Service Delivery Models in Speech-Language Pathology

Service Delivery Models in Speech-Language Pathology

Service Delivery Model Components

  • Setting Options:

    • At home
    • Outpatient clinic
    • School
    • Hospital
    • Community-based center
    • Classroom (in or separate room)
    • Telepractice (especially for nursing)

  • Dosage: Frequency, intensity, and episode of care.

  • Format Options: To be specified based on needs.

  • Providers:

    • SLP
    • Teacher or caregiver (with strategies for home implementation)
    • Student clinician

Service Delivery Model Examples

  • Vidola Speech Clinic: Clinic-based, 45-minute sessions, once a week.

  • Schools: Typically twice a week, groups offered unless intensive needs require individual sessions. Individual sessions crucial for AAC device training, followed by group sessions for skill carryover.

  • Skilled Nursing Facility (SNF): Daily service focusing on swallowing techniques or cognitive skills (with interpreter assistance).

Format: Direct vs. Indirect Service

Direct Service
  • Face-to-face time with the client.
  • Formats:
    • One-on-one
    • Group
    • Teletherapy
    • Parent coaching (on-site)
Indirect Service
  • Service provided without direct client interaction.
  • Activities:
    • Collaboration
    • Consultation
    • Training prep
    • Programming AAC devices (done outside of client sessions)

Dosage Decisions

  • SLPs determine dosage based on frequency, session length, and episode of care.
  • Example:
    • Junior high: 30 minutes x 30 sessions = 900 minutes yearly (averages to once a week considering holidays/absences).
    • Other options: 20 minutes, 15 times a year (once a month).
    • Bipolar clinic setting: Once a week for 45 minutes.

Dosage Terminology

  • Intensive: Highly concentrated therapy over a short episode of care. Example: Weekly sessions, 45 minutes each, twice a week or more.
  • Frequent: Moderate dosage at consistent intervals. Example: Weekly or bi-monthly, sessions less than 45 minutes.
  • Intermittent: Irregular or as-needed therapy.
    • Example: Two to five times a year for 60 minutes (rare in school settings).

Service Locations and Settings

Finding Appropriate Services
  • Group therapy (more than one client) vs. individual therapy (one-on-one).
  • Parent training.
  • Combination of direct and indirect services is common.

Video Examples: Therapeutic Approaches

Clinic Setting
  • One-on-one therapy in a clinic with multiple providers.
  • Focus: Speech sound differences, language impairment (vocabulary, grammar, comprehension), voice disorders, social skills, pragmatics, and functional communication.
  • Goal: Student success in regular education without intervention.
School Setting

  • Group therapy setting, using story telling like Tell Duck or One Rainy Day to engage students.

  • Practical and easy to incorporate a variety of goals.

  • The ultimate goal is to get student back to general education, and not to pull them out of class.

School-Based Service Considerations

Goal Alignment
  • Goals must align with Common Core standards or be linguistically appropriate, or address primary eligibility criteria.
    • Speaking and Listening (SL) standards (e.g., SL 1.6 for first grade) frequently used.
Potential population
  • School-aged children with language or speech disorders and/or kids needing functional communication, with an IEP.
District policies
  • Some districts disallow consults, need to look for SLP pay scale, not a teacher pay scale.
IEPs and Least Restrictive Environment (LRE)
  • IEPs are avoided until necessary to avoid more restrictive enviroments i.e. pulling them out of class.
  • The goal is general education.
RTI (Response to Intervention)
  • Consult part of RTI process, involving strategies/homework for teachers and parents. Must be explicitly defined as separate from IEP services.

Adult Therapy Example – Aphasia

  • Adult client with aphasia. It is suspected that it may Wernicke's due to lack of control and not recognizing the incorrect words.
  • Therapist uses repetition, and writing exercises.
  • Criticism of Therapist's tone: Impersonal, kiddish, and too formal.

Rehab Without Walls – In-Home/Community Therapy

Model Strengths
  • Individualized, one-on-one therapy in natural environment (home, community).
  • Customized interventions, team members, and goal setting.
  • Focus on durable outcomes and real-life functionality.
Example Goal
  • Patient walking dog for 30 minutes as a graduation mark.

Hospital Setting – Dysphagia Treatment

Scenario
  • Post-stroke patient with left-side muscle weakness affecting swallowing.
Treatment
  • VitalStim (neuromuscular electrical stimulation) to jump-start muscles during swallowing.
  • Swallowing exercises: tongue lift, straw exercise (2 seconds for muscle workout).
  • Compensatory strategies: turning head to the left (strong side) to close off the weak side.
Noted Benefits
  • Early intervention for stroke victims.
  • Family involvement in carrying over treatments.
Insurance
  • The insurance will dictate a patient's treatment

Classroom-Based Therapy & Co-Teaching Models

Benefits
  • Improves relationships with teachers.
  • Aligns therapy with academic goals.
  • Reduces therapy planning using classroom content.
Co-Teaching Models
  1. One Teaches, One Observes: SLP observes without direct impact (least effective).
  2. One Teaches, One Assists: SLP provides individual support (successful in one-on-one cases).
  3. Station Teaching: SLP and teacher split content and rotate students.Patient teaching.
  4. Alternative Teaching: SLP pulls small group for specific instruction.
  5. Team Teaching: SLP and teacher alternate, adding to the lesson (most effective for language-rich lessons).
Overall Impact
  • Influences writing, language, narrative development, and pronunciation.
  • Addresses core curriculum.
Key to Implementation
  • Start at comfortable level and gradually increase complexity.