Introduction
The fourth United Nations Sustainable Development Goal (Quality Education) emphasizes the promotion of quality learning opportunities for all, including access to education and sufficient support to ensure quality, inclusive, and equitable education.1 However, achieving this requires structural reforms of the education system and entails different challenges in each country.2-4
In Colombia, Article 67 of the Political Constitution of 19915 recognizes education as a right and as a public service that has a social function. In this sense, in order to guarantee education for all Colombians, a broad legislative framework has been developed, which includes Decree 1421 of 2017,6 “whereby educational services for the population with disabilities are regulated within the framework of inclusive education”, and Law 2216 of 2022,7 “whereby inclusive education and the comprehensive development of girls, boys, adolescents and young people with specific learning disorders are promoted”.
Nevertheless, in Colombia, the second most unequal country in Latin America,8 there are several challenges in terms of education, such as overcoming the low level of quality of education and closing the existing gaps in terms of participation.9
Similarly, it is necessary to consider the devastating effects of the COVID-19 pandemic, which revealed the deep economic and social gaps existing in the region and increased the disadvantages related to the adequacy of curricula and the generation of aids and accommodations for students with special needs.10 It should also be noted that the pandemic hindered or, in some cases, interrupted access to rehabilitation in different areas, including speech-language therapy, which is a facilitator of the educational processes of students with disabilities or learning disorders. The impact of this situation was evident in the return to face-to-face classes.11,12
Both the relationship between communication, learning and human development, as well as the effectiveness of the collaborative work of the speech-language pathologist with the educational community in achieving school success have been widely reported.13,14 Despite the above and the advances in the educational system, recent regulatory provisions do not explicitly establish the place of speech-language pathologists in this scenario. Given the above, the objective of this article was to present a critical analysis of the role of the speech-language pathologist in the context of inclusive education in Colombia.
The unclear current state of speech-language pathology in education
In Colombia, the speech language pathologist is an autonomous professional with a broad scientific knowledge of human communication and its possible variations, limitations and deficiencies, as well as the processes involved in it. Thus, the actions carried out by this professional are framed within a biopsychosocial perspective of the human being and, through these, they ensure the communicative well-being of children, young people and adults, promoting their comprehensive development and social inclusion.15,16
In recent years, the field of speech-language therapy has adopted a holistic approach to the treatment of communication disorders in accordance with the recognition of the complexity of the biological, psychological and social elements that make human communication possible.15-18 With this in mind, communicative health and its variations; language, speech, hearing and swallowing impairments; communicative limitations; and disability in general are considered to be determined by the relationship between individual factors (body structures and functions) and contextual factors (environmental and personal).14,17
Speech-language therapy in Colombia emerged in 1966 with the creation of academic programs in this specialty at the Universidad Nacional de Colombia and the Escuela Colombiana de Rehabilitación,18 but it was not regulated until 1997 with the enactment of Law 376.19 Speech-language therapy in schools in the country was also implemented in the 1960s,18 and in 2003, by means of Resolution 2565, the Ministry of National Education included speech language pathologists in the group of professionals who can perform functions that support the academic and social integration of students with special educational needs.20
According to Flórez-Romero,21 a school speech language pathologist should have both theoretical knowledge and procedural skills related to human communication, as they are fundamental to promote the development, learning, and participation of children and young people. Likewise, the author states that the work of speech language pathologists in the school setting involves working collaboratively with other professionals to promote communicative well-being, prevent language deficiencies, evaluate communication, carry out interventions, and offer counseling to parents and advice to school administrators and teachers.21
It is considered that the training and competencies of speech language pathologists are sufficient to meet the expectations and demands of inclusive education, so it is thought that these professionals can hold the position of pedagogical support teachers.6,22 However, this role imposes multiple challenges and does not include several of the speech language pathologists’ own functions, especially those directly related to their object of study, since the responsibilities of the pedagogical support teacher include participation in the formulation and monitoring of individual plans for reasonable accommodations and institutional improvement plans, raising awareness of the right to inclusive education, and accompanying and training teachers and families on issues related to inclusive education.6
Due to the above, it is necessary to differentiate between the speech language pathologist who fulfills the role of pedagogical support teacher and the one who practices the profession in the educational setting. Thus, the following questions arise in this regard: To what extent is the role of the speech language pathologist invisible in inclusive education? Are speech language pathologists working in the education sector as support teachers providing care consistent with inclusive education? How to promote communicative well-being when educational care is exclusively aimed at eliminating barriers in the environment? Working in a context of inclusion and equity in education makes activities such as the promotion of communicative health and the detection, assessment and intervention of communication disorders inappropriate?
An identity problem
With these questions in mind, in a qualitative study in which 17 Colombian speech language pathologists working in inclusive education were interviewed, Quintero-Uribe & Montoya Otalvaro23 found that the interviewees stated that their role is little recognized and that there is no consensus on the name of their position, giving rise to labels such as “speech language pathologist in inclusion”, “speech language pathologist in education”, “consultant in inclusive education or in educational inclusion”, among others.
In this sense, following the findings of Quintero-Uribe & Montoya Otalvaro,23 and because no further reports were found on the subject and the data are not representative, it is a priority to establish a consensus on the denomination of speech language pathologists in the educational setting in order to favor their political and social recognition. In any case, it should be kept in mind that the different denominations could be partly due to the recent reorganization of educational care.
Remnants of the biomedical approach in school speech-language therapy
Daza-Timana et al.24 published in 2017 a study in which they reviewed the intervention model in the practices of speech language pathology students at the Universidad del Cauca and found that diagnoses were mainly related to biological models and that most interventions were directed towards bodily functions. Likewise, Quintero-Uribe & Osorio-Montoya25 published in 2018 a study in which they interviewed 17 speech language pathologists working in inclusive education and found that 67% of the respondents had a conception of disability based on a deficit view, focused on deficiencies and linked to the biomedical model, and that 28.6% had a conception of education that matches the paradigm of integration. Other studies have reported that the highest percentages of research in speech language pathology with children are focused on the pathologization of childhood, as opposed to the premise of recognizing performance based on diversity.26,27
The ambiguity in the conceptions of inclusive education and disability and in the research approach to the disorder may be the result of a traditional training in speech-language therapy based on rehabilitation with a standardizing vocation that seeks to calculate the deficiencies in language, hearing, speech and oral pharyngeal function; to discipline the tongue; and to establish truths about pathologized subjects.28 Therefore, it is possible that some practices inherited from special education, segregation, integration and even from the traditional health paradigm still persist in some educational establishments.
Speech language pathology is constantly challenged to discuss its role in the educational scenario and to adopt an epistemic and methodological perspective that contemplates the identification and elimination of environmental barriers that limit the participation of students in academic activities. This must be done while working on the potentiation of communication skills, as well as on the creation of mechanisms, ways and means to understand and express knowledge in a context where all forms of being and relating are recognized and taken into account. An important step forward in this regard is proposed by the Colombian Ministry of Health and Social Protection in the document Perfil y Competencias Profesionales en salud. Perspectiva de las profesiones, un aporte al cuidado de la salud, las personas, familias y comunidades (Profile and Professional Competencies in health: Perspective of the professions, a contribution to healthcare, individuals, families, and communities). It defines the characteristics that various health professionals in the country, including speech language pathologists, must have.15
Early detection of language disorders and timely intervention: a contribution to educational quality
According to Christopulos & Kean,29 between 7% and 12% of elementary school students have language disorders, but only 18% of these cases are identified and receive treatment. Language difficulties have been related to academic and socioemotional problems, higher school dropout rates, increased risk of bullying, and aggressive and/or antisocial behaviors.30,31 This emphasizes the need to detect and intervene these difficulties in a timely manner, as well as to raise awareness and train the educational community on the subject in order to move towards an empathetic and protective education.
Speech-language therapy actions, both group and individual, have proven to be effective in the early detection and treatment of language disorders and in the promotion of communication skills in the school context.14,16,31,32 Likewise, in the educational setting, there is evidence of improvement in oral and written language through speech-language therapy interventions in aspects such as phonological awareness, expressive language, storytelling, pragmatic skills, decoding of written messages, comprehension and production of texts, among others.32-36
In this context, the American Speech-Language-Hearing Association37 states that collaborative intervention between the speech language pathologist and the teacher in the classroom promotes the development of communication skills critical for emotional and social functioning and school success. In this regard, several studies show that the planning and implementation of speech-language therapy intervention programs in groups of students have a favorable effect on oral, reading, and writing processes.36-40
In addition to their contributions in the field of language, speech language pathologists can also contribute to screening for early detection of hearing impairment and timely referrals due to the relationship between hearing impairment and language, speech and learning difficulties. This is of paramount importance as the population with hearing loss is on the rise and about 24 million children are affected by hearing impairment (60% from preventable causes).41
The need for speech-language therapy in education
Speech-language therapy, as a science-based profession, has demonstrated from a collaborative action framework its effectiveness in enhancing language and communication as a basis for socialization, school success, inclusion, and equity in education.21,37,42 Its pedagogical input is derived from evidence-based practice and is supported by knowledge in neuroanatomy, human development, cognitive theory, linguistics, multiculturalism, among others.14,15
Thus, collaborative work between the speech language pathologist and the teacher during the first years of schooling is fundamental, since students with oral language difficulties who are not identified and treated early are at risk of being at a disadvantage in terms of their reading and writing skills, academic performance, and even mental health.29-31,37,43
In this sense, the presence of these health professionals in the school is not limited to the roles they can play as pedagogical support professionals. In fact, their absence in the educational setting reduces the chances of early detection of language, speech, swallowing and hearing impairments and communication limitations, preventing timely interventions at sensitive periods of development.44-46
Likewise, the absence of speech language pathologists in educational establishments is a waste of the potential of human communication as a basis for building more equitable and inclusive communities. Actually, some experts suggest that best practices for treating students with language, speech, and hearing impairments are based on a collaborative approach between these professionals and other members of the educational community within the school.21,42 In addition, it has been widely reported that the lack of qualified professionals to identify and provide quality communication services in schools is one of the major barriers for students to advance in their educational process.47-50
Similarly, speech-language therapy has a positive impact on inclusive education as it contributes to the adaptation or flexibilization of the curriculum, the formulation and implementation of augmentative and alternative communication systems, counseling for parents, advice for teachers and the approach to the communication skills of both students with disabilities and other students. This includes students who are not contemplated in Decree 1421 of 20176 or in Law 2216 of 2022,7 such as people with exceptional abilities and talents.16,51
In the educational models of other countries, such as the United States, Australia and Chile, there is legislation that, within a framework of inclusion, contemplates the incorporation of speech-language therapy in the educational environment to promote the development of phonological, lexical, syntactic and comprehension skills during the literacy process, as well as to provide assistance in the creation of individualized education programs and even to train families in communication issues.44,52-54
On the other hand, it should be mentioned that the communication expertise of speech language pathologists is key to improving academic performance and favoring the harmonious transition of students at different educational levels. Therefore, it is important to continue promoting their participation in the school environment and to conduct research on their impact in this context.14 In this regard, it is worth noting that in the United States, given the increase in recent years of cases of children with communication and language difficulties, the demand for speech language pathologists in schools has increased due to their important contribution to the comprehensive development of students.55
Furthermore, in a scenario of high communicative demand, such as the school, it is possible to work on the promotion of the communicative well-being of teachers, since these professionals have multiple risk factors that can affect their communication.56,57 In fact, speech-language therapy intervention is widely recommended to reduce associated risk factors such as excessive and inappropriate use of the voice and stress.58
The contribution of speech-language therapy in schools is also reflected in the adaptation of environments and the generation of cultures that mitigate noise pollution. This helps to reduce the risk of noise-induced hearing loss, anxiety and depression,59,60 as well as to reduce the negative effects that permanent exposure to noise has on tasks such as reading comprehension.61
Speech-language therapy in today’s inclusive education: a vindicating proposal
In order to achieve quality, equity and inclusion in education, the contribution and knowledge of speech language pathologists are fundamental.
One of the challenges for these professionals is to establish agreements regarding their denomination in the educational setting. Consequently, in this article we propose to maintain the denomination used by Flórez-Romero21 “school speech language pathologist”, since it makes visible the denomination given and the setting in which they work.
The school speech language pathologist must harmonize their scientific knowledge about human communication and its variations, limitations, processes and deficiencies with the current models of attention to diversity. In this sense, their role in the different educational levels (preschool, preschool, elementary, middle and high school) should be based on the understanding that the communicative interactions that occur in the educational scenario are influenced by the biological, psychological, social and cultural dimensions and, therefore, no actions should be carried out during the school day that imply the segregation of students based on their communicative skills. On the contrary, a culture that recognizes and appreciates diversity as an inherent characteristic of others based on their capabilities, historical context, experiences, and cultural assets should be fostered.
Accordingly, the actions of the school speech language pathologist should be aimed at detecting students and teachers at risk of developing language, speech or hearing impairments; optimizing students’ communication skills; carrying out assessment, referral and intervention processes based on evidence-based educational practice; and working collaboratively with other members of the educational community through a receptive and proactive dialogue that allows responding to the characteristics of each person by strengthening inclusive institutional policies, practices, and cultures. Thus, their role can be key in the articulation between education and health institutions.
On the other hand, the expertise of these professionals could be of great help in the consolidation of the academic curriculum, as well as in the formulation and implementation of reasonable accommodations to identify and eliminate communication barriers, and in supporting the processes of people who require technological tools to communicate, such as hearing aids and augmentative and alternative communication devices, such as boards, speech-generating devices, etc.
In addition, for students with communication difficulties, individual intervention by school speech language pathologists may be an option as long as it does not restrict their attendance to academic activities and does not take place during the school day. This is a viable alternative to the single school day proposed in Colombia by the National Government, which seeks that educational establishments offer time for the development of biological, cognitive, socio-affective and spiritual aspects of students through recreational and pedagogical experiences.62
The school speech language pathologist can also carry out actions to prevent hearing loss and vocal abuse, such as the adaptation of environments that mitigate noise exposure, and has the ability to formulate research projects related to their field of study, the results of which could be used by schools to update their institutional policy documents.18,21,63
It is clear that school speech-language therapy faces important challenges to adapt to current educational requirements and that it must assume a proactive position that allows it to continue to gain recognition and involvement in decision making at the academic level in order to have a clearer understanding of its role in inclusive education. In this sense, the profession of speech language pathologists has the ethical and social responsibility to contribute to the construction and implementation of plans, programs and policies that, in harmony with the current goals of education for all, will promote the recognition of the profession within educational institutions for the benefit of the entire community.
Conclusions
Considering the knowledge background, speech language pathology is the ideal profession for the early detection of language, hearing, speech and swallowing impairments and their treatment. Speech language pathologists can act as intersectoral agents linking education and health and contribute significantly to meeting the communication needs of all students, thus impacting the social, emotional and cognitive processes that affect participation, learning, retention, and success in school.
The recent regulatory provisions on inclusive education in Colombia make speech-language therapy invisible. Thus, the presence of speech language pathologists in some schools is mainly temporary and in a different role, as pedagogical support teachers. This concept contributes to the ambiguity in their denomination and practices and, in addition, does not contemplate all the functions that speech language pathologists can perform in the educational context. In this sense, it is essential to reach a national consensus on the appropriate way of designating the professional in speech-language therapy in the educational scenario in order to increase their recognition.
Similarly, efforts should continue to focus on the continuing education of speech language pathologists from a diversity perspective and on the research and dissemination of their inclusive practices in order to promote a political and cultural change in which these professionals are widely recognized and their professional practice is valued in the educational scenario.
Inclusive education does not depend only on the design of an educational system that welcomes diversity under premises such as the identification of barriers to access to education. To achieve this, it is necessary to generate structural and articulated conditions that make the participation and learning of students with social justice viable. These conditions include the presence of professionals in speech language pathology in the interdisciplinary teams of educational establishments. To this end, the profession should participate in the review and design of educational policies and in the oversight of the allocation of financial resources for their implementation, as they are fundamental elements to advance towards education for all, as recommended in the report of the Organization for Economic Cooperation and Development.9
Conflicts of interests
None stated by the authors.
Funding
None stated by the authors.
Acknowledgments
None stated by the authors.
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Cristian Jovan Rojas-Romero1