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Early Intervention Speech Therapy

Therapy in the Classroom

Published October 26, 2010 11:02 AM by Stephanie Bruno-Dowling
Today I have a question for all the therapists who are working in a preschool setting. My question is this: where do you do the majority of your therapy? In my current school, there has been a recent push to do therapy within the student's preschool classroom. As we all know, however, sometimes that is easier to do than at other times.

For now, I would say I do about 75 percent of my therapy within the classroom and about 25 percent as pull-out to the speech room. Many of the little ones I work with have some really challenging issues regarding focus and attention. Preschool classrooms are thumping with energy and sound! Even though the ultimate goal is for the child to successfully and efficiently function within the classroom environment, isn't part of why they are receiving speech services to begin with because they need that one-on-one and/or small group specialized instruction??!  

Removing them from the enthusiastically noisy hustle and bustle of their class and working with them in a quiet, structured environment helps them. I feel I am providing an opportunity for them to gain the communication skills they lack as well as the confidence to use their words and hear their own voice. Once they do that in the speech room, then we can work on carrying it over to the classroom. If I can barely keep their attention and focus, then how is therapy within the classroom helping them?

In addition, if the child has specific articulation goals, working on them within the classroom really doesn't make much sense to me. Although I can help to ensure the child is carrying over skills from our sessions to the larger group setting, I feel that while the child is learning to make the sounds, they need to be able to hear me and their own speech. They need numerous opportunities to practice the words and sounds. Some of my caseload just started talking in the past year. Sounds, words and speech are all still so new and abstract for them. Why not give them an ideal setting to build the foundation they so desperately need to learn how to communicate?

As I stated, I am in the classroom the majority of the time, working one-on-one, in small groups and co-teaching with the teacher and other therapists. However, there are times when I honestly feel that a child is best served in a quieter environment (at least until they can strengthen their skills) without distractions so that they can have the optimal learning environment.

I would love to hear therapist thoughts and feedback on this issue!

13 comments

I am so glad I wrote the last two therapy-based posts regarding the " push " for " push-in " therapy.

November 9, 2010 10:48 AM

After reading many of your comments from last week’s post , I realized that I certainly am not the only

November 3, 2010 11:24 AM

Thank you for all the wonderful feedback!! I really agree with so much of what everyone has written. I am continuing to do some research on this topic and will write a follow-up post for next Tuesday.....

stephanie bruno dowling, blog author October 28, 2010 9:45 PM

A truly hot topic! In my close to 30 yrs in this field I have seen the pendulum to swing several times from all individual, to all "Milieu Therapy " to "push-in and pull-out" combination. I hod the position that no hard rule can apply to all cases. I would be concerned if a district like the one mentioned by Dee, would issue a decree that it should be all or none. Where is the clinical judgment and flexibility both of which are essential in any work with children?

Right now I am in a somewhat stressful situation with very rigid teaching team, who resent me being on their turf, and I have been reduced to pulling kids out much more than I would prefer. At the same time they want me to do a whole class of 16  lesson once a week (which counts as a group session for 5 of "mine"  kids). I enjoy it very much, and so do the kids, but there is no way to address actual "speech" issues (artic, phonology) in such a format.

Had I had my "druthers", I would have preferred to "just plop down at a table" (or on the rug) as one of previous writers wrote, and work in a truly integrated way, where no one entering the classroom could tell which kids had IEPs and which did not. Unfortunately, with Medicaid billing rules, as well as the strict and at the same time inconsistent rules of this particular classroom, this model of service delivery (which is in the best practices, with the exception of speech production issues) is not realistic.

Olga October 28, 2010 5:59 PM
Albany, NY

What a great topic!

As for me, I am on the fence about this. I work in a school district that mandates that all therapy be done within the self-contained preschool classroom and yes,  it can be frustrating at times. If you actually get anything therapy done with the noise, music, crying, dancing, etc. going on then it is usually the other kids who interrupt me in therapy and distract the already VERY distractible child who I am trying to work with. I really think that the kids on my caseload would be infinitely more benefited by taking them to the speech room where they can be instructed in an environment more condusive to getting them to focus and attend. To make matters worse, you also need to work around the preschool classroom schedule, which is a challenge. What child would rather work with a speech teacher than to go out for recess, have a snack, listen to a story or have music time?

On the other hand, children tend to learn a great deal from their peers. In our preschools we have 10 children on IEP's and 4 typically developing peers in one classroom. The typicall peers serve as role models for those kids who are on IEP's. I have seen amazing changes in children (on IEP's) when they bond with another child in the class. They become motivated to TRY to communicate with their peers. So that is a definite plus. However, there are also challenges to having typical peers in the classroom as well. For example, when the children who are typical become more "work" than the children on the IEP's.

Dee, Preschool Speech Pathology - Speech-Language Pathologist, Preschool classroom October 28, 2010 1:18 PM
Chandler AZ

I agree. If these children could acquire speech and language skills in the regular classroom then we wouldn't be seeing them in the first place. Our children are those who haven't been able to develop these skills under normal circumstances. So why would we want to walk down the same path with them with all the visual and auditory distractions? I am a strong proponent of bringing children out individually , then in a small group when they are ready. Once they have some strategies and are able to pick up verbal or visual cues from the teacher (who should be trained to provide carryover by observing stategies modeled by SLP) then transition to the classroom makes sense. I had worked in preschool settings for years, but now work in a hospital outpatient clinic due to my strong views on this.

Ruth Faye, Speech Pathology - SLP, Naples community Hospital Healthcare System October 28, 2010 9:42 AM
Naples FL

I currently service pre-k kiddos primarily  in pull-out session, 1:1 or small group, depending on severity.  Typically, if I see a child two or more times per week, I will see them once individually, and once or more with a peer.  I will also see them in-class, during a co-treatment in-class session with the OT, where we rotate small groups of 4-6 children, during their centers time, once per week ( so kids get the direct therapy time and an extra bonus time , in-class).  I agree, that most pre-k kids that are getting serviced under an IEP, are in need of an alternate setting that is less distractible.  They do not get the number of opportunities/trials for practice, when in a class setting; especially if there is  competition from other more talkative children.  I feel I have much more control, to guide the speech practice for stuctured or contrived practice , or more natural spontaneous speech practice situations; moving in and out of each, as the child is ready, and as I find clinically appropriate.  Luckily, I also do not have administration mandating that I only service in the classroom.  Often, I find that ultimately, we are dis-servicing students when we "lock "them into inclusion; when they are not truly ready-b/c they are not getting what they need.  I do often let teachers/staff in the class know what the child is focusing on in therapy, so that they can help monitor , model, and prompt during everyday class activities.  Many times, I use those teachable moments that occur everyday, when I am picking up or dropping off students to the class, and "see" a perfect opportunity to model or prompt right then and there, especially at snack times, arrival and departure times! --A.

A., speech language - SLP, elem. school October 27, 2010 3:02 PM
CT

I currently service pre-k kiddos primarily  in pull-out session, 1:1 or small group, depending on severity.  Typically, if I see a child two or more times per week, I will see them once individually, and once or more with a peer.  I will also see them in-class, during a co-treatment in-class session with the OT, where we rotate small groups of 4-6 children, during their centers time, once per week ( so kids get the direct therapy time and an extra bonus time , in-class).  I agree, that most pre-k kids that are getting serviced under an IEP, are in need of an alternate setting that is less distractible.  They do not get the number of opportunities/trials for practice, when in a class setting; especially if there is  competition from other more talkative children.  I feel I have much more control, to guide the speech practice for stuctured or contrived practice , or more natural spontaneous speech practice situations; moving in and out of each, as the child is ready, and as I find clinically appropriate.  Luckily, I also do not have administration mandating that I only service in the classroom.  Often, I find that ultimately, we are dis-servicing students when we "lock "them into inclusion; when they are not truly ready-b/c they are not getting what they need.  I do often let teachers/staff in the class know what the child is focusing on in therapy, so that they can help monitor , model, and prompt during everyday class activities.  Many times, I use those teachable moments that occur everyday, when I am picking up or dropping off students to the class, and "see" a perfect opportunity to model or prompt right then and there, especially at snack times, arrival and departure times! --A.

A., speech language - SLP, elem. school October 27, 2010 1:51 PM
CT

For me it depends on the classroom and the child. Lately I have been working in the classroom because there are groups the kids cycle through. I just plop down at a table and cycle the kids who are able through a variety of activities that meet their goals (including articulation.) It actually works well because they are used to the routine of doing this almost every day for about 15 minutes, so I get way more productions than in one 30 or 45 minute session.  There are a couple of kids for whom this doesn't work, and I pull them out. I'm so glad I don't work for a district which mandates one way or another...great topic!

Alexandra Streeter October 26, 2010 10:26 PM

Thank you for bringing up this topic. I wonder...can articulation and phonological therapy be done in this setting so that it will result in meeting IEP goals? Is there any evidence to indicate that this will work? I was involved in a similar situation with the exception that all therapy was to be done in the preschool classroom during "free time". To me it felt unethical to try to do therapy in this setting when I knew there were better options and I resigned after 5 days.

mb October 26, 2010 10:10 PM

I couldn't agree with you more about the distractions and lack of attentiveness.  In a perfect world the aides and teachers would keep the other children from digging in our bags, reaching over the tables and wanting to 'play' too.  I pull most of my kiddos for these reasons.  It's so hard to hear their speech productions and to ask them to repeat often is counterproductive.  Its already frustrating enough for them.  Although the trend is inclusion for therapy, it really isn't effective from my experience.  

paSLP October 26, 2010 6:29 PM

I agree-some students just need to be pulled out. This year I have many more kids in the classroom than out.

I work in private preschool settings only.

I do have one child that I would typically pull out, however, he is very reluctant to go.  Sometimes he will find a friend to bring with him but when he doesn't want to (or the friend says No) I just pull out my handy Kaufman cards and he says words where ever he is playing-and asks his friends, too.  

I have a different student (severe artic delay) who gets private therapy as well, and this year I am working on mainly get him talking to peers and the private SLP is focusing on the articulation-at the parent's request.  This is working out nicely.

L October 26, 2010 6:22 PM

I agree with you, although with my caseload, my percentages are reversed.  I see children with autism and developmental delays in the classroom (about 25% of my caseload) and the remaining (75%) are seen in the speech room.  With behaviors and distractions, I feel that the small group setting is more conducive to developing better speech and language skills with greater auditory feedback.  The students seem to build confidence and help each other as well.  It is truly therapeutic.

Brenda, educational - speech-language pathologist, public school system October 26, 2010 11:15 AM
Tulsa OK

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About this Blog


    Stephanie Bruno Dowling, M.S. CCC-SLP
    Occupation: Speech-Language Pathologist
    Setting: Early Intervention in Delaware County, PA
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