Revisiting the roles and responsibilities of speech-language therapists in South African schools

Significant changes have occurred in the education landscape over the past two decades. This requires a critical review of the roles and responsibilities of speechlanguage therapists (SLTs) and the education context. The process of redressing past inequities aims to benefit all learners equally. The current focus on inclusive education created a dire need for support of both teachers and learners, thus placing new demands on SLTs in the schools. The traditional pull-out model is now considered to be inappropriate, and replacement with the collaborative/‘push-in’ model of service delivery has been suggested (Earley & Bubb, 2004). Furthermore, the scope of the profession has expanded and SLTs are also required to provide language and literacy support to all learners in the classrooms. In addition to endemic issues in the education system, existing contextual factors such as language issues (e.g. the multilingual population, the dearth of speech-language pathologists (SLPs) proficient in African languages, and the preference of many parents for English as language for learning and teaching (ELoLT) (Du Plessis & Louw, 2008) further complicate the role of the SLT in schools. In addressing these crucial issues in schools certain key questions need to be addressed, namely how should SLTs go about their work in schools to have maximum benefit for both learners and teachers, and what are the implications of such suggested changes for training of future professionals? Currently two documents are available that guide SLTs in schools, namely the South African SpeechLanguage Hearing Association (SASLHA) document for private practitioners working in schools (South African Speech Language and Hearing Association Standards and Ethics Committee, 2007) and the American Speech-Language Hearing Association (ASHA)’s guidelines (2010) on the roles and responsibilities of SLTs in schools. The current set of guidelines for the provision of speech-language services by private practitioners in schools that was compiled by the SASLHA Ethics and Standards Committee (2007), focuses mainly on the practicalities of setting up private services in a school setting. It includes guidelines on contractual issues, the referral process, screening procedures, and consent from parents, record keeping, supersession, fees and arrangements regarding language enrichment programmes. The guidelines state that whenever language enrichment programmes are required by the school, the SLT needs to act as consultant and facilitator to teachers and parents, on condition that the costs should be carried by the school. These guidelines were intended to regulate Revisiting the roles and responsibilities of speech-language therapists in South African schools

Significant changes have occurred in the education landscape over the past two decades.This requires a critical review of the roles and responsibilities of speechlanguage therapists (SLTs) and the education context.The process of redressing past inequities aims to benefit all learners equally.The current focus on inclusive education created a dire need for support of both teachers and learners, thus placing new demands on SLTs in the schools.The traditional pull-out model is now considered to be inappropriate, and replacement with the collaborative/'push-in' model of service delivery has been suggested (Earley & Bubb, 2004).Furthermore, the scope of the profession has expanded and SLTs are also required to provide language and literacy support to all learners in the classrooms.In addition to endemic issues in the education system, existing contextual factors such as language issues (e.g. the multilingual population, the dearth of speech-language pathologists (SLPs) proficient in African languages, and the preference of many parents for English as language for learning and teaching (ELoLT) (Du Plessis & Louw, 2008) further complicate the role of the SLT in schools.
In addressing these crucial issues in schools certain key questions need to be addressed, namely how should SLTs go about their work in schools to have maximum benefit for both learners and teachers, and what are the implications of such suggested changes for training of future professionals?Currently two documents are available that guide SLTs in schools, namely the South African Speech-Language Hearing Association (SASLHA) document for private practitioners working in schools (South African Speech Language and Hearing Association Standards and Ethics Committee, 2007) and the American Speech-Language Hearing Association (ASHA)'s guidelines (2010) on the roles and responsibilities of SLTs in schools.
The current set of guidelines for the provision of speech-language services by private practitioners in schools that was compiled by the SASLHA Ethics and Standards Committee (2007), focuses mainly on the practicalities of setting up private services in a school setting.It includes guidelines on contractual issues, the referral process, screening procedures, and consent from parents, record keeping, supersession, fees and arrangements regarding language enrichment programmes.The guidelines state that whenever language enrichment programmes are required by the school, the SLT needs to act as consultant and facilitator to teachers and parents, on condition that the costs should be carried by the school.These guidelines were intended to regulate 1.What are the needs of South Africa?
2. What has to happen in education to create the type of citizen that South Africa wants?
3. What do the roles and responsibilities of SLTs in schools need to be to contribute to the grand plan?
4. Are these roles contributing to the grand plan?+

Professional preparation Curriculum changes:
• Mind shift from the 'pull-out' model to 'push-in'/collaborative model • Indirect to teachers/caregivers • Direct in-classroom services Re -training through CPD: Fig. 1.A critical review of the roles and responsibilities of SLTs in schools (based on Ehren, 2011 in Kathard et al., 2011).

ARTICLE
professional behaviour rather than addressing the specific roles and responsibilities of the SLT in schools.However, because of the changes in the education system and the expansion of the profession, a need for more comprehensive guidelines that would formalise the roles and responsibilities of SLTs in the education system was identified by Kathard et al. (2011).These authors conclude that it is imperative to take further action to ensure that the speech-language therapy and audiology (SLTA) professions participate meaningfully in supporting Basic Education.The current article responds to the call for action by Kathard et al. (2011) to critically address the roles and responsibilities of the SLT in South African schools.
In response to a recent call from the Health Professions Council of South Africa (HPCSA) (2012) to guide and document roles and responsibilities of SLTs in schools, the aim of this article is to critically review and explore the roles and responsibilities of SLTs in the schools and to consider the implications for professional and university training programmes.Ehren (in Kathard et al., 2011) suggested that such a definition of the roles of SLTs be guided by specific questions (refer to Fig. 1).Each of these questions is considered individually, although this article focuses on the third question which relates to the roles of SLTs in schools.

What are the needs of South Africa?
Education is the backbone of an economy as it develops human potential.However, education outcomes are currently not met in South Africa, despite policy changes which aim at creating equal opportunities for all through the policy of inclusive education (Department of Education, 2008), and a revised National Curriculum Statement that was presented as Curriculum Assessment Policy Statements (CAPS) (Department of Basic Education, 2010).The current education system is not meeting the needs of the country.Learners' performance in literacy and numeracy have been found to be unacceptably low (Motshekga, 2011).In order to become globally competitive, it is of the utmost importance to increase learner performance.In an effort to raise education standards, literacy and numeracy, as well as teacher training and support, have since become national priorities in basic education.SLTs have an important role to play in this regard.

What has to happen in education to create the type of citizen that South Africa wants?
In order to improve the quality of education, several systemic issues need to be addressed to create an environment conducive to teaching and learning: grade R is now included in the formal curriculum, and has become mandatory to prepare young learners for formal education and to reduce underpreparedness from 2014 on.Diversity needs to be accommodated by allowing learners to be educated in their home language until grade 3, and learners learning in a language other than their own, need to be supported (Kathard et al., 2011).There is a need for adequate facilities and resources, and their proper management.There is also an urgent need for more effective leadership and management of schools, which is being addressed at national and provincial levels.
In order to eliminate underperforming schools the national government currently invests a significant portion of the national budget for infrastructure improvement, school nutrition, scholar transport, school safety initiatives and learning materials to facilitate learning (Creecy, 2009).The number of learners in foundation-phase classrooms needs to be reduced.The new curriculum requires more parent involvement in the support of their children.The central role of teachers is acknowledged, but they need to be in class, on time and teaching.More teachers are required, and those currently in the system have to be retrained and supported to implement the curriculum (Motshekga, 2011).SLTs are well equipped to support teachers with in-service programmes in facilitating language for literacy.

What are the roles and responsibilities of SLTs in South Africa to contribute to the grand plan?
The scope of practice of speech-language therapy has grown and expanded over the years.Similarly to the situation in South Africa, ASHA was driven by educational reforms, legal mandates and evolving professional practices.These developments led to a redefinition of roles and responsibilities of SLTs working in schools, with the focus on four areas considered to be integral to service provision: critical roles, range of responsibilities, collaboration, and leadership (ASHA, 2010).These four areas are equally relevant to the South African context, but application needs to consider specific South African contextual needs.

Critical roles in education
SLTs have integral roles in education and are essential members of school facilities.They need to share in the responsibility of attaining educational goals.This implies that they work across all educational levels, which requires them to understand the curriculum with its learning outcomes and assessment criteria.SLTs need to understand how to make adaptations for learners with special educational needs.
In South Africa inclusive education policies are in place, which require SLTs to work with children with a range of communication and speech-language disorders.SLTs have to understand how the curriculum '...provides the context... not the content of intervention' (Ehren, in Kathard et al., 2011), as well as understand specialised curricula and integration of services.SLTs need to ensure educational relevance and address issues (e.g.culturally relevant and linguistically appropriate services) in their assessments and interventions which could impact on educational goals.It requires them to differentiate between language difference and a language disorder, work with interpreters and translators to accommodate culture and diversity (Sowden, 2007), and to develop and translate assessment tools and materials for the local context (Pascoe & Norman, 2011).Above all, assessment and intervention practices are required to be evidencebased.
It is important to understand the impact that communication disorders have on the child as a whole (e.g. in terms of personal, social/ emotional, academic, and vocational needs).Such a holistic approach is also applicable in contexts where SLTs work in special education and they are required to be proficient in treating feeding and swallowing impairments and be aware of the effect of such difficulties on the child as a whole.The complexities of the clients and contexts, as well as the diverse scope of practice, require a range of roles and responsibilities when SLTs are working in education contexts.

Range of roles and responsibilities
The range of roles and responsibilities of SLTs in the education system are varied.The Professional Issues Statement of ASHA (2010) corresponds to the exit-level outcomes specified for SLT graduates by the HPCSA (2005): Prevention: SLTs need to contribute to the prevention of academic failure in an evidence-based approach.It requires SLTs to support all learners in literacy (particularly in the foundation phase), and to collaborate with teachers.In South Africa prevention of language problems can be done through making teachers aware of the role of language in learning, the nature and consequences of language problems, as well as how to adapt their language to meet learners' needs (O'Connor & Geiger, 2009).
Assessment: SLTs need to conduct assessments in collaboration with others in order to identify learners with communication disorders.Assessment results need to inform instruction and intervention, which is consistent with evidence-based practice (EBP) (ASHA, 2010).The implication is that in South Africa SLTs need to be skilled to use standardised and authentic assessment tools and techniques.Currently this is a challenge because of the dearth of assessment measures developed in, and normed for African languages.In South African schools SLTs are often required to assess English as an additional language (EAL).There is also a dire need for SLTs to develop assessment material that meet the diverse needs of their clients (Pascoe & Norman, 2011).Whenever necessary, SLTs have to consult with professionals from other disciplines (e.g.teachers, occupational therapists, psychologists, physiotherapists, etc.) to obtain their input to plan suitable assessment and intervention.Currently there is little evidence of local interdisciplinary collaboration in terms of assessment practices in the education system (Kathard et al., 2011).This may impact on the reliability of assessments and the eventual treatment outcomes.
Intervention: SLTs are required to provide intervention that is appropriate to the age and learning needs of each individual learner, and is selected through an evidence-based decision-making process (ASHA, 2010).When dealing with learners with disabilities, the therapy techniques are clinical in nature as service delivery models are typically more diverse in the school setting than in other settings.SLTs working in the education system in South Africa, however, also have to focus on literacy and the role of language in both special and mainstream schools (Kathard et al., 2011) in order to improve education outcomes.
Programme design: It is essential that SLTs configure school-wide programmes that employ a continuum of service delivery models in the least restrictive environment for learners with disabilities, and that they provide services to other learners as appropriate (ASHA, 2010).South African schools require that SLTs are skilled in wholeclass intervention, which implies working with larger groups.Currently the trend in South Africa is for intervention to be provided mainly by private practitioners who work with individual learners and small groups.However, whole-class intervention programmes in the foundation phase to support teachers and learners, and which focus on the development of language skills to underpin the curriculum, are required.SLTs have a particular role to play within this approach.Their expert knowledge of language, phonology and literacy make them ideally suited to provide teacher support in the schools (O'Connor & Geiger, 2009).It also requires collaboration at District and Provincial levels to implement such programmes.
Data collection and analysis: According to ASHA (2010) SLTs are accountable for their clients' outcomes.SLTs in South Africa have to base their decision making on reliable data and therefore need to plan the collection of data during treatment and interpret such data (either for individual learners or for overall programme evaluation) to ensure that decision making is indeed data-based.In addition, they share the responsibility for learners' outcomes with educators (ASHA, 2010).
Compliance: SLTs are responsible for meeting government policies in performance of their duties (ASHA, 2010).In South Africa, SLTs have to comply with national and provincial regulations, as well as guidelines compiled by SASLHA (2007), andthe HPCSA (2005).Although individualised education plans (IEP) are not required by all schools, SLTs are encouraged to develop such plans to ensure appropriate and effective treatment.The roles and responsibilities of SLTs in education contexts have changed and increased significantly over the past decade.In view of the current needs of the country, learners, as well as teachers, need support in literacy and language in order to raise education standards.This turns the focus to the collaborative role of SLTs working in education contexts.

Collaboration in the educational system
Political reform resulted in the Department of Education (DoE) drastically reducing positions for SLTs in schools in South Africa.Such measures resulted in private practitioners becoming more involved in providing services to learners with communication disorders However, such services are not accessible to all learners, as private practitioners are mostly remunerated by medical funds and/ or parents who have the means to do so.Th e collaborative approach, as recommended by the DoE, focuses on identifying and managing barriers to learning at the learner, teacher, curriculum, and institutional levels (DoE, 2001b).Collaboration is therefore an integral part of all four levels as depicted in the concept map in Figure 2, which was created based on an in-depth literature review.

Level 1. Collaborative support to learners
Th e ultimate aim of all intervention practices in schools is to benefi t learners.At the learner level the SLT needs to play a preventive and supportive role.Prevention of communication disorders is one of the exit-level outcomes specifi ed by the HPCSA (2005).Th is includes the prevention of further learning problems (HPCSA, 2005), which is a broadening of their previous role which focused mainly on learners with communication disorders.Within an inclusive approach they are required to provide all learners with support in communication skills (including literacy), which relates to their role on level 1 as depicted in Figure 2. Th is calls for active engagement in planning, implementing and monitoring learners' progress, depending on the age and ability levels of the learners.Prevention is best conducted by providing preschool and foundation-phase learners with suitable intervention for literacy development and by addressing reading and writing skills in older learners (ASHA, 2010).
As was pointed out by Kathard et al. (2011), it is imperative that young children acquire adequate listening skills, as it allows them to perceive speech in a meaningful manner.The facilitation of listening skills allows learners to become competent in the use of language, which is a prerequisite for the acquisition of literacy skills.Learners need to develop metalinguistic skills to identify and analyse specific sounds to enable them to read and write.The acquisition of language skills is equally important for the development of numeracy, as it relies particularly on vocabulary and problem-solving skills.
Learners who do not have adequate and age-appropriate listening and language skills when entering formal education may be at risk for academic failure.The inability to perform academically, in turn, may cause problems such as low self-esteem, social maladjustment, and ultimately vocational problems.Academic failure can be prevented by ensuring that learners acquire ageappropriate listening and language skills preferably before they enter formal education.However, this is not possible in all cases in the South African context.For learners in many contexts these skills need to be targeted in the foundation phase with support provided to both teachers and children by the SLT.
Part of SLTs' roles in classrooms is to identify and support learners with language disorders and also to focus on foundational  language elements that support mastery of subjects (Kathard et al., 2011).They should focus on language for learning and include listening, reading, writing and speaking (O'Connor & Geiger, 2009).SLTs have an important role to play to support all learners, whether providing intervention directly or indirectly.Riley and Roach (2006) singled out the support of teachers as the key to high-quality early childhood development programmes.This has implications for the extension and growth of teachers on a national level (Fig. 2).The provision of continued professional development (CPD) activities is an important form of support to teachers (Wium & Louw, 2011).SLTs can contribute to learners' achievement as such teacher support has been found to be significant, particularly for learners in low-achieving, low-income urban and rural schools (Johnson, Mims-Cox & Doyle-Nichols, 2006).

Level 2. Collaborating with teachers
Working within a collaborative approach in schools requires that a range of service delivery models need to be considered, depending on the context and the needs of the learners and teachers (Cirrin et al., 2010).Teachers need to be supported through a process of training, mentoring, monitoring, and consultation.Because of the relationship between language, literacy and learning, it is imperative that teachers and SLTs work as a team in supporting learners in their acquisition of literacy.Team members need to firstly respect each other and show an ability to work towards similar outcomes.The collaborative model of support encourages team members to share their disciplinary knowledge.SLTs could share their knowledge of facilitating communication, language development and literacy acquisition, whereas teachers could provide insight into the context, the process of teaching and learning, the learners and the curriculum (Kathard et al., 2011).
Based on their knowledge and expertise in communication and language, SLTs have much to offer teachers and other education role players in the form of continuing professional development (CPD) activities to enhance the performance of learners in schools (ASHA, 2010).In addition, teacher support in the form of CPD activities contributes to a school culture and ethos that make teachers feel valued and motivated, renews their enthusiasm and prevents burnout (Earley & Bubb, 2004).

Roles of teachers
The Norms and Standards for Teachers (DoE, 2000) assigns specific roles to the practice of teachers.Teachers have to be: '...mediators of learning, interpreters and designers of learning programmes and materials, leaders, administrators, and managers, scholars, researchers and lifelong learners, community members, citizens and pastors, assessors and learning area or phase specialists' .Teachers need not only to be masters of the content of their subjects, but should also understand how children learn.Since the inception of the revised NCS in 2002, teachers have been expected to make a paradigm shift regarding their teaching and learning practices in the classroom (DoE, 2006).
Collaboration is a two-way process; therefore, teachers as curriculum experts need to guide the SLT in curriculum matters, and support him/her in managing large groups, e.g.whole-class teaching (Bauer, Iyer, Boon, & Fore, 2010).Collaboration requires that teachers allocate time in their schedule for the SLT to discuss specific learners, the learning objectives and how these can be achieved.With reference to the preventive role of SLTs, teachers can work with SLTs to include all learners in the classroom (whole-class teaching), which relates to the principles of outcomes-based education.

Roles of SLTs
The collaborative role of SLTs in schools is to work with teachers, other professionals and parents to meet the learners' needs.SLTs need to develop an understanding of the roles of all professionals working in schools (e.g.occupational therapists, school psychologists, social workers, etc.).Collaboration will enable all parties to share their knowledge and expertise in the planning and assessment of learners at team meetings.If children are to be viewed holistically, collaboration should extend to their home environments as well.Collaborating with parents is integral to supporting the child as communication is central to the social, emotional, and academic development of young children (Owens, 2002).This aspect remains challenging in South Africa.Although parent involvement is seen as integral to the education of a child (DoE, 2002) it is not often observed in under-resourced contexts (O'Connor & Geiger, 2009).SLTs have to explore and find ways to collaborate with parents and include them as partners to work towards improving language development and/or other communication problems.
Within a systems approach, not only teachers and parents should be involved in supporting the child, but the whole community.SLTs working in schools are part of the school community and therefore are responsible for presenting talks and information to parent associations and school governing bodies on how they can provide support to learners and teachers.For example they can be encouraged to make donations of resources (e.g.scrap paper, books, volunteer to support reading in grade 1 classrooms), or donate equipment for schools that will enhance learning (e.g.fans, carpets).Being part of the school community will require SLTs to participate in fund-raising activities that will allow the school to employ additional staff.It should be cautioned that SLTs exercise careful time management so as not to lose focus of their primary roles in the school.
Collaboration is further extended to assuming leadership roles in the school setting where SLTs have to articulate their roles and responsibilities and ensure delivery of appropriate SLT services.SLTs must advocate for appropriate programmes and services for learners.Apart from allocating time for assessment and intervention, they need to be allowed sufficient time for planning, meetings, consultation with parents and other professionals.SLTs also need time to attend professional development activities for CPD accreditation purposes and professional growth.ASHA (2010) states that SLTs have a responsibility to articulate their roles and responsibilities to teachers, other school professionals, administrators, support personnel, families, and the community.They also need to work to influence the development and interpretation of laws, regulations, and policies to promote best practice.
Another leadership role of SLTs working in schools involves the supervision and mentoring of new and inexperienced colleagues in the school context, as well as providing supervision to university students.This leadership role requires SLTs to engage in research, as it is important for evidence-based practice, particularly on collaborative practices related to assessment and intervention practices (ASHA, 2010).SLTs, as expert practitioners, should continually seek new information to improve intervention effectiveness.
Despite the emphasis on collaborative practices in schools, inter-professional collaboration remains challenging.Giess et al. (2012) reported that SLTs at times experienced themselves as assistants to the teacher, which is unacceptable as it does not allow them to focus on their specialised skills regarding language and literacy intervention.In South Africa, SLTs working in schools often experience the situation where teachers prefer them not to be in their classrooms (personal communication, E. Naude, August 2012).Such challenges can only be overcome when teacher and SLT training programmes emphasise working as a team as best practice, and by an effort from both disciplines to regard these challenges as opportunities to solve problems as a team (Giess et al., 2012).
In South Africa the understanding of collaborative practices between SLTs and teachers is in the development phase.In some contexts teachers are positive about it (Du Plessis & Louw, 2008), while others do not share the same feelings.Effective collaboration between SLTs and teachers requires that both parties understand their individual roles, and that SLTs take the educational environment into account.It is necessary to identify each discipline's individual knowledge base and approaches, as well as the new knowledge, skills and approaches required to work together in supporting learners in South African classrooms.

Level 3. Collaborating at district level
According to the DoE (2001a) SLTs' supportive role needs to expand to district levels (see level 3 in Fig. 2) as well.At district level SLTs can assist in the planning and implementation of support programmes for teachers.Considering the number of primary schools in South Africa (Kathard et al., 2011), SLTs will be best applied at level 3 where they could have maximum effect on a much larger number of teachers.SLTs could function as members of a support team which plans and implements support programmes for teachers, but could also visit schools and classrooms on a rotation basis to identify learners who experience challenges (particularly with literacy and communication).Such support will allow teachers to plan and facilitate language and learning, e.g. by implementing a balanced approach to literacy where there is an integration of the whole-language and phonetic approaches (Paul & Norbury, 2012).According to Education White Papers 5 and 6 (DoE, 2001a(DoE, , 2001b)), specific needs of individual learners may be addressed within the school context, or alternatively learners will be referred to full-service schools, where they will receive the necessary support from a team of professionals, but remain integrated in mainstream classrooms.Learners who experience severe challenges will be referred to schools for learners with special needs (DoE, 2008).This will require involvement of teams at district level.

Level 4. Collaborating at strategic level
SLTs also have a collaborative and consultative role to play at the level of strategic planning, which occurs at provincial and national levels (level 4 in Fig. 2).SLTs need to promote the profession by creating an awareness of their important role in contributing to learners' educational success and enabling all learners to meet their education goals.By becoming involved at the provincial and national education levels, SLTs may contribute to regulations and policies (Kathard et al., 2011), which in turn may impact on their role in schools (levels 1 and 2).In South Africa it is important that SLTs continue to advocate for positions for SLTs in schools, which is currently the case with SASLHA engaging in such discussions with the DoE (Kathard et al., 2011).Collaboration at the strategic level (refer to level 4 in Fig. 2) will ensure that all learners, particularly those who are vulnerable and at risk for educational failure receive the support they are entitled to.These roles and responsibilities of SLTs in schools, as depicted in Figure 2, have important implications for training curricula and continued professional development in South Africa.Such support on all four levels can contribute significantly to meeting the grand plan of the country.

Are these roles contributing towards the grand plan?
In answer to the fourth question, SLTs as expert practitioners should continually seek new information to improve intervention effectiveness.It is necessary for SLTs to participate in research to generate and support the use of evidence-based assessment and intervention practices (ASHA, 2010).They need to develop a deeper understanding of the nature of learning, teaching and the educational process.Practice-based evidence (PBE) provides the necessary information for decision making.Education officials need such data for planning and implementation of strategy to improve education outcomes, which links the role of SLTs in education with the fourth level (refer to the strategic level in Fig. 2).
Based on such evidence, and with regard to the current needs of the country, it is suggested that the DoE implements a policy that employs SLTs in schools.Such a policy also has to define their specific roles and responsibilities.The service delivery models to be used in schools, as well as curriculum training guidelines, would have to be developed.It is suggested that the monitoring of service delivery be done as a joint effort between the HPCSA and the DoE.SLTs therefore have a crucial role to play in providing support at learner, educator, curriculum and strategic levels.However, the changing roles and responsibilities of SLTs in schools have a range of important implications.

Implications of the new roles and responsibilities for professional preparation and development
The requirements of the world of work raises the question of how well future SLTs are prepared to perform these roles and meet the challenges of providing services to both learners and teachers in schools.It is important to critically assess whether the theoretical course work content of undergraduate students and the application to clinical practice in the schools is sufficient to prepare them to become independent schoolbased clinicians.Universities have long been striving to implement contextually relevant training, and because curricula can never be static, but have to adapt to meet the changing needs of the country, it is necessary to continuously review curriculum content.

Implications for undergraduate curricula
One of the issues to be considered for the curricula will be implementing inclusive education, which requires that SLTs move away from the 'pull-out' model of service delivery, and increasingly make use of the collaborative/'push-in' model as it allows learners to receive direct therapy from the SLT without missing out on classroom instruction.The 'push-in' model of support where learners are supported in the classroom is most suitable for learners who are struggling with the learning material because of language difficulties (Office of Special Education and Student Services, 2011).
The preparation of university students therefore needs to address supportive strategies for both learners and teachers.For some learners, practitioners may want to initially use a direct, rather than an indirect, approach.Newly acquired skills should ideally be generalised through a more indirect approach in the classroom.SLTs traditionally used the pull-out model of service delivery, as their professional training experiences required them to provide individual and group intervention outside the classroom (Brandel & Loeb, 2012).
Classroom support ('push-in' model) is not necessarily the answer to all interventions, as the pull-out model may still be used to provide specialised instruction for learners with, for example, articulation, language, voice, fluency, or swallowing disorders.The decision to follow the pull-out model will be determined by the nature and severity of some disabilities, or the needs and characteristics of the client (Brandel & Loeb, 2011;Cirrin et al., 2010).Another option to be considered is that of community-based instruction where learners are given the opportunity to generalise their skills in community settings (e.g.use of augmentative and alternative communication devices).
In line with collaborative practices SLTs may want to consider co-teaching, team-teaching, or make use of peer-learning strategies (Owens, 2002).It is agreed that team-teaching, where both teachers and SLTs play equal roles, is the most appropriate method within a collaborative approach (Giess et al., 2012).Team teaching strategies such as paraphrasing of information, creating graphic organisers, and teaching strategies for vocabulary learning (Office of Special Education and Student Services, 2011) are valuable tools to use in classroom settings.The decision regarding the model of service delivery needs to be a joint decision of the SLT and the teacher.The curriculum should therefore equip SLT students with knowledge about team work, specifically team building, role release and the management of conflict.
In a collaborative model of support, teachers learn to reinforce speech, language and literacy goals and to assess the learner's progress.They have to learn to implement specific techniques that will be of benefit to all learners and not only those with communication disorders.SLT students should not only learn about the collaborative model in their theoretical coursework, but also be provided with opportunities to gain clinical experience in working in the classroom and to adapt the curriculum for learners with special needs.
Strategies for sequencing and for developing narratives are also relevant for a curriculum.Students should learn how to provide cues and prompts to specific learners, and modify the language level of instruction to meet individual learners' needs.There may also be a need for small-group instruction in the class, and students should be prepared for it.
In South Africa, public service has an obligation to support universities in preparing students for the workplace, as universities generate future employees and colleagues.SLTs working in schools often collaborate with university training programmes to provide invaluable clinical supervision to university students.It is important that both universities and SLTs in schools collaborate to provide students with high-quality and relevant training to adequately prepare them to function as efficient professionals in the school setting.SLTs as supervisors could also involve students in practice-based research where they take part in intervention data collection, literature reviews on clinical issues, or have students participate in clinical research projects.Means (2009) suggested that curricula address legislative policies related to education, contextually based assessments, curriculum and therapeutic integration, assessment criteria of the various grade levels, and the use of the workload model rather than caseloads.It was also suggested that universities increase collaboration with school sites through the use of supervisor survey feedback which would allow pedagogical changes, and by inviting school-based SLTs as guest lecturers or guest speakers.
SLT students need to be well prepared in conducting valid and reliable assessments.The use of standardised tests is a challenge in the South African context with eleven official languages (Pascoe & Norman, 2011).Students therefore have to make use of alternative assessment methods, and need to be trained to do so.Practical experiences should allow students to provide therapy, monitor progress and write assessment and evaluation reports specifically in school contexts.University training programmes should ensure that SLP students are equipped to address multiple speech-language problems (Giess et al., 2012).The emphasis on literacy by the DoE requires SLTs to work with whole classes, which necessitates that students learn the skill to work with large groups.University training programmes should therefore create opportunities where students collaborate with teachers to present curriculum content (e.g.phonological awareness) to the entire class.Furthermore, interprofessional education, where SLTs and education students could share course work and clinical experiences and learn to collaborate pre-professionally, is an exciting new avenue for universities to explore.
Because collaboration is one of the key roles of SLTs working in schools, this aspect should not only be addressed in theory, but should be experienced in practice.The problem may arise that students doing their practical training in school contexts are supervised by SLTs who have not yet adapted to such a shift (Means, 2009), and continue to adhere solely to traditional 'pullout' service delivery methods.It is therefore important to ensure that the supervisors are comfortable with collaborative practices as they are role models to students.Universities have an important role to play in terms of CPD to inform and familiarise supervisors with such practices.SLP students who are trained and prepared to collaborate in school/education contexts may feel more confident to enter the schools and to provide high-quality services which will be to the benefit of both the learners and teachers.Curriculum content therefore needs to cover the expanding role and responsibilities, as well as current information regarding the education system in South Africa.Training in collaborative strategies and methods for implementing support for the learner and the teacher, at the district and the national level, is imperative.
SLTs have to become familiar with the CAPS and although it is not expected that they become curriculum experts, such as is required of teachers (DoE, 2000), it is necessary that they develop a basic understanding of the curriculum (Kathard et al., 2011) and focus on the linguistic and meta-linguistic foundations of curriculum learning.In South Africa SLTs are required to emphasise the importance of language and the role of language in literacy (e.g.listening, speaking, reading and writing), as well as in numeracy.
In the USA concerns were raised with regard to the preparedness of SLPs for schools (Giess et al., 2012;Means, 2009).To respond to these concerns, ASHA's Special Interest Group (SIG) 16, School-Based Issues, developed a University Outreach Committee Document for training programmes to prepare SLP students to work in schools (Giess et al., 2012).This document on the 'Roles and responsibilities of speechlanguage pathologists in schools' (ASHA, 2010) provides learning outcomes, formative assessments, projects and suggestions for training programmes for use in the preparation of students to work in schools.Based on the ASHA (2010) document and the process described by Giess et al. (2012), it is proposed that a resource document be developed for South African SLP training programmes to prepare students for careers in schools.Such a document should specifically address the role of collaborative support as depicted in Figure 1.This would ensure that future SLTs are well prepared to enter the school system to perform the crucial role of partnering and collaborating with other professionals to meet learners' needs in the local context.It could also be beneficial for university supervisors to engage in professional discussions on curricula and coursework weaknesses and collaboratively develop basic coursework that address school-based issues.

Implications for professional development
The changing roles and responsibilities of the SLT in schools also necessitate consideration of educational opportunities for professionals.Presenting CPD opportunities on collaborative methods and strategies in the classroom to both SLTs and teachers will strengthen the collaborative role of SLTs in the school system.Using SLTs who are already working within collaborative frameworks in schools as guest lecturers and workshop presenters will further this cause.
Traditionally SLTs were trained in university clinics with a clinical perspective of use of standardised assessments (Means, 2009: 97), which relates to the medical or specialist's model.In order to work in schools SLTs now need an educational background which also emphasises the integration of school-based curricular concepts and non-standardised assessment methods to be used in the South African context.Many of the SLTs currently working in schools may require re-skilling through CPD programmes to make a mind-shift from pullout to collaborative service delivery models.These SLTs could then further support student training.

Conclusion
A critical review of the changing role of the SLT in schools in South Africa has major relevance to the important question regarding the grand plan (Ehren, 2011in Kathard et al., 2011).SLTs can make an essential contribution to education and preparing citizens of the future if the roles and responsibilities of the SLT in schools can be formalised in a document by SASLHA, if negotiations with the DoE can result in a structure to employ SLPs in schools, and if training curricula can be guided by a professional document.Such actions would assign a key role to collaboration and secure the future of SLTs in schools.
Currently there is a shortage of SLTs working in the schools in South Africa.At present many learners are served by SLTs contracted by individual schools or parents, and in some cases by SLP students during their clinical practicum.It is important that SASHLA, as the professional body, continues to advocate for the profession.The possibility of community service in school contexts where the need for increased education outcomes are most pressing should be considered (Kathard et al., 2011).The changing roles and responsibilities of SLTs also point to the urgency for undergraduate training curricula to reflect these changes and to prepare students to develop as independent school-based clinicians.
In conclusion, there is a pressing need for SASLHA to establish a specialist task team to address the issues raised in this article.Firstly, it is suggested that a research-based, collaborative approach be followed to determine what training programmes currently offer and what suggestions they may have to prepare students for careers in the schools.In addition teachers, education officials, and teaching programmes need to be consulted in a true collaborative fashion to determine their needs and suggestions.Based on these results, recommendations for SLT curricula and interprofessional education opportunities could be formalised for university training programmes.Secondly, a need was identified for a new official document that guides the roles and responsibilities of SLTs working in schools.SASLHA has a proud tradition of responding to changes in and challenges of the South African landscape and one of the association's objectives is to act as a resource for its members.The development of such a guideline would ensure optimal outcomes for learners.Such actions by SASLHA would contribute to forging the future development of contextually relevant practice in South African schools to the benefit of both the learners and the teachers.

Fig. 2 .
Fig. 2. Th e levels of collaboration of SLTs in the education context.