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

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 naturaleducation 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 toIndirect 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 toPull-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-BasedModel • 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 pathologistplays 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

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

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

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

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

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 dpaul@asha.org