John Heilmann from the University of Wisconsin-Milwaukee and Andrea Bertone from the Wisconsin Department of Public Instruction, recipients of the 2020 Researcher-Practitioner Collaboration Grant
Barriers and Facilitators to Inclusion in the Schools: Exploration at the State, District, and Clinician Levels
What originally sparked your interest in your research?
John: “My interest in this topic began years ago, thanks to some inspiring colleagues—particularly in occupational therapy—who really changed the way I think about what ‘outcomes’ should mean. One colleague working with AAC (augmentative and alternative communication) really emphasized the importance of functional outcomes, which got me thinking beyond speech skills. Around the same time, I was also learning from some like-minded professionals in child language who were advocating for what we now call inclusive practice. It made me realize how often, as speech-language pathologists, we hyper-focus on specific skills like pronouncing phonemes or constructing sentences and lose sight of a bigger question: How is this child functioning in their real-world environment?
It’s not only about whether a student can say a word or form longer sentences—it’s about whether they can participate meaningfully in their school environment. Are they able to engage with the curriculum? Can they express their needs to a teacher? Can they have real conversations with their peers? Those are the questions that began to spark my interest in a more holistic approach to speech-language interventions.
I also started to see how our training in speech-language pathology follows a medical model—we evaluate, treat, and aim to ‘fix’ a disorder—but that approach doesn’t always translate well to school settings. Inclusive practice challenges us to shift our thinking. It’s about ensuring that the work we do in the speech room connects to the student’s everyday experiences in school. For example, if I’m helping a student improve their storytelling skills in a session, how do we ensure they can use that skill to engage meaningfully in classroom discussions? This naturally led to the idea of collaborating with teachers, so speech-language services don’t happen in isolation, but rather as a shared responsibility to support the whole student.
Another key moment for me was meeting the head of speech-language pathology for Wisconsin’s Department of Public Instruction, Andrea Bertone. We immediately connected over ideas like participation, educational relevance, and functional outcomes. I began learning about implementation science, which was a game-changer. It made me realize that as researchers, we need to have more humility. Instead of ‘throwing information’ at clinicians by writing papers that few read or use, we need to be listening—hearing what’s working, what’s not, and understanding their context. Implementation science gave me a structured way to approach these questions and opened the door to more meaningful collaboration.
The most transformative part of this journey over the past few years has been hearing directly from SLPs and special education directors. We’ve had real conversations about what’s possible given the constraints of time and resources. For example, when you’re under tight time pressures, is it really necessary to write lengthy reports, or are there more effective ways to use that time? Asking these questions has been incredibly powerful and has driven my passion for this work."
What obstacles are you seeing that need to be overcome as you conduct this work?
John: “The key obstacle I’ve encountered in this work is a pervasive mindset issue—particularly around shared responsibility. Too often, there’s this unspoken attitude that special education students are only the responsibility of special education staff. I’ve heard stories where teachers say things like, ‘Take your kids out of my room,’ suggesting that these students aren’t seen as a shared concern for the whole team. This mindset is one of the biggest barriers to overcome. Real inclusion requires everyone—general educators, special educators, and speech-language pathologists—to recognize that they are collectively responsible for all students.
Another significant challenge I’ve observed is around interprofessional collaboration. Initially, I thought terms like ‘interprofessional collaboration’ were just passing buzzwords—like advocacy had been in the past. But after talking to SLPs and special educators, I realized that collaboration isn’t just jargon; it’s at the heart of the work they do. Effective advocacy and real collaboration require more than just working alongside others—it’s about being willing to reconsider professional roles and boundaries. It means asking hard questions, like: Am I willing to share what I consider ‘my’ domain—speech and language—with teachers or occupational therapists? Can they see me as an equal partner who adds value to the classroom, rather than just an extra set of hands to help out?
A further barrier I’ve noticed is vulnerability. Both teachers and SLPs feel it—teachers may worry about being judged by specialists who are in the room, asking themselves, Am I saying the right things? Am I doing the right things? Meanwhile, SLPs often feel equally exposed, wondering, Is what I’m doing from an educational perspective good enough? Is this really helping the student? That sense of vulnerability can inhibit collaboration and reduce the willingness to try new approaches.
Lastly, there’s the structural issue of administrative support. Collaboration takes time, and time is money. Without a flexible workload that builds in time for consultation and teamwork, meaningful collaboration becomes difficult to sustain. What’s crucial is having leadership that not only supports collaboration but actively sets the tone for shared responsibility across the entire school community. When administrators prioritize this kind of teamwork and provide the necessary time and resources, real progress becomes possible.”
How are you approaching this work, and how did the ASHFoundation help?
John: “The ASHFoundation was instrumental in launching this work by providing the seed funding we needed to get started. Their support didn’t just give us resources—it validated the importance of the project, which opened doors and helped us build key partnerships. With that initial funding, we began what’s known as exploration-level research in implementation science. We wanted to understand the real-world barriers and facilitators of inclusive practices from the perspectives of speech-language pathologists and special education administrators.
We started by conducting focus groups to hear directly from SLPs and administrators about what helps and hinders inclusive practices. That qualitative work gave us critical insights into recurring themes—what’s working, what isn’t—and we followed it up with surveys to gather quantitative data. By looking at factors like years of experience, work settings, and populations served, we could identify key determinants that affect how SLPs implement these practices.
The ASHFoundation’s support not only allowed us to do this research but also helped us engage meaningfully with hard-to-reach participants. Special education directors and administrators are incredibly busy, and offering real compensation was key to getting a representative sample. More importantly, having their backing brought credibility to our work, which helped our partners gain recognition from their leadership. This external validation was critical when we applied for additional funding.
As a result, we were able to secure a partnership with the Wisconsin Department of Public Instruction. Now, we’re collaborating with state leaders in speech-language pathology and special education, and we’re positioned to make a lasting impact on inclusive practices at a statewide level.”
So bottom line: Why should anyone care about this research?
John: “Honestly, for too long, researchers have taken a top-down approach—we’ve been telling clinicians what they should do, prescribing solutions without fully appreciating what implementation looks like in the real world. We’ve lacked the humility to listen and truly understand their experiences. That’s why this work has been so transformative for me—hearing their stories firsthand has been incredibly inspiring and humbling.
It’s eye-opening to see the dedication, the challenges, and the stress that these professionals face every day. I felt this deeply during one of our talks when someone asked how many in the room had been practicing during the pandemic, and nearly everyone raised their hand. It hit me hard—these are people who were on the front lines during an unimaginably difficult time, while my own experience during the pandemic was mostly remote. Their resilience is remarkable.
So, why should people care? Because we, as researchers, need to shift our approach. Instead of merely offering abstract solutions, we must learn from the speech-language pathologists who are directly engaged in this work. The reality is, we haven’t always equipped them with the right tools and information to succeed in such complex roles. Moving forward, the answer lies in genuine, collaborative partnerships—partnerships that are mutually beneficial. I want to contribute in a way that genuinely adds value to their work, helps them build skills, fosters a sense of community, and addresses their real-world needs because it matters deeply.
We recognize, much like in medicine and other fields, that improving outcomes and reducing disparities requires adapting innovations to fit the realities of those on the ground. That means understanding what clinicians need in order to serve their students and clients effectively. This work excites me because I see the potential impact—not just in theory, but in practice. And that’s what keeps me passionate about it.”
View More Recipient Spotlights