Service Delivery Models and Inclusive PracticesService Delivery Models and Inclusive Practices in Speech-Language Pathology: Challenges and in Speech-Language Pathology: Challenges and

SolutionsSolutions

Connecticut Speech-Language-Hearing Association

Spring 2010 Conference

March 26, 2010

Diane Paul, PhD, CCC-SLPDirector, Clinical Issues in Speech-Language Pathology

American Speech-Language-Hearing AssociationRockville, MD

Learning ObjectivesLearning Objectives

• Describe advantages and disadvantages of various service delivery models (e.g., pull-out, classroom-based, collaborative-consultation) and identify which models are more compatible with inclusive practices.

• Present challenges and formulate solutions for selection and implementation of classroom-based and collaborative-consultation service delivery models for individual students.

Learning ObjectivesLearning Objectives

• Develop an action plan for implementing different service delivery models to benefit individual students with roles of speech-language pathologists, teachers, and administrators clearly defined.

Agenda-Part OneAgenda-Part One

• 8:30-8:45 am Advantages and disadvantages of various service delivery models and compatibility with

inclusive practices

•  8:45-9:10 am Pairs discuss experiences with different types of service delivery models and inclusive practices

•  9:10-9:30 am Full group discusses types of models used by participants

Inclusive PracticesInclusive Practices

Intervention services that are based on the unique and specific needs of the individual, provided in a setting that is least restrictive (ASHA, 1996)

Inclusive Practices for Students with Inclusive Practices for Students with Communication DisordersCommunication Disorders

• Encouraging peer interactions with typical language models

• Providing services in the natural education environment

• Integrating speech and language intervention within the classroom curriculum and activities

Inclusive PracticesInclusive Practices

• Collaborating with speech-language pathologists, teachers, parents, and others to achieve communication goals;

• Bringing speech and language services to the child rather than taking the child to a separate treatment room

Potential Value of Peer Language Potential Value of Peer Language ModelsModels

Inclusive settings afford opportunities for natural, meaningful language use with peers with typical speech and language development.

Service Delivery Models for Speech-Service Delivery Models for Speech-Language PathologyLanguage Pathology

Range: Traditional pull-out services

toIndirect collaborative approaches

C continuum

C combination

C communication needs

• Components• Rationale• Conceptual and empirical bases for using a

particular model or models in inclusive classroom settings

• A model by any other name, may be the same

Range of Service Delivery Models Range of Service Delivery Models Used In School Speech-Language Used In School Speech-Language

Pathology PracticePathology Practice

Pull-Out ModelPull-Out Model

Typically, speech-language pathologist provides direct treatment in a separate therapy room with an individual or small group.

ComponentsComponents——Pull-Out ModelPull-Out Model

Role: The speech-language pathologist serves in a direct role.

Context: A separate treatment room is the primary context for speech and language intervention. The communication partners are typically adults; partners may also be peers with speech and language disabilities when small groups are used.

Pull-Out ModelPull-Out Model

Goals: Communication goals are typically separate from the classroom curriculum, but may be integrated.

Collaboration: Collaboration is not a characteristic of this model, but it may occur among the speech-language pathologist, teacher, parents, and others.

Pull-Out ModelPull-Out Model

• Prevailing context for providing speech and language services in the early years of the field

• Continues to be the most used service delivery model for preschool and school-aged children

• Discrete language units

Pull-Out ModelPull-Out Model

• Isolated context

• Content of the classroom curriculum may also provide the focus of intervention activities

• Confer with classroom teachers

Reasons for Pull-Out ModelReasons for Pull-Out Model

• Teaching certain skills requiring repetitive drills

• Teaching a new behavior • Working with children who are easily

distracted • Working with children who have more

severe disabilities

Pull-Out ModelPull-Out Model

• Preference to receive special services out of the view of peers

• Control communication variables by limiting auditory and visual distractions and structuring conversational exchanges

Problems Inherent toProblems Inherent toPull-Out ModelPull-Out Model

• Isolation

• Difficulty with generalization

• Lack of meaningful social-communication interactions (“Nelson—context stripping”)

• Only a few studies have tested these assumptions

Classroom-Based ModelClassroom-Based Model

Speech-language pathologist provides service directly in the classroom in coordination with the classroom teacher

ComponentsComponents—Classroom-Based —Classroom-Based Service Delivery ModelService Delivery Model

Role: The speech-language pathologist serves in a direct role.

Context: The classroom is the primary context for speech and language intervention. The communication partners are adults and typically developing peers.

Classroom-Based ModelClassroom-Based Model

Goals: Communication goals are integrated within the regular classroom curriculum.

Collaboration: The teacher, speech-language pathologist, parents, and others work together to select goals and determine appropriate intervention strategies.

Forms of InteractionForms of Interaction

• One teaches, one “drifts”

• Team teaching

• One teaches, one observes

AdvantagesAdvantages—Classroom-Based—Classroom-BasedModelModel

• Goals relevant to classroom needs• Better generalization• Frequency of intervention• Alleviation of problems incurred by pulling

the student out of the classroom• Provision of services to students who are at

risk but not identified or receiving services

Classroom-Based ModelClassroom-Based Model

Classroom-based models within inclusive settings also provide opportunities to foster communication interactions with typically developing peers, who can model appropriate language forms and functions.

Collaborative Consultation ModelCollaborative Consultation Model

• Problem solving and mutual goal setting from multiple perspectives that are relevant to a child's communication needs

• Teacher is responsible for direct implementation, and the speech-language pathologist plays a more indirect role, offering information and guidance

ComponentsComponents—Collaborative —Collaborative Consultation ModelConsultation Model

Role: The speech-language pathologist serves in an indirect role.

Context: The classroom is the primary context for speech and language intervention. The communication partners are adults and primarily typically developing peers.

Collaborative Consultation ModelCollaborative Consultation Model

Goals: Communication goals are integrated within the regular classroom curriculum.

Collaboration: The teacher, speech-language pathologist, parents, and others work together to select goals and determine appropriate intervention strategies.

Collaborative Consultation ModelCollaborative Consultation Model

• Shared responsibility

• Shared accountability

• Shared resources

Compatibility of Service Delivery Compatibility of Service Delivery Models With Inclusive PracticesModels With Inclusive Practices

• Service delivery models may be used singly or in combination

• Certain models may be more consistent conceptually with inclusive practices

• Certain models may lead to more favorable speech and language outcomes

Service Delivery ModelsService Delivery Models

• Service delivery models are dynamic and models or combinations of models may vary over time

• Service delivery models along a continuum should be selected on the basis of individual communication needs and compatibility with inclusive practices

Compatibility of Service Delivery Models With Compatibility of Service Delivery Models With Features of Inclusive Practices for Children with Features of Inclusive Practices for Children with

Speech and Language DisabilitiesSpeech and Language Disabilities

Features of Inclusive Practices

Service Delivery Model

Pull-Out Classroom-Based

Collaborative Consultation

Provides opportunities for peer language models

No Yes Yes

Compatibility of Service Delivery Models With Compatibility of Service Delivery Models With Features of Inclusive PracticesFeatures of Inclusive Practices

Features of Inclusive Practices

Service Delivery Model

Pull-Out Classroom-Based

Collaborative Consultation

Provides services in natural educational setting

No Yes Yes

Compatibility of Service Delivery Models With Compatibility of Service Delivery Models With Features of Inclusive PracticesFeatures of Inclusive Practices

Features of Inclusive Practices

Service Delivery Model

Pull-Out Classroom-Based

Collaborative Consultation

Integrates speech and language intervention within the classroom curriculum and activities

Possible Yes Yes

Compatibility of Service Delivery Models With Compatibility of Service Delivery Models With Features of Inclusive PracticesFeatures of Inclusive Practices

Features of Inclusive Practices

Service Delivery Model

Pull-Out Classroom-Based

Collaborative Consultation

Collaboration occurs among speech-language pathologists, teachers, parents, and others to achieve communication goals

Possible Yes Yes

Compatibility of Service Delivery Models With Compatibility of Service Delivery Models With Features of Inclusive PracticesFeatures of Inclusive Practices

Features of Inclusive Practices

Service Delivery Model

Pull-Out Classroom-Based

Collaborative Consultation

Brings speech and language services to the child rather than taking the child to a separate treatment room

No Yes Yes

Agenda-Part 2Agenda-Part 2

• 9:30-9:45 am Group discusses challenges for use of classroom-based and collaborative consultation service delivery models

•  9:45-10:00 am Small group discusses challenges and solutions to implementation (e.g., working with teachers, student and parent perceptions, support from administrators)

• 10:00-10:15 am BREAK

• 10:15-10:45 am Group discusses case studies from participants and brainstorms solutions

•  

ChallengesChallenges

• High caseloads/workloads

• Fidelity of intervention– Quality– Intensity– Consistency

• Teacher interest/understanding of alternative service delivery models

ChallengesChallenges

• Administrative support

• Accountability demands

• Parent perception of pull-out

Agenda-Part 3Agenda-Part 3

• 10:45-10:55 am General guidelines and components of actions plans

• 10:55-11:15 am Small groups develop action plans for implementing new service delivery model/s

•  11:15-11:25 am Group discusses major components of action plans

•  11:25-11:30 am Participants indicate major point/s learned

Action Plans-General GuidelinesAction Plans-General Guidelines

• Provide leadership to ease resistance and enlist support

• Gain administrative support for the use of inclusive settings and compatible service delivery models

Action Plan-General GuidelinesAction Plan-General Guidelines

• Establish a mechanism for collaborative partnerships with time for collaboration.

• Serve as a resource to families/caregivers: convey information on the value of inclusive practices and various service delivery models

Action Plan-General GuidelinesAction Plan-General Guidelines

• Decide on service delivery model or models on the basis of individual communication needs and changes over time

• Determine providers, activities, context

• Evaluate individual and program results

• Celebrate success

Action Plan-ComponentsAction Plan-Components

• Providers: WHO is involved in service delivery—SLP, teacher, peers?

• Activities: WHAT are you going to do? How often? How will you evaluate results?

• Context: WHERE? and WHEN? will service be provided—treatment room, classroom, resource room, cafeteria, home? Instruction time, recess, snack time?

Action Plan-ComponentsAction Plan-Components

Include in-service training opportunities• Provide current information about inclusive

practices and compatible service delivery models to administrators, teachers, and related service providers

• Use professional policies regarding inclusive practices, caseload/workload, and service delivery models

Action Plan-ComponentsAction Plan-Components

Provide in-service education on an ongoing basis (mentoring collaborative partners)

• Informal contact

• Interactive dialogue

• Role modeling

• Demonstration

• Observation and feedback

• Direct assistance

• Long term planning

Action Plan-ComponentsAction Plan-Components

Conduct evaluation• Individual students

• Overall program

Celebrate success

For More InformationFor More Information

Diane Paul

dpaul@asha.org