A Case for Consultation

Elementary school classroom

Photo by perspicacious.

It is an age-old question and one that every therapist must ask for every student.  Which is the best service delivery model for a student? Earlier this year ASHA offered the following statement as a guide for service delivery:

SLPs provide intervention that is appropriate to the age and learning needs of each individual student and is selected through an evidence-based decision-making process. Although service delivery models are typically more diverse in the school setting than in other settings, the therapy techniques are clinical in nature when dealing with students with disabilities. (ASHA, 2010)

Although other forms of service delivery exist, such as a self-contained model where the speech pathologist is the educator responsible for curriculum as well as intervention, the majority of services delivery models within a school setting can be defined as either direct services in a pull-out setting, direct services within a classroom setting (including community and home settings), consultative services where the speech pathologist is providing indirect services to the student by providing guidance, intervention techniques, and therapy strategies to other individuals working with a student, or a combination of these models.  Direct services, whether provided in a classroom or in a pull-out setting, appear to dominate as a service delivery model.  It is common to find direct services as the primary form of intervention when reviewing individualized education plans.  When comparing the amount of time between direct services and consultation listed on Individual Education Plans it would be a rare to find the amount of time spend by the therapist providing the service of consultation to exceed the amount of direct services. Unless a student is nearing dismissal from services, consultation is rarely the primary from of service delivery.

Sample of How Services Are Written on an IEP

Service Setting Frequency
Direct Speech-Language Intervention General Education or Special Education 60 min / week
Consultation General Education 15 min / month

What if we were to explore the possibility of providing a consultative model as the primary form of intervention and direct services as a the secondary model? What would happen if, on every IEP, the amount of service delivery time was swapped so that whatever amount of time was listed for direct services became consultation and vice versa?  What impact would this have on the role of the speech therapist within a school setting and, more importantly, what impact would it have on intervention for students?

Sample of Swapped Frequency on an IEP

Service Setting Frequency
Direct Speech-Language Intervention General Education or Special Education 15 min / month
Consultation General Education 60 min / week

If the primary role of the speech pathologist were to shift from direct service provider to consultant, the responsibilities of the speech therapist would change accordingly to more of a professional development position. The educators who provide direct instruction for students the majority of the time, such as general education and special education teachers, would become trained by the speech language pathologist in therapeutic techniques.  The speech pathologist would act as a guide, coach, and mentor helping to facilitate best practices.  Imagine a speech pathologist providing workshops to small groups of teachers, sharing research about the latest techniques, making or finding video or audio clips that can be used to educate parents and educators.  The following are points to consider when exploring a switch to a service delivery model where the speech language pathologist’s primary function is to provide consultative services.

Therapist as Sage

A direct service delivery model, no matter the setting, leads some to believe that the speech therapist providing the direct service has been granted the magical powers to provide intervention.  These individuals falsely believe that the work of the speech therapist alone, given the time allotted on the IEP, will allow the student to achieve speech-language goals. Often however, the approach that works better is when the entire body of educators, including the parents or guardians, work together to achieve the goals.  One reason some therapists choose an inclusion model of direct service delivery is to provide other educators with a model of how to provide carry-over services.  The idea is that by the therapist providing services in the room with another educator present that educator will pick up and employ the techniques the therapist is using during times when the therapist is not present. Of course this method of transference might work for some educators, but there is still a mind-set by many that what the speech therapist does is separate from what anyone else does with a student.  Reducing the expectation of direct services and increasing the expectation of consultative services reinforces the idea that everyone working with the student is responsible for every goal and every subsequent intervention to meet those goals.

Conducting Workshops

Although the speech language pathologist might already be doing some trainings with educators it is often the case that this happens in isolation, is limited formally to staff meetings once or twice a year, or happens informally during brief discussions in the hallway.  It is true that speech language pathologists are already providing professional development that is ongoing and dynamic, but this is rarely viewed as the primary role of the therapist.  Constructing a structured system for provision of professional development to staff members increases the awareness, knowledge, and abilities of every educator for every student.  Providing a therapist time to build learning communities, both within a school or across a district (or even beyond), increases the likelihood that the professional development will be effective and long-lasting.

Workload Remains Unchanged

A consultative model would result in a lessening of direct service provision however the overall workload of a therapist would remain unchanged.  The amount of time a therapist would be working toward achieving students goals as listed on an IEP would be the same.  Note the tables suggest shifting the time, not reducing the time allotted per student.  It should be noted however that direct service delivery often occurs in group settings.  Likewise, provision of consultative services could occur in a group setting.  When a therapist is conducting a workshop to a variety of educators, an indirect service is being provided to every student with whom that educator works.

Speech Therapy For All

If it were possible, every student could benefit from spending time with someone trained in facilitating speech and language production.  In a direct service delivery model only students with specified goals reap the benefits of working with a speech language pathologist.  Over time general educators may pick up techniques from the therapist, but that only occurs when the therapist is working with a student within that classroom and it is usually only for the span of one school year before the student moves on to a different general educator.  In a consultative model, trainings can occur for every educator every year, expanding the number of students impacted by the work of the therapist.  Interested educators (and parents) could participate in workshops and learning communities at any time to enhance their knowledge and skills. In this way, every student could benefit from the speech therapist, providing a more unified and universal vision of education as a whole.

Consultation is a part of every speech therapist’s job responsibility whether it is written formally in an individualized education plan or not.  Therapists provide this service constantly during casual conversations and, to a lesser extent, in formalized workshops and meetings.  As caseloads get larger and the demands placed on educators increase these types of conversations are often the first casualties.  Rather than entering into a discussion about therapy techniques, working together to create a lesson plan, or participating in a therapy session educators are off to meet their next requirement. Therapist might find themselves running to the next therapy session rather than having the time to converse in detail about a student.  By adjusting service delivery in such a way that consultation becomes the primary mode of service delivery speech therapists effectively duplicate themselves. By extension, the therapist then makes a greater amount of impact to more educators and, more importantly, to more students.

References:

American Speech-Language-Hearing Association. (2010). Roles and Responsibilities of Speech-Language Pathologists in Schools [Professional Issues Statement].

Language Literacy Labs: http://www.speechpathology.com/articles/article_detail.asp?article_id=77

Christopher R. Bugaj, MA CCC-SLP – host of the A.T.TIPScast, an award-winning podcast featuring tools to differentiate instruction. Chris is the co-author of The Practical (and Fun) Guide to Assistive Technology in Public Schools: Building or Improving Your District’s AT Team and presents at local, state, and national conferences.

Comments

  1. This is really an interesting post Chris. I really have thought that my job as a sped teacher is as much about communication as it is about teaching academics. I hope that more SLP's start thinking about their time this way. The biggest issue I see is parents…many parents equate direct service with actual teaching, even though many times is all the other stuff that is important. We have to really work on educating parents so this can be considered!

  2. “individuals falsely believe that the work of the speech therapist alone, given the time allotted on the IEP, will allow the student to achieve speech-language goals. ”

    I feel like I constantly fight against this at IEP meetings. Some parents have a really tough time letting go of direct service even if it’s no longer appropriate.

    • Patrick and Sarah,

      Thanks for the kind words about the post! One strategies that might be helpful would be to include blogs/posts/articles/podcasts etc. like this in a monthly newsletter (or even a small section in the school’s newsletter). I know, I know…when do I have time to do a newsletter? But maybe investing time in a newsletter of sorts will pay off in saving time later down the line. It could even be short, like “Here’s your monthly Speech tidbit…”. Just a half sheet of resources stuck in every student’s speech folder.

      Another idea might be parent homework – Instead of the student having speech homework, the parent is given an article to read. Maybe the student’s speech homework is to make sure mom and dad read this. The student must initial (in the same place a parent typically initials) that his/her parents have read it!

      I have other ideas too, PTO presentations, Parent-Night Presentation, Videos…but if kept going it would be another entire blog post :)

      I think, over time, little by little, change can occur! Keep up the good work!
      Chris

  3. I would love some guidance on how to write a measurable IEP goal for a student who is receiving speech services only on a consultation basis. Any input would be greatly appreciated!

    • Hey there Brandi,
      I think the goal should be based on the need no matter what the service delivery model turns out to be. Start by establishing the need to write the goal and then determine the best way to meet that need.
      Hope that helps!
      Chris

Trackbacks

  1. [...] a fellow blogger/podcaster, Chris Bugaj – A.T.Tipscast wrote a piece for ASHA about speech services-A Case for Consultation.  In this country the majority of students who receive speech services receive direct service. [...]

  2. [...] relevance of communication disorders.  There is also an excellent post on the ASHA blog called The Case for Consultation.  I am very excited to implement some of these incredible ideas.  Thank you to all of the ASHA [...]