Speech-language pathologists (SLPs) who work in schools have the opportunity to provide therapeutic services through a variety of service delivery models. A service delivery model can be understood as an orderly arrangement of resources with the purpose of meeting a specific educational goal (Cirrin et al., 2010). It specifies “where, when, and with whom the intervention takes place” (Paul & Norbury, 2012, p. 88). The four main types of service delivery models discussed in this article include: 1) pull-out model, 2) push-in model, 3) consultant model, and 4) response to intervention (RTI) model.
Pull-out Model (therapy room)
The SLP works with an individual student or small groups of students to address communication impairments in a separate room. According to research conducted by Mullen and Schooling (2010), this appears to be the most utilized model. They reported that 91% of students, regardless of disorder or severity, receiving school based speech-language therapy were in pull-out groups of two to four students. One of the benefits of the pull-out model is that it provides a decreased visual and auditory distraction as compared to other models and the students tend to follow therapist prompts more closely (Roberts, Prizant, & McWilliam, 1995). A disadvantage is that there maybe a lack of carryover between what the students learn in therapy and what takes place in their classroom and school environment (Miller, 1989).
Push-In Model (classroom based)
The SLP works with an individual or small groups of students to address communication impairments in the student’s classroom. Within the push-in-model, there are two different types of services provided, direct and indirect. Under direct services, the SLP works together with the classroom teacher as part of a team providing instruction to the classroom (Ehren, 2000). Meanwhile, with indirect services, the SLP serves as a consultant to the classroom teacher to support the needs of students with speech-language impairments (McGinty & Justice, 2007). One of the benefits of classroom based therapy are that the classroom is a natural environment where children have multiple opportunities to practice the target language behavior with adults and classmates in typical situations. The student’s textbooks, assignments, and classroom vocabulary can be used as the content for language therapy (Miller, 1989). It also provides other adults, besides the speech-language therapists, the opportunity to become more aware of the child’s deficits and provide support in the classroom environment (Wilcox, Kouri, & Caswell, 1991). Areas of concern for classroom based therapy include the muddling of roles between the SLP and the classroom teacher and diluting down of therapy (Ehren, 2000).
The SLP provides consultation to interventionists so that they may support the educational needs of students with language and communication disorders. Interventionists include: parents, regular education teachers, special education teachers, speech-language pathology assistants, and peers. As a consultant, the SLP remains responsible for assessing the student’s progress, determining when goals have been met, and providing additional intervention strategies as necessary (Paul & Norbury, 2012).
Response To Intervention (RTI) Model
RTI is an evidenced-based framework that provides early intervention to all at-risk school children in order to identify and provide interventions to children with exceptional needs (Cummings, Atkins, Allison, & Cole, 2008). RTI is made up of 3 tiers. At Tier I, all students are screened in the classroom with a brief assessment in order to identify which students may benefit from additional instruction to achieve predetermined goals. At-risk students are monitored for their response to general education instruction. At Tier II, students who fail at Tier I are provided additional support through adult-led supplemental small group tutoring instruction with progress monitoring. At Tier III, students who fail at Tier II are provided more intense support with progress monitoring within the general population and/or may be referred to special education (Ehren & Whitmire, 2009). Sample roles of the SLP include: 1) participate in assessment and progress monitoring of Tier 1 students to decide if they need additional interventions, 2) develop and monitor Tier II intervention groups and progress monitoring of students to decide if they need additional interventions, and 3) participate in progress monitoring and evaluations to determine if Tier III students need special education services (Montgomery, 2008). Summarized, SLPs “can be consultants, trainers, and auditors for Tier I, assessment developers and supplementary instructors in Tier II, and clinicians in Tier III” (Ukrainetz, 2006, p. 298).
Efficacy of Service Delivery Models
Research conducted by Valdez & Montgomery (1997) examined the effectiveness of classroom group and pull-out group therapy. The participants included African-American children in a HeadStart program with speech-language delays who were assigned to either classroom group or pull-out group therapy for six months. Researchers concluded that group therapy was as effective as pull-out group therapy. A study by Throneburg, Calvert, Sturm, Paramboukas, & Paul (2000) examined the effectiveness of classroom based direct service, classroom based indirect service, or group pull-out services. The participants included students in grades K-3 who qualified for speech-language services who were assigned to a therapy group in either a classroom based direct service, classroom based indirect service, or group pull-out therapy. Researchers concluded that classroom based direct service therapy was more effective in teaching content vocabulary to students who qualified for speech or language services. A study by Cirrin et al., (2010) indicated that more research needs to be conducted in order to fully comprehend the efficacy of the collaboration model. One benefit of the RTI model is that it improves instruction for all students while affording the SLP more time to serve the students’ needs on their caseload (Montgomery, 2008).
Ivan Campos, M.S., CCC-SLP, is a pediatric bilingual speech-language pathologist in Southern California. He can be reached at email@example.com.
Cirrin, F. M., Schooling, T. L., Nelson, N. W., Diehl, S. F., Flynn, P. F., Staskowski, M., ... & Adamczyk, D. F. (2010). Evidence-based systematic review: Effects of different service delivery models on communication outcomes for elementary school–age children. Language, Speech, and Hearing Services in Schools, 41(3), 233-264.
Cummings, K. D., Atkins, T., Allison, R., & Cole, C. (2008). Response to intervention: Investigating the new role of special educators. Teaching Exceptional Children, 40(4), 24-31.
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Ehren, B., & Whitmire, K. (2009). Speech-language pathologists as primary contributors to response to intervention at the secondary level. Seminars In Speech & Language, 30(2), 90-104.
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Miller, L. (1989). Classroom-based language intervention. Language, Speech, and Hearing Services in Schools, 20(2), 153-169.
Montgomery, J. K. (2008). Models of RTI for SLPs: Is this what we have been waiting for?. SIG 1 Perspectives on Language Learning and Education, 15(1), 13-21.
Paul, R., & Norbury, C. (2012). Language disorders from infancy through adolescence: Listening, speaking, reading, writing, and communicating. Elsevier Health Sciences.
Roberts, J. E., Prizant, B., & McWilliam, R. A. (1995). Out-of-class versus in-class service delivery in language intervention: Effects on communication interactions with young children. American Journal of Speech-Language Pathology, 4(2), 87-94.
Throneburg, R. N., Calvert, L. K., Sturm, J. J., Paramboukas, A. A., & Paul, P. J. (2000). A Comparison of service delivery models: Effects on curricular vocabulary skills in the school setting. American Journal of Speech-Language Pathology, 9(1), 10-20.
Ukrainetz, T. A. (2006). The implications of RTI and EBP for SLPs: Commentary on LM Justice. Language, Speech, and Hearing Services in Schools, 37(4), 298-303.
Valdez, F. M., & Montgomery, J. K. (1997). Outcomes from two treatment approaches for children with communication disorders in Head Start. Communication Disorders Quarterly, 18(2), 65-71.
Wilcox, M. J., Kouri, T. A., & Caswell, S. B. (1991). Early language intervention: A comparison of classroom and individual treatment. American Journal of Speech-Language Pathology, 1(1), 49-62.