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
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 collaborativeconsultation service delivery models for individual
students.
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.
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
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)
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
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
Potential Value of Peer Language
Models
Inclusive settings afford opportunities for
natural, meaningful language use with peers
with typical speech and language
development.
Service Delivery Models for SpeechLanguage Pathology
Range: Traditional pull-out services
to
Indirect collaborative approaches
C  continuum
C  combination
C  communication needs
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
Pull-Out Model
Typically, speech-language pathologist
provides direct treatment in a separate therapy
room with an individual or small group.
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.
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.
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 schoolaged children
• Discrete language units
Pull-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 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 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 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
Classroom-Based Model
Speech-language pathologist provides service
directly in the classroom in coordination with
the classroom teacher
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.
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.
Forms of Interaction
• One teaches, one “drifts”
• Team teaching
• One teaches, one observes
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
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.
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
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.
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.
Collaborative Consultation Model
• Shared responsibility
• Shared accountability
• Shared resources
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
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
Compatibility of Service Delivery Models With
Features of Inclusive Practices for Children with
Speech and Language Disabilities
Features of
Inclusive
Practices
Provides
opportunities for
peer language
models
Service Delivery Model
Pull-Out
Classroom- Collaborative
Based
Consultation
No
Yes
Yes
Compatibility of Service Delivery Models With
Features of Inclusive Practices
Features of
Inclusive
Practices
Provides
services in
natural
educational
setting
Service Delivery Model
Pull-Out
Classroom- Collaborative
Based
Consultation
No
Yes
Yes
Compatibility of Service Delivery Models With
Features of Inclusive Practices
Features of
Inclusive
Practices
Integrates speech
and language
intervention
within the
classroom
curriculum and
activities
Service Delivery Model
Pull-Out
Classroom- Collaborative
Based
Consultation
Possible
Yes
Yes
Compatibility of Service Delivery Models With
Features of Inclusive Practices
Features of
Inclusive
Practices
Collaboration
occurs among
speech-language
pathologists,
teachers, parents,
and others to
achieve
communication
goals
Service Delivery Model
Pull-Out
ClassroomBased
Collaborative
Consultation
Possible
Yes
Yes
Compatibility of Service Delivery Models With
Features of Inclusive Practices
Features of
Inclusive
Practices
Brings speech
and language
services to the
child rather than
taking the child
to a separate
treatment room
Service Delivery Model
Pull-Out
Classroom- Collaborative
Based
Consultation
No
Yes
Yes
Agenda-Part 2
•
9:30-9:45 am
•
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
•
10:15-10:45 am
•
Group discusses challenges for use of classroom-based
and collaborative consultation service delivery models
BREAK
Group discusses case studies from participants and
brainstorms solutions
Challenges
• High caseloads/workloads
• Fidelity of intervention
– Quality
– Intensity
– Consistency
• Teacher interest/understanding of
alternative service delivery models
Challenges
• Administrative support
• Accountability demands
• Parent perception of pull-out
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
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
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
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
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?
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
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
Action Plan-Components
Conduct evaluation
• Individual students
• Overall program
Celebrate success
For More Information
Diane Paul
dpaul@asha.org