Rethinking Service Delivery

Posted by Gena Swanagan Frazer on 4/16/2021 7:00:00 AM

Over the course of my thirty year career, many things have changed about the Speech Language Pathologist (SLP) scope of practice and role in education and medical field….when I graduated the idea of SLPs addressing dysphagia and childhood apraxia had just been introduced. One thing that hasn’t changed much in the world of the school-based SLP is service delivery.  Research suggests that SLPs tend to take one scheduling option and apply it across their entire caseload despite individualized factors. The majority of services are provided 2-3 times a week in a pull out group outside of the general education setting (Brandel &  Frome Loeb, 2011).  The reason for this uniform approach? Some studies suggest that it is related to habit and large caseloads numbers (Chiang & Rylance) but I believe that traditional scheduling prevails because it best fits the block scheduling of the school day. The push of bell-to bell instruction with uninterrupted reading and math blocks has narrowed daily student availability to roughly 40 minutes per grade level.  This limited availability is manageable for SLPs as long as they are assigned to one building and have 6 or fewer students with identified needs that benefit from small group intervention per grade level.  Are you thinking that this perfect situation is unlikely to occur in schools with caseloads over 65 and a growing enrollment?  You aren’t alone; the SLP Department at Earlywood Educational Services (EES) is thinking the same thing.  

inclusive services With service delivery in mind, this year’s SLP Professional Development has targeted the idea of Inclusive Therapy with help of two former Earlywood SLP employees: Kristy Wright, a consultant from Indiana IEP Resource Center and Christina Bradburn, a national seminar leader from Shelbyville Community School Corporation. These professionals shared information regarding Co-Teaching and Inclusive Services through a Workload Model, respectively. These professional development opportunities were a good way to get the conversation regarding alternative service delivery started, identify therapists’ comfort level, and determine the need for additional information/training.  As this a major shift in thinking and practice for the SLPs and subsequently school personnel, the process will be slow; partnerships and practices will need to be established over time. Many therapists already provide whole group intervention such as, The Sound System to promote phonological awareness or The Expanding Expression Tool kit to build oral and written language skills as a general education initiative but do not view these whole class activities as therapy. SLPs that feel comfortable and have established relationships with teaching staff may trial a new service delivery model for a portion of their students by starting with one classroom or one grade level to determine what works best for their building. 

What might these inclusive services look like? As services are based on individualized student need, services will not be uniform; instead they vary by student, school, and therapist.  Based on the material presented and therapist feedback, here are some ways that inclusive therapy may be implemented:

Classroom based therapy Classroom therapy based on a continuum Co-Teaching Model.  The use of Co-Teaching is an effective model with a wide service delivery variance. Under the Co-Teaching umbrella there are many levels of shared responsibility. One foreseeable model may find the SLP in the classroom supplementing instruction or reteaching previously presented content with a group of students on their speech caseload or a group of identified  students and typical peers via a learning station.  Another potential model may have the SLP leading an intervention lesson targeting oral and written vocabulary development for an entire class.  A team teaching approach is beneficial as the teacher will be exposed to the SLP’s  use of  visuals, specific models, and level of cues/prompts associated with IEP goals during instruction and the SLP will become more familiar with classroom content and rigor.

Another inclusive service is the use of short, frequent articulation drills such as, 5-Minute Kids versus longer sessions on a more infrequent basis.  This service can be conducted in or out of the classroom using curriculum material such as, spelling and vocabulary lists and curriculum reading material. Research regarding service delivery supports individual sessions. A study by Willingham (2002) compared mass practice (the studying of material in one long session) vs distributed practice (the learning of new material in short sessions over several days)  and the effect on student achievement.  The results of the study indicated distributed practice was more effective than mass practice for retention of new information. An additional study by Kamhi (2006) suggested that more treatment time, especially in individualized sessions, will result in more student gains, which may in turn, shorten the duration of or need for speech therapy. Another benefit of the shorter session is less time out of the general education setting which will help maintain the least restrictive environment for students and  in turn, reduce any potential harmful effects that are discussed during IEP development.   

Change can be difficult but I believe that the SLPs at EES are excited about trying new service delivery models. They are innovative thinkers that are always honing their skills. It will be exciting to see the positive impact a more inclusive model can have on student learning. 

Gena Swanagan Frazer

Gena Swanagan Frazer,  M. A., CCC/SLP
SLP Department Head