The Fusion of Public Health and Speech-Language Therapy in Schools: Has the Time Come?

BACKGROUND: The burden of communication disorders in school age children is substantial. These disorders are among the most prevalent in schools. Communication disorders are also linked to numerous sequalae, such as poor socio-emotional health, poor academic and professional outcomes, high levels of unemployment, and increased healthcare utilization and costs. Nevertheless, children with these disorders are among the least likely to receive services from a rehabilitation professional. In fact, more than half of school-aged children with a communication disorder do not receive any speech-language therapy support. Clearly, new approaches to communication disorders in schools are needed.   METHODS: We conducted a narrative review of scholarly and applied literature in three parts. The first justifies the fusion of public health and speech-language therapy in schools. The second explores public health frameworks for speech-language therapy and compares the same to tiered service delivery models recently implemented within schools. The third addresses the implications of this fusion for research in communication disorders and for clinical practice.   RESULTS: Traditional models of speech-language therapy clinical practice in schools are no longer sustainable given the current challenges posed by childhood communication disorders. A communication disability public health approach is needed to overcome these challenges. Tiered service delivery models provide an excellent opportunity to pivot speech-language therapy practice and research in schools towards a public health approach.   CONCLUSION: Through this narrative review, we argue that the future of speech-language therapy in schools must take advantage of advances in public health to respond to current child health needs in our communities. We strongly recommend the fusion of public health and school-based speech-language therapy to address the communication health needs of future generations.