What are the different Service Delivery Models?

Pullout Only (Traditional) Speech language Services:

By definition, pullout speech language services occur whenever the SLP works independently and provides small-group or individual services in a setting that is separate from the students classroom (e.g., speech therapy room, hallway, etc.) (Norris, 1989). Pullout therapy falls under the category of direct services. The goals of pullout services do not necessarily coincide with the content standards established by the state (Norris, 1989). These services occur apart from the classroom, teacher, curriculum, and nondisabled peers, and they are often times disconnected from the students regular daily activities (e.g., lunch, recess, transitions, etc.).

The biggest criticism of the pullout only service delivery model is that newly taught skills do not necessarily carryover (i.e., generalize) to other settings (ASHA, 2005; Elksnin & Capilouto, 1994; Gresham, Sugai, & Horner, 2001; Miller, 1989). Anderson and Nelson (1988) identified several disadvantages to pullout speech language services. First, pullout services are not often relevant to the students academics or social needs. Skills targeted in the therapy room are not related to the curriculum, and social situations cannot be replicated (Gresham et.al, 2001). Next, students who are pulled out of class miss valuable classroom instruction and activities. Upon returning to class, these students are held responsible for learning missed subject matter. On some occasions, they may be expected to learn the material on their own and make-up any missed class work. With this being said, it is not to say that pullout speech language therapy does not have a place in the schools. Traditional pullout may be necessary when students are taught a new skill or require intensive and individualized programming beyond what can be achieved in a classroom setting (ASHA, 1993).

Collaborative Consultation

This type of indirect service is employed when a group of individuals (e.g., the SLP and teacher) collaboratively solve problems related to the students academic and functional skills (Miller, 1989). Collaborative consultation is described as an interactive process that enables groups of people with diverse expertise to generate creative solutions to mutually defined problems (Idol, Paolucci-Whitcomb & Nevin, 1994, p. 1). It can be the medium that supports interactions between teachers and SLPs in order to address the students speech and language weaknesses (Merritt & Culatta, 1998).

There are several disadvantages to utilizing collaborative consultation. First, it can be difficult to find time to collaborate with teachers on an ongoing basis. Second, many SLPs do not have the pre-service training in order to implement a collaborative consultation model. Next, collaborative consultation is not often recognized as speech therapy by school staff, parents, and administrators. Lastly, it may be difficult to find a teacher or staff member who would be willing to collaborate to solve a problem.

Co-teaching

Friend (1992) divides co-teaching into seven distinct variations. In the one teach, one observe model, the SLP observes the classroom teacher provide instruction in the room. Information gleaned from the observation is often used to assess the students communication skills in a naturalistic setting in order to design future classroom lessons, accommodation or modifications for the student. The one teach, one observe model is also used whenever the SLP or teacher want to model to another individual a particular instructional strategy (e.g., LINCS) or program (e.g., PECS) that can be used with a student. The one teach, one drift model involves one professional providing instruction while another circulates around the room to monitor the students speech and language skills, provide additional support, or redirect behavior. Station teaching occurs when the instructional content and class is divided into two smaller groups in the classroom. Then each group takes turns receiving instruction from the teacher and the SLP during that class period. Next, the parallel teaching model divides the students in the class into two groups. The SLP teaches a group of students using specially designed strategies for students with communication impairments while the teacher teaches the remaining group of students. According to Friend, each professional teaches the same instructional content but in very different ways. In the fifth type of co-teaching, the SLP provides remedial teaching to those students who have not yet mastered portions of the curriculum while the teacher continues on with teaching the remaining students in the classroom on new subject matter. During supplemental teaching, the SLP, learning disabilities specialist or classroom teacher presents a lesson using a traditional presentation format, whereas the other teacher adapts the lesson for students who have difficulty mastering the material (Elksnin, 1997, p. 416). The last variation of co-teaching is team teaching. The teacher and the SLP jointly teach a lesson to students with and without disabilities.

No matter which type of co-teaching service delivery mode is used, in order for it to be effectively designed and implemented, teachers and SLPs must work together to problem solve and design appropriately individualized and differentiated lessons. This can be very difficult to accomplish. There may not be enough time to collaborate with the teacher to design these lessons. Many SLPs have not had pre-service or in-service training in co-teaching, and therefore they are not comfortable trying this approach. Additionally, some teachers, administrators, and parents do not feel that co-taught classroom lessons provide for intensive instruction on communication goals and objectives. There are many barriers to overcome.

Integrated Classroom-based Services

Integrated classroom-based speech language services utilize a continuum of service delivery options based on the students unique needs. Depending on these unique needs, the SLP targets educationally relevant speech and language skills from the following menu of options: Pullout services that support the classroom and curriculum, co-teaching, collaborative consultation, adaptation or modification of the curriculum, creation or adaptation of classroom materials, adaptation of the students environment, programming or creation of assistive technology, or some combination thereof (this list is not exhaustive). These service delivery options are designed to positively, directly, and indirectly impact upon the students academic and functional performance across educational settings. The students speech and language impairment is targeted systematically and thoughtfully within the context of the general education curriculum through the use of research-based strategies, collaboration, modifications, and accommodations.

Integrated classroom-based services utilize curriculum related listening, speaking, reading and writing activities as vehicles for learning language and speech skills (Elksin, 1997). By design, this type of service is educationally relevant, impacts the general education curriculum, and facilitates academic, social, emotional, and vocational progress (Ehren, 2000, p. 220). Integrated classroom-based services pull from the best of all worlds when it comes to speech language services. It strategically combines a little bit of direct services (e.g., pullout, co-teaching, etc.) with a little bit of indirect services (e.g., collaborative consultation, programming AAC devices, etc.) in order to create comprehensive and individualized speech language services for students with communication impairments.

That being said, integrated classroom-based services are not easy to implement using the traditional speech language schedule. Instead, SLPs need a flexible scheduling option (e.g., 3:1 Service Delivery Model) in place in order to have the freedom and structure to provide these services.

The goal of introducing alternative models of service delivery [is] not to eliminate pullout services; rather, the goal [is] restriction of the use of pullout services to appropriate cases and the provision of alternative approaches when they best serve students needs (Sanger et al., 1995, p. 80).