Speech Language pathology undergraduates' views about Educational Speech Language pathology from their theoretical and practical experiences

ABSTRACT

Purpose:  this study aims to discuss speech language pathology undergraduates views about educational speech language pathology actions, and verify the knowledge as well as the theoretical and practical experiences acquired during their graduation course.

Methods:  78 undergraduates from speech language therapy in their last year of the graduation course participated in this study. They belong to five Brazilian universities and answered a questionnaire with open questions about their formation emphasizing speech language pathology in the educational context.

Results:  most undergraduates understand that their graduation courses enabled knowledge on speech language pathology in the educational context; 27.63% reported that this knowledge represents a clinical perspective, and only 14.47% of them reported that they received information about speech language pathology actions that foster language and learning promotion. 43.59% mentioned that speech language pathology function inside schools should be clinical, 25.64% reported that their function must be language promotion, and 14.10% named both ways of action.

Conclusions:  through the undergraduates' reports, it was possible to notice that graduation courses at this area tend to discuss speech language pathology actions inside school in a clinical perspective. However, it was possible to perceive that a minority of the undergraduates was capable to discuss speech language pathology actions in school through language and education promotion.

Keywords: Speech, Language and Hearing Sciences; Education, Continuing Education,

RESUMO

Objetivo:  discutir, sob a ótica dos graduandos de alguns cursos de Fonoaudiologia do Brasil, sua percepção acerca das ações fonoaudiológicas voltada à educação, bem como verificar o conhecimento e as experiências teórico/práticas que estes estudantes tiveram durante seus cursos de graduação em Fonoaudiologia.

Métodos:  78 acadêmicos do último ano do curso de graduação em Fonoaudiologia, pertencentes a cinco diferentes universidades brasileiras responderam a um questionário com perguntas abertas sobre sua formação com enfoque na Fonoaudiologia Educacional.

Resultados:  a maior parte dos acadêmicos percebe que seus cursos propiciaram conhecimentos acerca da Fonoaudiologia Educacional, sendo que 27,63% relataram que os conhecimentos adquiridos partem de um viés clínico e apenas 14,47% dos graduandos apresentaram um conhecimento voltado para uma atuação fonoaudiológica que preconize a promoção da linguagem e do aprender. Quanto à função que deve ser exercida pelos fonoaudiólogos educacionais, 43,59 % citaram a atuação clínica, 25,64% relatam que a função que devem exercer é de promoção da linguagem e 14,10% citaram as duas formas de atuação.

Conclusão:  pode-se perceber por meio dos relatos de graduandos em Fonoaudiologia que os cursos de graduação nesta área ainda tendem a discutir a Fonoaudiologia Educacional apenas sob um enfoque clínico dentro da escola. Apesar disso, já se percebe uma minoria que discorre a respeito da atuação do fonoaudiólogo educacional por meio de ações de promoção da linguagem e da educação.

Descritores: Fonoaudiologia; Educação; Educação Continuada

Introduction

The first Speech Language Therapy courses in Brazil in the early 1960s were grounded on a clinical-oriented model¹. From this model, the speech language pathologist identifies general problems related to oral and/or written language, and after screening them, guidelines are outlined to be applied in the school. Such guidelines, mainly between the 1960s and 1990s followed a medical-therapeutic focus.

Due to this clinical tendency of working, it is still common nowadays that teachers as well as speech language pathologists identify school problems in their students in a point of view that understands language in their formal aspects and learning by means of biological, individual and pathological parameters^2),(3. Thus, speech language therapy practice in schools held by Brazilian language speech therapists are based on some guidelines, such as screenings, counseling and referrals to restricted groups in the population considered at risk for diseases and disorders. Following this clinical tendency, several research studies still focus on students' disorder detection and discussion^4)-(8, not on speech-language health promotion and literacy.

Concomitant to this view grounded on clinical actions for the so-called school-related disorders, since the end of the last century, concerning health promotion and literacy, it can be pointed out another theoretical-methodological tendency which conceives the speech language pathologist as a mediator and co-author in the elaboration and development of language promotion-related actions in the educational context^3)-(10.

From this conception, speech language pathologists started to think about their work in school settings by means of actions which contemplate a partnership between them and the teachers, recognizing teachers' social role and knowledge, and including themselves in the political-pedagogic project of schools, enabling a deeper, jointed reflection on the involved educational aspects, specially the appropriation of oral and written language. Based on this second tendency, speech language pathologists quit the emphasis on clinical aspects in their actions in school settings, and propose activities for the socialization of practical and theoretical knowledge among speech language professionals and educators. Thus, new approaches contemplating the complexity of language processes have been developed, besides favorable conditions have been created so that school and families participate in the educational process in and out of the school context^2),(9.

Due to the importance of the speech language therapeutic work in school institutions, it is perceived that health professional qualification and education is an important factor of change in a process marked by hardships, diagnoses and students' stigmatization in a healthy learning process¹¹.

Keeping in mind the working possibilities of a speech language pathologist in the educational context, and the resolution which regulates speech language pathologists' occupation in educational settings, CFFa n. 387/2010¹², it is perceived that such professionals' qualification requires an increasing set of complex knowledge which meets not only the diversities of school communities demands, but also steady updating in such knowledge. Thus, the role of graduation courses must be strategic, privileging the relevant aspects for the qualification of speech language professionals¹³.

It is worth pointing out that speech language pathologists' initial formation also had a biomedical, organicist model, without taking into account socio-historical contexts in education and health. Currently, this broader view on the involved determinants to promote health and language start to appear in documents regulating speech language pathologists' education. The resolution CNE/CES 5/2002¹⁴⁾ is an example, although it does not specify speech language therapists' qualification for the educational context.

The guidelines for speech language pathologists' education hold the importance to consider social contexts, individual and collective actions integrated to other professionals, health promotion, among other aspects. However, what official documents enunciate does not necessarily imply its occurrence in practice; thus, it is necessary that the course syllabus contemplates such actions. In addition, students must have access to this knowledge and be qualified to carry out such speech language therapeutic actions in the education field from a socio-historic model, and not a medical-therapeutic one any longer.

Observing the need for speech language therapeutic practice in the education field to be contemplated in a broader way in speech language pathology courses, this paper aims to discuss, in the light of undergraduates from some speech language pathology courses from Brazil, their perception on speech language therapeutic actions oriented to the education field, and also verify the knowledge and theoretical/practical experiences that those undergraduates had along their graduation courses.

Methods

Research approval was performed by the Ethics Board of Universidade Tuiuti do Paraná by means of protocol number 000134/2009.

In order to carry out this research, a questionnaire was elaborated and applied (Figure 1) with 7 questions on Speech Language Pathologists' education concerning their work in the educational context. The questionnaire was answered by 78 undergraduates in the last year of their Speech Language Pathology graduation course from five higher education institutions located in different states: one in Santa Catarina State, three in Paraná State and one in São Paulo State. Initials standing for each state they are located were attributed for institution identification, as well as a number to identify the universities from the same State.

Figure 1:
Questionnaire on Educational Speech Language Pathology

The inclusion criterion for the students in this research was to be attending the last year of the Speech Language Pathology course, once it was expected that at this point all students would have attended an academic discipline related to Educational Speech Language Pathology.

It deems necessary to clarify that all students answered the questionnaire individually and in writing, in their institution facilities, time scheduled by the course coordinator. After explanation on the research objectives, all undergraduates, who accepted to participate, signed the free consent form.

Result analysis is descriptive, frequency presented in ratios. The analyzed results were organized in the following theme categories: - Theoretical and Practical Qualification on Speech Language Pathology and Education theme; Knowledge provided by disciplines on Educational Speech Language Therapy; Reasons to include a Speech Language Pathologist in school staff; Speech language pathologist's role in schools; Task difference between the Clinical and Educational Speech Language Pathologist;

Results

Table 1:
Theoretical and practical qualification in the Speech Language pathology and Education theme^*

• Legend: PR (Paraná State), SC (Santa Catarina State), SP (São Paulo State).

Regarding theoretical/practical qualification in Educational Speech Language Therapy theme, 76 (97.44%) out of 78 students answered that the graduation course in Speech Language Pathology provided knowledge on Speech Language Therapy in the educational field, and only two undergraduates from two different universities answered negatively (2.56%), their courses did not provide knowledge on this area, according to Table 1.

Table 2:
Knowledge provided by disciplines on Educational Speech Language pathology^*

As it can be observed in Table 2, for 27.63% of the participants, knowledge provided in graduation on Educational Speech Language Pathology is related to the clinical performance or the first tendency of therapeutic action explained in the paper introduction; for 14.47% of the students, knowledge obtained in the graduation course has an educational focus, that is, related to their work at schools by means of actions contemplating their social role and partnership, according to the second tendency also presented in the paper introduction, and 3.95% of the participants mentioned knowledge referring to both theoretical-methodological tendencies formerly featured.

Other participants (10.53%) mentioned other types of knowledge, for example, speech language therapists at schools and/or different ways to perform their job, although such accounts were not clearly explained to include them in other more specific analysis categories.

It can also be observed that 43.42% of the participants mentioned other disciplines which addressed Educational Speech Language Pathology, but they did not elucidate the types of knowledge which were obtained.

Table 3:
Experiences in Educational Speech Language pathology during graduation

As for the experiences during graduation on Educational Speech Language Pathology, it is evidenced in Table 3 that 35.90% of the interviewed undergraduates mentioned Clinical performance, experienced in the clinical training or even in schools. 7.69% of the participants reported that their experiences were related to the language promotion itself in educational settings, and 14.10% reported they did not have any experiences at all.

Other participants (7.69%) did not mention or did not answer about their experiences, and 34.62% reported other kinds of experiences, such as the location where they went through those experiences, the "quality" of such experiences. However, they did not evidence any aspects that could include them in any other more specific categories. Those who reported only theoretical experiences were also included in this group, as the study also considered academic practice as lived experience.

By means of the result description, it can be perceived that answers with a clinical/preventive approach in Educational Speech Language Pathology scope were mentioned more than any other answers.

It is worth pointing out that when participants were questioned whether a speech language therapist should be part of a school staff, 100% of them answered that this professional should integrate this context.

Table 4:
Reasons for Speech Language pathologists' inclusion in the school staff^*

• ^# Each participant could mention more than one reason

It can be observed in Table 4 that when participants answered about the reasons why a speech language pathologist should be part of a school staff, 43.59% stressed that this professional should perform practices of detection, diagnosis and referrals, 19.23% of the interviewees answered that a speech language pathologist may perform a multidisciplinary job, 12.82% answered that this Professional must perform helping and counseling actions to teachers, other 12.82% of the undergraduates answered that the language speech pathologist should participate in the school planning, and only 8.97% of the respondents think that the speech language pathologist must carry out actions to promote reading and writing and/or literacy in school settings.

In the item "others", 16.67% of the undergraduates mentioned the need for speech language therapists to improve the quality of education and help in the development and work with reading and writing. However, it must be pointed out that such answers are not clear enough to be added to the other categories.

Table 5:
Speech Language pathologists' role in schools^*

• Legend: PR (Paraná State), SC (Santa Catarina State), SP (São Paulo State).

When questioned what should be a speech language pathologist's task in the educational context, 34 participants (43.59%) answered that it is a clinical one. Other 20 participants (25.64%) mentioned that a therapist has the task of language promotion. Among the respondents, 14.10% mentioned that a speech language pathologist's task must be clinical as well as promoting language, and 16.67% did not answer or were not clear enough in their answers, hindering their categorization.

Table 6:
Difference between clinical speech Language pathologists and educational speech language pathologists' work^*

When questioned whether they can perceive the differences between clinical and educational fields of work, 12.82% of the undergraduates answered that there are not any differences between these areas, and 87.18% can perceive differences in speech language therapists' tasks in these areas as evidenced in Table 6.

Among the 68 participants who reported perceived differences between the clinical and educational speech language pathologist, 76.47% mentioned that their task in a clinic should be detection, diagnosis and individual therapies focused on school disorders and disabilities, while the other 25.53% did not define a speech language pathologist in speech language therapy clinic.

When the same 68 interviewees explained speech language pathologists' tasks in school settings, 32.35% mentioned clinical tasks, ratifying the historically medical-therapeutic tendency of speech language therapy. Others (27.94%) mentioned education-focused performance, while 19.12% did not mention the tasks of an educational speech language pathologist.

Table 7:
Participants' reasons to work in the area of the Educational Speech language pathology^*

• ^# Each participant could choose more than one reason for his/her justification
• **Calculated Percentage over the 42 participants that wish to work in the area
• ***Calculated Percentage over the 36 participants who do not wish to work in the area

When questioned whether they would work as speech language therapists in the educational context, 42 participants (53.85%) answered affirmatively, and among those, 38.10% justified their answers by stating their identification with the area, 26.19% mentioned the importance of this professional in school settings, 16.67% answered that they would work in this area due to job market demands, 9.52% answered they had already had experience in this area, that is why they would continue working in this field. Others (14.29%) reported that they would work in this area for other reasons such as promotion of the speech language therapy activities, to take contests, and to help with students' disabilities.

From 78 respondents, 36 (46.15%) answered that they would not work in educational settings, and among those, 47.22% justified that they did not identify with the area, 25.00% believe they lack knowledge to work in the area, 22.22% did not justify, and 5.56% mentioned other reasons such as lack of professional recognition and the current professional status of Educational Speech Language Pathology.

Discussion

From the data gathered in the researched group, it can be perceived that undergraduates' education in graduation courses still has a clinical-therapeutic focus. Thus, similarly to speech language therapeutic practices in health and education areas which were influenced by reductionist views for over three decades, away from the necessary broad understanding of health-disease processes, the therapeutic possibilities¹⁵ and the institutional performance beyond a view of curing, curriculum disciplines to qualify speech language professionals for school settings are still dimensioned like that. In other words, there are flaws in their education once the course syllabus disregards social, historical, cultural, economical, political and pedagogical dimensions in the broader understanding of the processes surrounding health and education. Moreover, restricted understanding of these processes prevents students, in their educational process, to expand and deepen their knowledge on the educational Brazilian reality, on the documents guiding teaching, and the policies regulating Education in this country, which would enable to cope with "school failure" and the restricted conditions of literacy among our population. Speech language therapists' major, oriented to the educational field, requires the establishment of a relation between the areas which will demand a relocation and refocusing of the traditional actions of a health professional, and must be grounded on theoretical-methodological options that enable students a critical-reflexive development as well as active participation in the insertion/work of speech language pathologists in the educational context.

Even undergraduates who stated that they acquired knowledge on this area during their graduation course, they pointed out that it was not enough for their qualification. Research carried out on the qualification profile in the Educational Speech Language Pathology offered by IES¹⁶⁾ (Institutions of Higher Education/Ministry of Education) evidenced that the amount of time related to this theme is still restricted so that students feel qualified to work in that area. Average time-length for disciplines addressing this field in graduation courses is 60 hours, that is, curricula contemplate this specialized field in speech language pathology with minimum amount of time.

It can be perceived through most undergraduates' answers that their experiences in the area of Educational Speech Language Pathology, during their graduation course, were based on screenings and detection of students' disorders, that is, there seems to be greater concern to detect disorders rather than promoting language and literacy.

Besides being a recurrent view in the undergraduates' answers, it is noticeable that Educational Speech Language Pathology is connected with consultations in the pathological clinic, as some undergraduates when questioned about their experiences in the Educational Speech Language Pathology area, reported their clinical experiences in clinical training where they cared for referred patients due to learning disabilities, thus they needed to contact their schools. That is, their answers evidence that they do not consider schools as a professional work setting.

In spite of such answers evidencing that undergraduates are set apart from educational settings, they are coherent with the traditional task of an educational speech language therapist in this context, which aims to sort out normal from pathologic as well as the standardization of oral and written language. In order for them to reach their goals, they generally carry out screenings, diagnoses and referrals of children with language disorders to specialized care. It also objectifies the operationalization of the professional who works at schools, providing information and techniques by means of lectures, counseling, qualification courses, describing symptoms and causes of language disorders so that the school staff can cope with "problematic children"¹³. Such practices, grounded on behavior standardization, are still hegemonic¹³ nowadays, unveiling clinically-oriented actions rather than the objects and needs of the educational system.

Regarding undergraduates' answers towards the speech language pathologists' role in schools, shown in Table 5, it can be perceived a tendency for a clinically-oriented view again on the part of most students. It is worth pointing out that this kind of action, oriented to the identification of assumed students' deficits, and referring them to clinical care, transfers students' learning demands to therapeutic settings. In addition, this role oriented to teachers' counseling and qualification, in which the speech language pathologist only passes on fragmented knowledge on their studied object, disconnected with the knowledge and practices of these teaching professionals and educational demands, delegate teachers to the condition of a passive audience, not providing them elements for them to act in a transforming way upon school reality¹⁷.

The articulation between speech language pathologists and teachers must be effected, mainly through deep discussions on public educational policies as well as the promotion of an effective, more consistent partnership oriented to the school reality.

Still regarding the role of the educational speech language pathologist, favorable answers could be perceived towards clinical care within school institutions, although this kind of work is barred in such settings.

Undergraduates' opinion diversity on educational speech language pathologists' role is evidenced by observing Table 6 about the difference between clinical and educational speech language pathologists' tasks. As for clinical care, most interviewees mentioned problem detection, diagnoses and therapy, among their tasks, turned to individualized care focused on complaints. As for educational speech language pathologists' tasks, it is evidenced that clinical tendency is the most mentioned among the interviewees, focused on problems/disorders standardization, away from the educational focus itself. It is also worth pointing out that over half of the respondents thought of working as educational speech language pathologists, and many of them mentioned the importance of this professional for helping with school disabilities, referring again to pathologies/disorders.

Speech language therapeutics, focused only on pathologies, disconnected from reflections on socio-historical determinants involved in the teaching-learning process usually leads to students' pre-diagnosis. Most of the time, children referred to clinical care to cope with learning disabilities, have feelings of incapability. Thus, children and family members blame themselves for the so-called "school failure", exempting the educational system from responsibilities and disregarding social, economic and political factors related to that failure ¹⁸.

As shown in Table 7, subjects who would not work in school settings justified that position due to the little recognition of their profession in the educational context. Groups of teachers, just like groups of speech language pathologists also view pathologists' main task as the detection of students' problems and/or disorders and referrals for clinical care. Thus, school problem-solving is, on one hand, related to teachers who identify "problematic students", and on the other hand, speech language pathologists who mostly ratify this recommendation and refer those students to clinics outside the school, and finally, students will have to undergo treatment.

Another view to this problem results in the implementation of joint actions between teacher and therapist in order to promote children's reading and writing, besides integrated actions between education professionals, family and speech language pathologists aiming to change behavioral barriers that may contribute to consolidate the student as a subject "with difficulties", which can only be overcome away from school. It is observed that knowledge on educational speech language pathologists' role is still contradicting, even for undergraduates who may work in this area in the future. It was common, among their answers, that Speech Language Pathology course does not provide them with the necessary knowledge to work in this area.

In spite of the recurrence of clinically-focused work within schools, some undergraduates are inclined to the educational area, once they seem to have a more critical view of the Brazilian educational system. Such a position enables speech language pathologists to perform their jobs without looking for an organic problem to be treated in students who do not meet behavioral and learning expectations, but viewing those students as subjects with multiple sociocultural experiences, with full learning conditions.

Throughout the undergraduates' accounts, it is clear the idea that a really committed professional to the improvement of the quality of teaching may contribute for the implementation of important changes that enable the access and written language appropriation on the part of the Brazilian population¹⁷. Therefore, it is necessary that speech language pathologists change the way they view students, writing and learning, considering subjects' constituent diversities, whether in writing or ways of thinking, expressing and being in order for Speech Language Pathology to move away from its standardizing character, historically perpetuated in school settings.^.

To make that happen, it is necessary that Speech Language Pathology graduation courses provide a broader view on the Speech Language Pathology, once it is still restricted to clinical knowledge, as this study evidences. Many research participants report they do not have enough knowledge to work in the Educational Speech Language Pathology field. Lack of knowledge and confidence, mentioned in the participants' answers also refer to changes occurring in the speech language pathological work at school settings. If undergraduates go to a school for a training course, and teachers expect them to "detect and treat" disorders, many times these students have to deal with a contradiction, and pursue answers to the following questions: What shall I do? What do professionals expect from my work?

Therefore, speech, language pathologists' education must provide knowledge on both tendencies mentioned in this study in order for the students to have options or at least a critical thinking on education and how Speech Language Pathology is related to it. Thus, perhaps in the near future, new therapists may leave the university with a less restricted and stigmatized view, which has decisively hindered the history of Brazilian Educational Speech Language Pathology so far.

Speech Language Pathology actions in the educational context must be interdisciplinary and aim at promoting changes in the Brazilian educational system, that is, they must be committed to the knowledge of education policies and the discussion on the several ways to improve the guidelines that orient such educational system. Besides, the professionals involved must be willing to establish multidisciplinary interactions focused on the educational demands¹⁵.

Conclusion

By means of this research results, it is noticed that there is still a long way so that theoretical and practical principles guiding speech language pathological actions be changed and oriented to the demands of the current educational system in the country.

It can be perceived in the answers provided by Speech Language Pathology undergraduates that graduation courses still discuss their professional performance in the educational context only under a clinical focus, that is why screenings, counseling and referrals are the commonest mentioned tasks. In spite of that, it can be perceived that a minority addresses educational speech language pathologists' work by means of language and education promotion, assuming that speech language therapists are part of the school team and planning.

In order to foster an improvement in the Speech Language Pathology field in the school context, it is fundamental that Speech language pathology graduation courses deepen their teachings on the Educational area, mainly in relation to its historical context and professional tendencies in this area, by means of theoretical reflections and practice, besides the definition of criteria and parameters that warrant quality teaching for this content.

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• Erratum
  In this article, published in the journal Revista Cefac, volume 18(1):198-208,add up the following author:
  Simone Farinha.

Publication Dates

• Publication in this collection
  Jan-Feb 2016

History

• Received
  07 May 2015
• Accepted
  06 Oct 2015