had already been curriculum for students who
were low, but not for students who passed the CASL and the language tests but who
were struggling. She put it all together in one place.

And she’s really expanded. She did the whole curriculum around Zones of Regulation
that is used with OTs.

When I first heard her at a PD it was 2007 and I thought “this is IT”.

To get back to testing...

I also do the metacognitive piece which is asking them how they think their skills are. We
did a pre-test. It’s about where do you think your skills are. I look to them to see where
they think they struggle and if they even have the ability to be metacognitive. The really
low students do not.

Do you have any advice for me as SPED teacher how I can work with SLPs in assessing
and working with students on the spectrum?

Observing - helping us see the behaviors across different settings sometimes we don’t
see the meltdowns in a math class so this help us be aware so we can start seeing the
challenges. Keeping track of the different strategies that we use naturally. Do I always
have to repeat instructions, provide visuals, front load…

How often do you talk to the SPED teachers and Gen Ed teachers about students on
your caseload?
We talk around progress reporting time which is quarterly (if all goes well).
 REFLECTION

In-depth reflection on the information about how the SLP assesses individuals in order to
diagnose ASD (or qualify for special education), as well as how they monitor the
progress on communication and language goals for individuals on the spectrum.

First and foremost, this interview has taught me that SLPs wear many hats. In the words
of Crystal Sanford, they are “mistresses of many, and the masters of none.” What she meant by
this is that she is tasked with knowing a little about many things but not being able to really
delve into any particular area. For example, she clarified that when she was in school to
become an SLP, she had to learn both the clinical side as well as the educational side of
speech and language pathology. She was trained to help individuals who have suffered from a
stroke in the same way that she was trained to service students with ASD. Nonetheless, after
being a service provider for over 20 years, Crystal has been able to hone her craft and expand
her knowledge through continuing education and practical experience.
Because of Crystal’s wide breadth of experience, she mentioned that she can easily
recognize symptoms of ASD, but that she is not “ethically” qualified to uniquely make the
diagnosis. As an SLP, she can assess for symptoms that would indicate that an individual has
the challenges associated with autism, but the diagnosis itself would come from a
developmental or psycho-educational psychologist. Her diagnosis is therefore part of the
process, but not the sole qualifier itself. This seems slightly counter-intuitive to me, as the
communication and social challenges that an individual presents on the spectrum can in and of
themselves be qualifiers, so it would seem like an SLP should have the ability to make the
diagnosis. Crystal indicated that this process may change in the future.
Crystal’s description of how she assessed individuals in order to help diagnose them and
monitor progress is very much in line with the readings we have been exposed to in our
program. She conducts standardized assessments like the​ CASL (the Comprehensive
Assessment of Spoken Language). However, she does not use this assessment in isolation, as
there are many other factors that need to be considered with individuals on the spectrum. This
is because the variability of communication levels can be so great. Some individuals can score
very high on the CASL but still exhibit social and communication challenges. Therefore, she
must rely on conversation outside of the test itself, and has even created her own set of probing
questions. She additionally relies on interviews and observations to inform her diagnosis and
evaluations. Therefore, the formal assessment is only one component of a much more involved
process.
I also learned from interviewing Crystal that the teachings and assessments of Michelle
Garcia Winner is considered standard across the SLP world. I knew she was embraced by
Occupational Therapists for her Zones of Regulation practices, but I did not know that she has
also created a system of assessments that many SLPs use as their social language protocol.
This is extremely fascinating, as it addresses a rising need with high functioning students who
score high on tests like the CASL but still have difficulties with social communication.
Detailed and in-depth reflection on the information about how best to collaborate with the
SLP in assessing individuals on the spectrum.

SLPs are part of a team that often includes the SPED teachers, Gen Ed teachers,
Occupational Therapists and Psychologists. However, these service providers often work in
isolation, which is not ideal.
I asked Crystal about her process for keeping in communication with teachers, and she
mentioned that she will speak with teachers in passing, especially if an urgent need arises. This
may be when a student is exhibiting behavioral challenges that need intervention, like the
creation of a social story, or one-on-one discussions with the SLP. However, with students that
are on her caseload but do not have any issues that require frequent discussion, she updates
her goals quarterly (during Progress Reporting) and will communicate electronically.
This does not seem like enough, but it’s an unfortunately reality given how busy
everyone on the team is and how many students an SLP has on their caseload. The best way to
collaborate with an SLP in assessing individuals on the spectrum is through continuous
discussion with the SLP, inviting the SLP in to my room to observe, recording any observations I
notice in the classroom, speaking with other teachers, parents and friends about their
observations, and helping to monitor the goals through informal assessments in my classroom.
The more we can speak together about the strengths and weaknesses/challenges of our
students, the better!