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Speech in the Schools

Service Delivery Models: Looking Beyond Pull-Out

Published July 21, 2010 10:11 AM by Valerie Lill

Not that long ago (including when I started working in public schools 10 years ago), the majority, if not all, of the speech-language students with whom I worked received "traditional" speech therapy services. Meaning, kids grouped together by age/class/speech-language needs came down to my room with their speech folders once or twice per week for 30 minute sessions.  I admit, at that time I rarely saw students outside of the "speech room." 

However, over the years my philosophy of service delivery models  (and from my experience, that of many school-based SLPs) has changed  away from the "traditional" small group pull-out model.  Although many students on my caseload do receive "traditional pull-out" speech therapy services, the majority of my students are serviced in a flexible service delivery model or pull-out in addition to other approaches.

This will be the first of a series of blogs (not necessarily consecutive, but ongoing) regarding different service delivery models I've tried with different types of students and the effectiveness of each approach for my students.  Not every approach will work for everyone or has worked for my students, but as the new school year approaches, I really hope more and more SLPs consider different service delivery models other than the just "pulling out" kids to the "speech room." 

Traditional pull-out speech therapy DOES have value and is an appropriate service delivery model many times; however, I find for many students a combination of service delivery options works best. I'm also interested in hearing what types of service delivery strategies other SLPs have tried and how others have succeeded in areas in which I have failed or did not feel successful.

I'll start the discussion by talking a little bit about traditional pull-out speech therapy. I do individual and/or small group pull-out to some extent at all three levels at which I work (elementary, middle, high school).  My social skills groups for students on the autism spectrum occur as small group sessions, sometimes in the speech room and other times in the autism support classroom. Direct, small group instruction is important for students with autism since it is well documented they do not pick up social skills the way "typical" peers do.  At the elementary level, I do both individual and small group pull-out for kindergarten and first grade "speech-language only" students and with all of my life skills students. 

As I've stated earlier, small group pull-out does work well for many students especially it is used in combination with other service delivery models such as consultation or push-in services.  I just wanted to set the ground work indicating that I do use the pull-out speech therapy model for many of my students. In upcoming blogs, I want to talk about the other service delivery models I have tried and/or currently use with students in addition to or in replacement of traditional pull-out services and talk about why.

13 comments

My principle wants me to do more inclusion and to change my goals/benchmarks to more general goals to use in class; however, the students don't need general goals they need specific goals to improve those skills that are deficient, that's why they are getting service. She frequently states the research shows inclusion is better.  Does anyone have any research stating pull-out with intense training in small group or 1:1 is better? Any thoughts, suggestions?  I need all the support on this. Thanks

j b, , SLP school February 21, 2011 2:21 PM

What seems like forever ago, I blogged about different service delivery models that I have found effective

January 19, 2011 10:50 AM

Push in does sound harsh.  This is my first year where I will be pushing in and I am not quite sure what I am doing.  It doesn't help to have a supervisor who is a typical supervisor.

Carolyn Battle, Com. Disorders - Speech Teacher, DOE September 29, 2010 7:08 PM
New York NY

I am also looking to do more push-in services next year.  I would like to know what your role is when you go into the classroom.  Any information will be helpful.

Eva August 16, 2010 10:47 PM

In my last post , I started a discussion about alternate service delivery models than traditional small-group

August 4, 2010 11:04 AM

Re: terminology - I agree about how it may sound a bit "threatening" to teachers...Instead of "push-in" how about something like "integrated service delivery"? "

Valerie Lill July 31, 2010 8:06 PM

Melissa -

I'm not sure what you mean by "approved service delivery models." That might be something your state regulations address. In PA, there isn't a such list -we're free to provide services as we see fit for the student and write our IEPs accordingly. What are the 7 models?  There are numerous +/- I could list (as could many other school based SLPs) for each strategy.  In upcoming blogs I'll be discussing a variety of different service delivery models and give you my two cents on what worked for me/didn't work.

Valerie Lill July 31, 2010 8:05 PM

Thank you for this blog. I have worked in the public schools for 18 years and have become increasingly more supportive of  inclusion-model speech-language services. Though all my students benefit and receive some level of pull-out treatment, I serve many in the regular education or support classroom as much as possible. It's a win-win situation...other children benefit from the language rich interaction (and I can identify the soft-signs for potential problems non-identified students are experiencing) and my students' target behaviors have a better chance for reinforcement in my absence. It also has lessened the problems with scheduling as 'down time' is less and less available for pull-out services.

Susan, same - Speech-Language Pathologist, Middlesex Public School System, district wide July 30, 2010 11:26 AM
Saluda VA

I worked in a large public school district for a number of years and am currently working in a small private school for students with special needs. In both settings, I have worked cooperatively with teachers to facilitate communication in the classroom setting.  It was very rewarding.  When I hear colleagues using the word "push-in", I cringe.  It sounds so aggressive!  We have lots of skills and information that can enhance the classroom experience, but we need teachers to see us as collaborators, not people who "push-in".  As "semantic specialists", I would think that we should be able to come up with words that are a little less threatening.

Kathy , Speech/Language - SLP, Special Needs (private school) July 29, 2010 10:27 PM
Sparta NJ

I am taking a graduate level class in Speech and Language Pathology.  One of my discussion questions is to state the pro's and cons of 3 out of the 7 appproved service delivery models. While my text book does state the 7 service delivery models, it does not specifically state the pros and cons. Can anyone give me some ideas. I am not a speech pathologist, but am taking this course to get my certification in special ed. I have been working in the field for 17 years as a paraprofessional. Melissa

Melissa Blanchard, Special Education - Ed. Tech. III, Portland Schools July 27, 2010 7:14 PM
Portland ME

Budget cuts and the economy are changing traditional therapy. As a school supervior for more than 30 SLPs, we tried numerous approaches to best practice and RTI. Large group, push-in can be effective with some children. Others needed additional 1-1 intense work even for a few minutes at the back of the classroom as pre or post work. The new artic - speedy speech - therapy approach worked best for early intervention and older students within the schools.  Also, targeted drill work for some language/vocabulary learning proved very successful.  Therapist are finding new and very effective ways to approach therapy.

JoAnn, Speech - Supervisor, East Ramapo School District July 22, 2010 1:26 PM
Spring Valley NY

It's been a work in progress for me that is STILL a work in progress and probably always will be. I've found some things that work great for some students, but don't work at all for others. It's really individualized b/c not the same thing can work for all students. I just want to present some things I've tried, and I'm anxious to hear what others are doing! I won't talk exclusively about push-in, but that certainly will be part of the discussion at some point.

Valerie Lill July 22, 2010 9:17 AM
PA

Thank you, I'm looking to do a lot more push-in this next year, but I'm still not quite decided on exactly how.

Heather July 21, 2010 5:21 PM

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    Speech in the Schools
    Occupation: School-based speech-language pathologists
    Setting: Traditional and specialized K-12 classrooms
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