The Informed SLP: Speech Language Pathology Research
  • Home
  • What We Do
    • What is The Informed SLP?
    • Team
  • Members Login
    • Birth to Three
    • Preschool & School-Age
    • Adults
  • Blog
  • Join

Guest post: Push-in services—how to collaborate!

9/1/2017

3 Comments

 
Occasionally we get member questions that are so good we want to share them. We bring in expert guest posters for these, as well, so you hear from somebody other than us. Enjoy!
Picture

The first thing we need to do is to define what is meant by “push-in” versus collaborative services. Push-in, or integrated therapy, is the provision of therapeutic intervention in the context of the classroom setting (Cross, Traub, Hutter-Pishgahi, & Shelton, 2004). The term collaboration however, is defined across a spectrum of integration. For example, according to Friend (2008) the most integrative service delivery is cooperative teaching (co-teaching), where the special educator, or in this case the SLP, and the classroom teacher plan together and carry out a lesson together. In contrast, the least integrative services include one-teach/one-float or assist, and one-teach/one-observe, where the classroom teacher teaches the lesson and the SLP “pushes in” to assist specific students, or observes specific students on their caseload, and there is no planning with the classroom teacher. This chart explains the spectrum of collaboration from most integrative to least integrative, and the roles of the SLPs and classroom teachers: 
​
Picture
(Blosser & Kratcoski, 1997; Elksnin & Capilouto, 1994; Friend, 2008; Hartas, 2004; Pershey & Rapking, 2003; Suleman et al., 2014)

​Therefore, instead of talking about “push-in” services 
we really need to be talking about collaboration, and look at what type of collaborative services we need to provide.  Regarding the evidence for providing collaborative services versus pull out speech therapy services, there is some evidence for the efficacy of both. 

There is limited empirical evidence available regarding the efficacy of service delivery models used by SLPs on the outcomes of students with speech-language impairments in the schools (Brandel & Frome Loeb, 2011; Cirrin et al., 2010; Mullen & Schooling, 2010). One way to measure effectiveness of interventions is to report them by effect sizes. It is reported in the literature when teaching curricular vocabulary, that the effect sizes for children who received collaborative services in the classroom is significantly larger (d = 1.65) compared to children who receive classroom based “push-in” services by SLPs without collaboration (d = 0.3) with the teacher (SLP and teacher working independently of each other) (Cirrin et al., 2010; Throneburg, Calvert, Sturm, Paramboukas, & Paul, 2000). 

Take-home point: If SLPs provide collaborative services in the classroom, even at lower integrated levels, it is important to plan with the teacher in order for it to be effective.


​The evidence-based systematic review by Cirrin et al., (2010) provided effect sizes from the articles these authors reviewed. They reported that when teaching 
curricular vocabulary, the effect size of traditional pullout therapy model (d = .76) was larger than that of classroom-based intervention without collaboration with the classroom teacher, indicating that there were more positive gains made by students in the traditional pullout model (Cirrin et al., 2010; Throneburg et al., 2000). In another study it was reported that when a pullout service delivery model was used, when treatment time was used efficiently, and when clinical time was spent therapeutically, there were improved outcomes for students in schools (Justice et al., 2017). Overall, the literature indicates that traditional pullout therapy has some efficacy, particularly when compared to in-class models without collaboration, and if use of treatment time is maximized (Cirrin et al., 2010; Elksnin & Capilouto, 1994; Justice et al., 2017; Throneburg et al., 2000). Further research is needed to determine the efficacy of traditional therapy model for a variety of speech and language skills (Cirrin et al., 2010; Throneburg et al., 2000).

Take-home point: There is evidence for use of traditional therapy services in a pullout model, as compared to a "push-in" model without planning with the teacher, at least for teaching curricular vocabulary.


Overall, SLPs should stop using the “push-in” ideation and move to a collaborative approach, working with the teachers, if we are providing services in the general education classrooms. The literature has shown that at least for curricular vocabulary our students learn better from a higher integrative approach or a pullout (traditional service delivery) approach. The question remains if these services are similarly effective for other speech and language skills, however more research is needed. Furthermore, if we are using a traditional pullout therapy approach SLPs need to maximize the use of our treatment time within the 20 or 30 minutes we have our students.  Therefore, there is support for use of both types of services and both IDEA (2004) and ASHA (2010) support the use of a variety of service delivery models based on the individual needs of our students and the idea that one size does not fit all.  ​
This blog post by:
Laura T. Glastetter-Stone, MS, CCC-SLP
of Anne Mason Elementary, Georgetown, KY and University of Kentucky, Department of Rehabilitation Sciences Doctoral Program, Lexington, KY


​Portions of this content by Glastetter-Stone have been submitted for publication: Glastetter-Stone & Howell, D. (2017). 
Speech Language Pathologists and Classroom Teachers: Understanding our Roles as Collaborative Partners in the Classroom. Manuscript submitted for publication.

  • ASHA. (2010). Roles and Responsibilities of Speech-Langauge Pathologists in Schools. [Professional Issues Statement]. Retrieved from www.asha.org/policy.
  • Blosser, J. L., & Kratcoski, A. (1997). PACsA Framework for Determining Appropriate Service Delivery Options. Language, Speech, and Hearing Services in the Schools, 28(2), 99–107.
  • Brandel, J., & Frome Loeb, D. (2011). Program Intensity and Service Delivery Models in the Schools: SLP Survey Results. Language, Speech, and Hearing Services in the Schools, 42(4), 461–490.
  • 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 the Schools, 41(3), 233–264.
  • Cross, A. F., Traub, E. K., Hutter-Pishgahi, L., & Shelton, G. (2004). Elements of successful inclusion for children with significant disabilities. Topics in Early Childhood Special Education, 24(3), 169-183.
  • Elksnin, L. K., & Capilouto, G. J. (1994). Speech-Language Pathologists' Perceptions of Integrated Service Delivery in School Settings. Language, Speech, and Hearing Services in the Schools, 25(4), 258–267.
  • Friend, M. (2008). Co-Teach! A handbook for creating and sustaining effective classroom partnerships in inclusive schools. Greensboro, NC: Marilyn Friend, Inc.
  • Hartas, D. (2004). Teacher and speech-language therapist collaboration: being equal and achieving a common goal? Child Language Teaching & Therapy, 20(1), 33-54.
  • IDEA. (2004). Individuals with Disabilities Act. Retrieved from sites.ed.gov/idea/about-idea/
  • Justice, L. M., Logan, J., Jiang, H., & Schmitt, M. B. (2017). Algorithm-Driven Dosage Decisions (AD3): Optimizing Treatment for Children With Language Impairment. American Journal of Speech-Language Pathology, 26(1), 57–68.
  • Mullen, R., & Schooling, T. (2010). The National Outcomes Measurement System for Pediatric Speech-Language Pathology. Language, Speech, and Hearing Services in the Schools, 41(1), 44–60.
  • Pershey, M. G., & Rapking, C. I. (2003). A survey of collaborative speech-language service delivery under large caseload conditions in an urban school district in the United States. Journal of Speech-Language Pathology & Audiology, 27(4), 211-220.
  • Suleman, S., McFarlane, L.-A., Pollock, K., Schneider, P., Leroy, C., & Skoczylas, M. (2014). Collaboration: More than 'Working Together' An exploratory study to determine effect of interprofessional education on awareness and application of models of specialized service delivery by student speech-language pathologists and teachers. Canadian Journal of Speech–Language Pathology & Audiology, 37(4), 298-307 210p.
  • 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.
3 Comments
Irene
2/5/2019 07:32:14 pm


What I gather is the evidence for push-in seems to be similar to that of inclusion: great in theory, but no school (at least not currently) is going to pay the money to implement it properly. I serve 50 students across the grades PreK-8 at 2 different schools, which is not uncommon. How would i even begin to collaborate with all of those teachers for each student to provide collaborative in-classroom services and be effective? If my district were to implement a push-in only model, I would quickly fall back into the no-collaboration group due to workload. So to answer the original asker's question: the evidence does not support the case of push-in unless the district is going to reduce your caseload to only several classrooms so that SLPs can collaborate/co-teach effectively because that is seems to be the key factor in efficacy of in-class services.

Reply
Katie O
9/11/2019 09:07:35 pm

I agree with the size of your caseload having to be manageable to do this. I have 37 students this year and am co- servicing (collaborating) in a high school and it is definitely a challenge with that many. However, with creative scheduling and supportive admin, it is possible!! Keep pushing for lower caseloads!

Reply
Katie O
9/11/2019 09:05:18 pm

Thank you for posting this. I am currently co-servicing (collaboration of planning with teachers) my students in the schools and this research is the push I needed to know that what I am doing is working and research based! Thank you!!

Reply



Leave a Reply.

    Picture

    By The Informed SLP Team,
    with occasional guests​
    Picture

    Better Information.
    Better Outcomes.

    Learn what works
    Along with
    members of The Informed SLP
    View all blog posts

    Blog posts by title:


    ​In a fog: Five facts + twelve clinical takeaways about chemo brain
     
    #AmIQualified: Let’s talk about bilingualism and white supremacy in CSD, one layer at a time
     
    #AmIQualified:  Let’s talk about privilege in speech–language pathology
     
    #AmIQualified: Let’s talk about moving from cultural competence to cultural humility

    The Not-New Speech Norms Part 2: An American Tale

    ​Motivational interviewing and behavioral change in clinical practice

    ​Standardized language tests: That score might not mean what you think it means

    ​The grammar guide you never knew you always wanted

    ​Top 12 questions about ASHA CEUs—answered

    ​Schools, safety, SLPs, and the evidence

    ​Response to #BlackLivesMatter, 2020

    COVID-19 and Dysphagia: Considerations for the Medical SLP

    ​COVID-19 and Cognition: Impact for the Medical SLP

    ​Looking for evidence on telepractice for SLPs?

    ​"I don't get what the difference is between ASHA's Evidence Maps, speechBITE, and The Informed SLP..."

    ​SLPD vs. PhD: What's the difference?

    ​That one time a journal article on speech sounds broke the SLP internet

    ​The difference between respecting our science and loving our science

    ​What does the evidence show about treatment intensity?

    ​EBP as a blame game

    ​The EBP barrier nobody is talking about

    ​Guest post: On evidence analysis

    ​Guest post: On trauma and language development

    ​Guest post: Working memory, processing speed, and language disorder

    ​Guest post: Push-in services—how to collaborate!

    ​Guest post: Complexity approach for speech sound disorders

    ​How am I supposed to find time to read research?!?

    ​SLPs: How to make sure you're using EBP

    ​SLPs: How to get access to full journal articles 
     
     
     

PlEASE READ ​our  privacy & terms and conditions of service policies.


CONTACT US
© COPYRIGHT The Informed SLP ® 2015. ALL RIGHTS RESERVED.
  • Home
  • What We Do
    • What is The Informed SLP?
    • Team
  • Members Login
    • Birth to Three
    • Preschool & School-Age
    • Adults
  • Blog
  • Join