1. Service Delivery Models and Inclusive Practices in Speech-Language Pathology: Challenges and Solutions
Connecticut Speech-Language-Hearing Association
Spring 2010 Conference
March 26, 2010
Diane Paul, PhD, CCC-SLP
Director, Clinical Issues in Speech-Language Pathology
American Speech-Language-Hearing Association
Rockville, MD

2. Learning 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.

3. Learning 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.

4. Agenda-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

5. Inclusive 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)

6. Inclusive Practices for Students with Communication 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

7. Inclusive 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

8. Potential Value of Peer Language Models
Inclusive settings afford opportunities for natural, meaningful language use with peers with typical speech and language development.

9. Service Delivery Models for Speech-Language Pathology
Range: Traditional pull-out services
to Indirect collaborative approaches
C  continuum
C  combination
C  communication needs

10. Range of Service Delivery Models Used In School Speech-Language Pathology Practice
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

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

12. Components—Pull-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.

13. Pull-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.

14. Pull-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

15. Pull-Out Model Isolated context
Content of the classroom curriculum may also provide the focus of intervention activities
Confer with classroom teachers

16. Reasons 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

17. Pull-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

18. Problems Inherent to Pull-Out Model
Isolation
Difficulty with generalization
Lack of meaningful social-communication interactions (“Nelson—context stripping”)
Only a few studies have tested these assumptions

19. Classroom-Based Model
Speech-language pathologist provides service directly in the classroom in coordination with the classroom teacher

20. Components—Classroom-Based Service 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.

21. Classroom-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.

22. Forms of Interaction One teaches, one “drifts” Team teaching
One teaches, one observes

23. Advantages—Classroom-Based Model
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

24. Classroom-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.

25. Collaborative 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

26. Components—Collaborative Consultation 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.

27. Collaborative 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.

28. Collaborative Consultation Model
Shared responsibility
Shared accountability
Shared resources

29. Compatibility of Service Delivery Models 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

30. Service 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

31. Compatibility of Service Delivery Models With Features of Inclusive Practices for Children with Speech and Language Disabilities
Features of Inclusive Practices
Service Delivery Model
Pull-Out
Classroom-Based
Collaborative Consultation
Provides opportunities for peer language models No
Yes

32. Compatibility of Service Delivery Models With Features of Inclusive Practices
Pull-Out
Classroom-Based
Collaborative Consultation
Provides services in natural educational setting No
Yes

33. Compatibility of Service Delivery Models With Features of Inclusive Practices
Pull-Out
Classroom-Based
Collaborative Consultation
Integrates speech and language intervention within the classroom curriculum and activities
Possible
Yes

34. Compatibility of Service Delivery Models With Features of Inclusive Practices
Pull-Out
Classroom-Based
Collaborative Consultation
Collaboration occurs among speech-language pathologists, teachers, parents, and others to achieve communication goals
Possible
Yes

35. Compatibility of Service Delivery Models With Features of Inclusive Practices
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

36. Agenda-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

37. Challenges High caseloads/workloads Fidelity of intervention
Quality
Intensity
Consistency
Teacher interest/understanding of alternative service delivery models

38. Challenges Administrative support Accountability demands
Parent perception of pull-out

39. Agenda-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

40. Action 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

41. Action 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

42. Action 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

43. Action 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?

44. Action 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

45. Action 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

46. Action Plan-Components
Conduct evaluation
Individual students
Overall program
Celebrate success

47. For More Information
Diane Paul