Service Delivery Models in SLP

Service delivery model

A specific component of the intervention plan that determines how treatment will be delivered (e.g. individually vs within groups; by a clinician directly, or through clinician coaching a parent)

Multidisciplinary Team (MDT)

Bringing together a group of professional from different fields to determine treatment plans, to be sure that all avenues of treatment are available

• own assessment, own goals, not always shared

• don't talk to each other (con), every individual therapist sets their own goals, develops their own treatment

• family has to relay info to other team members (keeper of info)

• pros: person gets lots of support

What makes an MDT? What are the key features of an MDT?

• professionals from each discipline conduct their own assessments, factor in their own results and come up with a discipline specific treatment plan for their patient

• key feature: team meeting to discuss/share the treatment strategies and results (may or may not happen)

• goal setting is separately implemented within each discipline, so patient’s goals will be different depending on which discipline they focus their treatment on

Interdisciplinary Team (ITD)

Professionals of different disciplines are collaborating on goal setting whilst conducting their own assessments

• share results with other disciplines

• By discussing results together, all disciplines can address elements of the goals and objectives of other fields into their intervention plans

What makes an IDT? What are the key features of an IDT?

• client goals developed by taking into account the client’s needs in each discipline

• single assessment of the client conducted in unison by various profession

• during intervention, each profession will try to incorporate elements of goals from other disciplines when possible

• goals are client-centred with all team members working towards these goals

Transdisciplinary Team (TDT)

All professionals are working together on a single assessment and forming a single plan for the client

• often has a lead therapist oversight

• Team will review outcomes of the session together and develop objectives that reflect all disciplines involved

• Set goals with family, self-governing team that can oversee progress as have built goals together

What makes a TDT? What are the key features of a TDT?

1 professional responsible for overseeing client’s plan and working towards overarching goals across disciplines as a single group

Direct service delivery

• 1 on 1 with client

• clinician directs therapeutic activities for the client

• instrumental, group, individual, intervention: speech, language, dysphagia rehab

Indirect service delivery

When clinician works with a family member, teacher, therapist and/or medical professional regarding a client's specific needs but does not have face-to-face contact with the client during therapy activities

• consultative, training, coaching, courses

• training them so they can do intervention with client without clinician present at the time

Service delivery settings SLPs work in

• special education

• psychiatric

• hospital - outpatient, rehab, acute

• pre-schools and schools

• homes

• retirement villages

• research

• private practices

• community stroke rehab

• Ministry of Education

• Deaf community

• NICU

• justice sector

• universities

• rehab facilities e.g. Burwood hospital

• corrections (prisons)

• assisted living facilities (disability, aged care)

• hospice care

TD Model vs MDT - What do SLT do differently

TD Model

• single assessment carried out by multiple specialists of different disciplines

• specialists work together to decide on a goal and plan

MDT

• SLT carries out own individual assessment of client then devise own plan/goal for client

• implement plan/goal without conversing with any other disciplines working with the client

TD Model vs MDT - difference for clients

TD Model

• more ideal for client, as single plan for client’s goal is created with all the client’s needs in mind and is made with the knowledge of multiple specialists

• 1 lead person - ideal because client has single person they can ask all their questions to

MDT

• issues that client may be facing will have to be assessed by anther professional

• will be team meeting to discuss treatment ideas

• goals will be separate

• client would need to be in contact with each individual specialist and they will have to take the individual concerns with things to each different specialist - can be confusing

Indirect vs direct service delivery - What do SLT do differently

Indirect

• no hands on contact

• consult with others (e.g. teachers, family, other medical professionals) on how they can provide service to clients/group of clients

• broad focus on group needs

• needs to be easily implemented by people that aren’t experts in SLT (e.g. teachers and family members)

Direct

• working face-to-face with client and working on specific communication difficulties

• focus on specific treatment and diagnosis

Indirect vs direct service delivery - difference for client

Indirect

• they are able to have more frequent help through their family/teachers (not just 1 hour session with SLT)

• SLT unable to pick up on how well the treatment is working

Direct

• focused treatment towards client, can be specific to the client and what works for them

Clinical vs consultative - What do SLT do differently

Clinical

• uses a small group or 1:1, or in collaboration with other service

Consultative

• works with the team that works with the client, but not with client themselves

Clinical vs consultative - difference for client

Consultative

• Hospital setting

  • SLT could consult on staff taking care of patient

• Education

  • client wouldn’t get 1:1 specialist SLT consultation but teachers and family would be advised on communication support instead - efficient for SLT but not necessarily better for client

Clinical

• clients would perhaps be getting more effective, specialised support

ID Model vs MDT - What do SLT do differently

MDT

• each discipline creates their own plan and works independently

ID Model

• each discipline conducts their own assessment

• but results are shared between disciplines to allow crossover for goals and treatment

ID Model vs MDT - difference for clients

MDT

• treatment may include many different therapeutic activities that fulfil goals in 1 discipline

ID Model

• therapy may fulfil goals from several disciplines simultaneously

ID Model vs TD Model - What do SLT do differently

TD Model

• everyone continuously works together to do 1 assessment and one treatment plan together

• 1 person takes lead/responsibility

ID Model

• working with other professions to deliver each individual service and reach individual goals

• working across services

ID Model vs TD Model - difference for client

TD Model

• can be easier to understand for client as there’s 1 clear plan and goal made collectively by different services

• 1 point of contact responsible for implementing the intervention plan

ID Model

• allows for goals across services

• potentially more confusing as many different professionals/services have their own goals and environments

Individual vs Group Therapy

Individual

• 1:1 client, family, SLT

Group

• more than 1 client with SLT

Individual vs Group Therapy - difference for client

Individual

• 1:1 good for teaching skills, high productions, high repetitions

Group

• good for maintenance, participation and environmental supports

• efficient for SLT - time/cost wise

Telepractice vs In-person - What do SLT do differently

• Be aware of tech availability, client’s ability to use and potential technical disruptions

• Props may be different - online vs physical objects

• more planning time may be required for telepractice to encourage conversation topics

• can be harder to judge clients cues online, need to be proactive in checking in around tiredness, or allowing time for responses

• easier for client to “not turn up” to telepractice so additional reminders may be useful

Telepractice vs In-person - difference for client

• client may struggle with tech/access

• online can be more tiring for client so session may need to be shorter

• some clients will prefer 1 or the other (might need additional support or completely refuse to do one)