Service Delivery Models

Options in SchoolsSchool Therapy 101 & 201Mary Bahr Schwenke, M.S., CCC-SLP, Barbara Jungbluth Jermyn, PT, ATP, Carlynn Higbie, OTRMJ Care, Inc.

Choosing a Service Delivery System

Guided by the OT, PT or SLP professional organization preferred practice patterns

Every service model should address four ideas: Overall effectiveness Coordination with other programs and services Commitment of all parties Resources available

Best Practice

Services should receive services that are matched to his/her needs and are flexible to changing conditions

What is best for one student may not be best for another

Is research-based, effective, and uses measurable techniques to provide intervention

Service Delivery Options

Monitor Collaborative Consultation Classroom-Based Pull-Out Self-Contained Program Community-Based Combination

Monitor

The student is seen, for a specified amount of time per grading period to monitor or “check” on skills

This model often precedes dismissal

Collaborative Consultation

Therapist, regular and/or special education teacher(s), parent/families work together to facilitate a student’s communication and learning in educational environments

Indirect model; direct therapy services are not provided

Classroom-Based

Integrated services; curriculum based, transdisciplinary, interdisciplinary or inclusive programming

Emphasis on providing direct services to students within the classroom and other natural environments

Team teaching by the therapist and regular and/or special education teacher is frequent with this model. More often for SP/L than for OT/PT

Pull-Out

Services are provided to students individually and/or in small groups within the school environment

Some services are provided in the physical space of the classroom, hallways, libraries, therapy rooms etc.

Self-Contained Program

The therapist is the classroom teacher

Therapist is responsible for providing both academic/curriculum instruction and remediation

Community Environment-Based

Services are provided to students within the community environment

Goals and objectives focus primarily on functional skills in the community setting

Combination

Two or more service delivery options are provided

For example: Individual and small group on a pull-out

basis 2x/week Classroom-based 1x/week and pull-out

1x/week Individual pull-out, small group pull-out

and collaboration

Service Delivery Decisions

Service delivery decisions are made are based on the: Need to provide FAPE for each student, in the Least Restrictive Environment, which is consistent with the student’s

individual needs, as documented on the IEP.

The Role of the Therapist

Therapist is the most knowledgeable person to recommend the service delivery model for therapy services

Input from parents and other team members is always taken into consideration

Considerations When Choosing a Service Delivery Model

Strengths, needs and emerging abilities

Need for peer modeling

Communication needs as they relate to the general curriculum

Need for intensive intervention

Considerations When Choosing a Service Delivery Model

Effort, attitude, motivation and social skills

Disorder(s) severity

Age, cognitive and developmental level

Response to InterventionRtI

New roles for therapists

Responsiveness to Intervention

Multitiered approach to providing services and interventions to struggling learners at increasing levels of intensity

Involves universal screening, high-quality instruction and interventions matched to student need, frequent progress monitoring, and the use of child response data to make educational decisions

RtI

As a school-wide prevention approach, RTI includes changing instruction for struggling students to help them improve performance and achieve academic progress

Educational system must use its collective resources to intervene early and provide appropriate interventions and supports to prevent learning and behavioral problems from becoming larger issues

RtI Funding

Individuals with Disabilities Education Improvement Act of 2004 (IDEA ’04) allows up to 15% of special education funds to be used to provide early intervening services for students who are having academic or behavioral difficulties but who are not identified as having a disability.

Response to InterventionRtI

RtI is meant to be applied on a school-wide basis

RtI practices and activities vary from state to state, but all share the core features of systematically looking at children’s responses to the education

RtI is most frequently viewed as a three-tiered model, similar to those used for service-delivery practices such as positive behavioral support

Response to InterventionRtI

Schools may decide to implement more than three tiers of intervention. The following labels can be applied for use in discussing tiered service delivery:

o Tier 1: Primary Supports and Interventionso Tier 2 and Beyond: Secondary Interventionso Special Education: Tertiary Interventions

National Research Center on Learning Disabilities http://www.nrcl.org/rti_practices/tiers.html

RtI: Tier 1: Primary Supports and Interventions

Tier 1 refers to primary supports for students in the general education classroom

Tier 1 instruction is the base level of educational service delivery aimed at meeting the needs of most students in the school setting.

Tier 1 instruction is provided to the whole class. Tier 1 intervention occurs according to school

schedules and curriculum guidelines. Tier 1 instruction is provided by general

educators who are "highly qualified" as defined by NCLB 2001 legislation.

RtI: Tier 2 and Beyond: Secondary Interventions

Tier 2 and Beyond interventions have an assessment role and address the assessment question of how well a student responds to a specific research-based intervention.

Tier 2 and Beyond is considered to be an intervention intended to remediate the student's deficits and promote participation in Tier 1 with general education students.

Tier 2 and Beyond instruction is provided in small groups (two to four students).

RtI: Tier 2 Tier 2 and Beyond interventions last for

nine to 12 weeks and can be repeated as needed.

Tier 2 and Beyond provides for three to four intervention sessions per week, each lasting 30 to 60 minutes.

Instruction is conducted by trained and supervised personnel (not the classroom teacher).

Response to Intervention -RtI

Special Education: Tertiary Interventions Eligibility for Special education services may be

available to students with intensive needs who are not adequately responding to high-quality interventions in Tier 1 and Tier 2 and beyond. Special education instruction is provided to

individual students or small groups. Continuous progress monitoring informs the

teaching process. Special education teachers deliver the instruction Exit criteria are specified and monitored so that

placement is flexible

Role of OT and PT in RtI

School-based physical and occupational therapists may have roles in the school setting outside of the Special Education spectrum.

These roles are at the universal level: team teaching providing professional development.

The Occupational Therapy Practice Framework identifies five categories of intervention (AOTA, 2002), one of which is to create or promote. It is not specific to individuals with disabilities.

Role of OT and PT in RtI

Universal Intervention This approach may be an incidental or optional category of

occupational therapy intervention in schools, as an occupational therapist may provide services that are likely to improve occupational performance for all students in a school. This approach is often called a universal intervention.

Examples: consulting on an ergonomic seating plan, contributing to the design of a playground, developing a backpack awareness program, mentoring teachers in a cognitive-sensory program for self-

regulation, assisting in the development of a school wide handwriting

curriculum.

Role of OT and PT in RtI

It is essential that occupational therapy practitioners understand the federal legislative and regulatory parameters of RtI and EIS in the No Child Left Behind Act of 2001 and the Individuals with Disabilities Education Improvement Act of 2004 (IDEA).

It is also essential for practitioners to know their state practice regulations, particularly those that relate to possible physician referral and individualized evaluation as the basis for intervention.

Role of OT and PT in RtI

The idea of RtI is that educators should measure objectively over time a child's response to whatever intervention is used to help him learn. This process is sometimes called progress monitoring.

Occupational and physical therapy practitioners’ familiarity with evidence based practice and their continuous evaluation of an individual’s progress aligns well with RtI’s requirement for scientifically based instruction and systematic data collection.

Roles of SLPs in RtI

Speech-language pathologists can play a number of important roles in using RtI to identify children with disabilities and provide needed instruction to struggling students in both general education and special education settings.

These roles require some fundamental changes in the way SLPs engage in assessment and intervention activities.

Challenges and Opportunities in RtI Model

OT’s, PT’s and SLP’s must engage in new and expanded roles that incorporate prevention and identification of at-risk students as well as more traditional roles of intervention.

This involves a decrease in time spent on traditional models of intervention (e.g., pull-out therapy) and more time on consultation and classroom-based intervention.

Program Design

OTs, PTs and SLPs can be a valuable resource as schools design and implement a variety of RtI models.

The following functions are some of

the ways in which OTs, PTs and SLPs can make unique contributions:

Collaboration

OTs, PTs and SLPs have a long history of working collaboratively with families, teachers, administrators, and other special service providers

Assisting general education classroom teachers with universal screening

Participating in the development and implementation of progress monitoring systems and the analysis of student outcomes

Meeting the Challenge

The foundation for SLPs’ involvement in RtI has been established through the profession’s policies on literacy, workload, and expanded roles and responsibilities.

To meet this challenge, OTs, PTs and SLPs will need to be

Open to change Open to professional development Willing and able to communicate their

worth to administrators and policymakers—to educate others on the unique contributions that OTs, PTs and SLPs can make consistent with the provisions of IDEA ’04.

Response to Intervention

SLP Intervention examples

Speedy SpeechNorth Shore School District 112Highland Park, IL

Students are screened for misarticulations in spontaneous and elicited speech and in oral

reading Students with mild misarticulations receive 5- 7 minutes of intensive direct 1:1 service times

per week for 8 weeks (Large number of productions of target sound(s) in short period of time) (Tier I) Activities are tailored to each student’s level of proficiency

Speedy Speech

Students are provided with school and home folders for practice which parents are required

to sign Interventions are provided in the hallway outside the classroom Students who do not reach individualized goals are seen for an additional 8 weeks (Tier II) Students who have not met goals at end of 16 weeks are referred for therapy (Tier III)

Story TalkSan Diego School District, CA

Program facilitates development of narrative oral language skills SLP leads a 30 minute session in the general

education classroom that focuses on story telling skills

Language scaffolding strategies are used to teach students to ask meaningful questions to elicit

additional information in order to enhance the oral narrative

General education teacher remains in classroom during lesson and continues process by having students write their stories

START-IN™: A Response to Intervention (RtI) Program for Reading

Commercial product by Judy K. Montgomery, Ph.D., CCC-SLP & Barbara Moore-Brown, Ed.D., CCC-SLP

START-IN™, developed by Dr. Judy Montgomery and Dr. Barbara Moore-Brown, is a nine week, 45 hour, small group (1-5 students), evidence-based program for struggling readers in elementary grades.

START-IN

This Response to Intervention Program consists of 16 Tasks that address the National Reading Panel's (NRP) five building blocks of reading Phonemic Awareness Phonics Fluency Vocabulary Text Comprehension

START-IN

Students with reading difficulties complete the 16 Tasks in one hour sessions, five days a week, using reading materials from their classroom or library.

Field tested for three years in urban schools, START-IN™ reduces unnecessary or inappropriate referrals to special education.

http://www.superduperinc.com/products/view.aspx?pid=START11

Key Resources

American Speech-Language-Hearing Association (2006). Responsiveness-to-intervention technical assistance packet. Available at www.asha.org

Butler K., & Nelson, N. (Eds.). (2005). Responsiveness to intervention and the speech-language pathologist [Special issue]. Topics in Language Disorders, 25(2). (See six articles on RTI and SLPs.)

Mellard, D. (2004). Understanding responsiveness to intervention in learning disabilities determination.

Key Resources National Association of State Directors of Special Educ

ation. (2005). Response to intervention: Policy considerations and implementation.

National Joint Committee on Learning Disabilities. (2005). Responsiveness to intervention and learning disabilities. Available from LD Online.

Strangman, N., Hitchcock, C., Hall, T., Meo, G., & Coyne, P. (2006). Response-to-instruction and universal design for learning: How might they intersect in the general education classroom? [PDF]