The Impact of the Opioid Crisis on Language and Literacy Development in School-Age Students and the SLP’s Ethical Responsibilities Related to this Issue
According to the Center for Behavioral Health Statistics and Quality (2016), an estimated 26,000 pregnant women ages 15 to 44 illicitly used opioid pain relievers and/or heroin. Additionally, it is not known how many pregnant women legally used methadone or buprenorphine during physician-supervised medication-assisted treatment to prevent withdrawal symptoms and reduce cravings. We do know that after infants recover from neonatal abstinence syndrome (NAS), a disproportionate number of them experience cognitive, behavioral, developmental, and educational challenges and disabilities. Fill et al. (2018) documented that 14%, compared to 10.8% in a matched group of children without NAS, will receive speech and language services. A history of NAS increases the child’s likelihood of receiving speech and language treatment 1.33 times.
Oei et al. (2017) documented significantly lower literacy and numeracy skills among post-NAS children compared with their peers. As cautioned by Proctor-Williams (2018), “The opioid crisis is not just in the headlines” (p. 1). Even though the symptoms of NAS may be resolved in a child’s infancy, the effects of NAS may have long-term adverse neurodevelopmental outcomes. As post-NAS children enter schools in larger and larger numbers, school SLPs must know how to collaborate with other professionals (e.g., school psychologists, social workers, school nurses, guidance counselors, other special education teachers, and administrators) to best identify and meet the needs of these students. “Infants and children post-NAS present difficulties that cross boundaries of expertise and require interprofessional collaboration” (Proctor-Williams, 2018, p.8). Society is just beginning to acknowledge the opioid crisis. More research is needed to develop best practices for service of students who are post-NAS.
One could argue that it is the role of the school principal and/or Local Education Agency Representative to take the lead on maintaining confidentiality and professional ethics related to students who present with post-NAS. However, it could also be argued that every member of the school team should be cognizant of these responsibilities.
The SLP needs to know the legal aspects of accessing, creating, and using student records. State and federal statutes related to student records and confidentiality must be honored by all school districts and must be part of the knowledge base of all professionals in the school setting. School districts that use electronic billing for Medicaid reimbursement must comply with the Health Insurance Portability and Accountability Act of 1996. “A major goal of the Privacy Rule is to assure [sic] that individuals’ health information is properly protected while allowing the flow of health information needed to provide and promote high quality health care and to protect the public’s health and well-being” (U.S. Department of Health and Human Services, 2003). The Family Educational Rights and Privacy Act (FERPA, 1974) is the federal law that applies to school records and outlines the requirements of educational recordkeeping. FERPA mandated that every school district must have written educational records and that personally identifiable information about students must be kept confidential. Parents have the right to inspect and review such records and also have the right to request copies. When a school staff member views confidential records, an access log must be kept. The access record must identify the staff member by name and title. Parents must consent before information from confidential records is shared with outside agencies or other professionals. Parents may request an amendment of records if they consider the information to be inaccurate or misleading. Notes that are retained by a staff member and not shared with anyone else are not considered part of the confidential record.
When a student turns 18 years old, parents may no longer access a student’s records unless that student provides permission. Educational records do not include treatment records of students 18 years or older that are maintained by health care professionals. Every public-school district is required to adopt an educational records policy and to implement procedures that meet the standards of FERPA. The school district must notify parents and students of their rights pertaining to student records, maintain a permanent file on each student, and maintain separate special education records. Parents have the right to refuse disclosure of directory information to the public. Each state may enact its own local law. When a discrepancy exists between federal and state mandates, the more restrictive statute must be followed (Wisconsin Department of Public Instruction, 2004).
The types of records kept by a school district may include directory data, progress records, behavioral records, pupil physical health records, and patient health care records. School districts must have written policies about where each type of record is housed, who may access the information, and how the information is used. The following are descriptions of these types of records:
- Directory data—Records that include the student’s name, address, telephone number, e-mail address, date of birth, place of birth, weight, height, dates of attendance, photographs, name of the school most recently previously attended, and participation in extracurricular activities are all types of directory data. Directory data usually are more accessible to a wider audience within the school district.
- Progress records—Records that include the pupil’s grades, attendance, immunization, screening results, and possibly extracurricular activities are types of progress records.
- Behavioral records—Records that include psychological test results, personality evaluations, documentation or summaries of conversations, written statements relating to the student’s behavior, achievement test results, and physical health records are types of behavioral records. Such records often are kept in a separate file, in a separate filing cabinet, and in a different location from that for directory data. Many school districts have policies that limit the personnel who have access to behavioral records.
- Pupil physical health records—Records that include basic health information about a student, including immunization records, an emergency medical card, a log of first aid and medicine administered to the student, an athletic permit card, logs related to attendance of services provided by a physical or an occupational therapist, and documentation related to hearing, vision, scoliosis, and lead poisoning screenings, are types of pupil physical health records. Information such as diagnoses, opinion, and judgments made by a health care provider is not included in a physical health care record. Only basic health information may appear in such a file.
- Patient health care records—Records relating to diagnoses, opinions, and judgments about a student made by a health care provider are examples of patient health care records. Written, drawn, printed, spoken, visual, electromagnetic, or digital information that is recorded or preserved must be kept in this separate file. IEP team summaries of evaluation findings, IEP team reports, IEP documents, intervention plans, remediation notes, and any other information that exceeds the definition of basic health information must be treated as a patient health care record.
When collaborating with parents, educators, and other professionals to provide quality service to children who present with post NAS, the SLP must be aware of his or her ethical responsibilities. There are at least six aspects of the ASHA Code of Ethics that address such issues: (a) Articles I-B and IV-C call for interprofessional collaboration; (b) Article I-O requires the SLP to protect the confidentiality and security of records; (c) Article II-A mandates that the SLP stay within his or her scope of practice; (d) Article II-D requires the SLP to be a life- long learner; and (e) Article IV-R requires the SLP to comply with local, state, and federal laws applicable to professional practice (ASHA, 2016).
Training institutions, supervisors, and students-in-training, as well as practicing SLPs, are advised to learn more about their legal and ethical responsibilities related to meeting the needs of children with post NOS. The population within our schools is growing. The communication disorders, and their connections to literacy development, are becoming more complex. More research is desired in this area.
American Speech-Language-Hearing Association. (2016). Code of ethics [Ethics]. Available from www.asha.org/policy/
Center for Behavioral Health Statistics and Quality. (2016). Key substance use and mental health indicators in the United States: Results from the 2015 National Survey on Drug Use and Health, (HHS Publication No. SMA 16-4984, NSDUH Series H-51). Retrieved from http://www.samhsa.gov/data/
Family Educational Rights and Privacy Act (FERPA). (1974). (20 U.S.C. n 1232g; 34 CFR Part 99).
Fill, M. M. A., Miller, A. M., Wilkinson, R. H., Warren, M. D., Dunn, J. R., Schaffner, W., & Jones, T. F. (2018).Educational disabilities among children born with Neonatal Abstinence Syndrome. Pediatrics, 142(3), e20180562.
Oei, J. L., Melhuish, E., Uebel, H., Azzam, N., Breen, C., & Wright, I. M. (2017). Neonatal abstinence syndrome and high school performance. Pediatrics, 139(2), 1–10.
Proctor-Williams, K. (2018). The opioid crisis on our caseloads. The ASHA Leader, 23(11), 42–49. Available at https://leader.pubs.asha.org/doi/10.1044/leader.ftr1.23112018.42
U.S. Department of Health and Human Services. (2003). Summary of the HIPAA Rule. Retrieved from http://www.hhs.gov/ocr/privacysummary.pdf
Wisconsin Department of Public Instruction. (2004). Student records and confidentiality. Madison, WI: Author.