I’ve been thinking about how to format this post for awhile. If I waited for the perfect way to share this information-I’ll probably wait for another two years….
Why do I think that children benefit from both school based services and outpatient services? Part of it is that my experience has shown that students who have both make better progress. Here’s part of why I think that is. When I think about service recommendations-I think of four things:
- Frequency
- Duration
- Intensity
- Carryover
Frequency refers to the number of times per week that I schedule a child. I am interested in frequency as it pertains to how long I think they can retain the information we’ve learned in therapy. If I am constantly reteaching a student or client-I may increase the frequency to see if that helps them retain their skills.
Duration refers to how long something takes. Again, I want to think about how long the student needs in order to gain skills within a single speech session.
Intensity-This refers to how the information is delivered. For example, individual therapy could be considered more intense than group therapy because it allows you to get more repetitions within a single period of time. Taking a CEU course for me in person is generally provides greater intensity than reading a book or doing an online webinar.
Carryover-The ability to complete something in a variety of different environments with a variety of different people.
I’ll give you an example of failed learning from me. I wanted to learn how to knit. I took one class for three hours in a small group of 4 people. I had the duration-because I was able to knit at the end of class-and I had good intensity-I was able to learn how to knit. But I didn’t have good carryover and/or frequency. I should have tried knitting at home 2-3 times per week-but instead I didn’t do anything. I was not able to learn how to knit because I lacked the correct amount of frequency as well as carryover of skills.
So how does this translate to school/outpatient therapy?
When these services are combined-we exhibit increased frequency of services. We also exhibit increased intensity as outpatient therapy is generally one on one allowing for increased repetitions. Schools are able to work on similar skills within group sessions which provides the student opportunities to target their sounds with a variety of listeners. School SLPs are also able to gain the help of other trained teachers etc. to facilitate carryover throughout the day. Outpatient SLPs generally have consistent contact with families which can lead to greater carryover within the home environment. The student benefits from getting similar information from more than one trained professional and in more than one location.
REFERRALS-It shouldn’t be a dirty word.
School speech language pathologists are not allowed to make referrals because there is a fear that the parents could sue the school district for these additional services. Here’s two ways to bring up outside services without recommending them. Ask the parents if they receive any outside services. If they ask what that is just use strategy two: Some parents are able to access habilitative speech and language services through the medical model by using their medical insurance.
WHO should get therapy in clinic and in schools?
This is where I think increased collaboration can help school districts. When I ask speech language pathologists who they would “refer” for outpatient services, I generally hear about the more severe cases. In my state, students don’t qualify unless they are 2 Standard deviations below the mean on two language measures. But I know that many of these students get tremendous services through the school districts in other states. So I hope the students who don’t qualify for school services (but who still fall bel0w the mean) are “referred” or given some information on the possibility of outpatient services. A simple, Johnny does not meet our state’s qualifying criteria as a speech and language impairment which is _______. Some families are able to access services through the medical model which is reimbursed through their medical insurance.
I think we could help caseloads by “referring” out students who we think would still be on our speech caseloads after two years of therapy. By working together on more “mild” cases, we could hopefully help reduce caseload sizes within the schools.
Not every family (or even most families) are able to commit to outpatient therapy due to cost, time commitment, insurance coverage issues etc. There are mandates for more coverage of habilitative (outpatient) pediatric therapy but insurances are also changing or limiting their coverage. My goal is that families know that is an option.
I see a lot of talk in different states in social media of how we are managing increased caseloads. Some states are moving away from providing language treatment when students don’t have any other IEP services. Some states no longer treat single sound errors. Some states are moving away from articulation all together. I see people comment about how an inability to produce /r/ or /s/ is not impacting a student educationally. My hope is that increased collaboration and referrals could be another answer to rising caseloads in the schools that continued to allow students to access services that we are uniquely qualified to provide.
Thank you for writing this post. I agree with everything said. I work at a clinic and I treat some significantly impaired students whom did not qualify for services in the schools because of the required 2 SD requirement. These children need speech still, even though they did not qualify. I feel honored to be able to help. In addition, are the students who are getting both services and they do advance very quickly because of the “bonus” sessions. All SLPs should work together for the advancement possibilities of every student. Thanks! Manda
Thank you! Like the idea of calling them bonus sessions.
Different people bring different perspectives, target different things…it’s a good thing to have more sets of eyes on a kiddo. The only “scary” thing about referrals in the public school is that if it is perceived that a school SLP recommended extra therapy, the school district will be on the hook financially, should the parents decide to pursue that option (and some powers that be might not be very happy about that). Sometimes when a parent brings a clinical therapist (CT) to a school IEP, it appears like the clinical therapist is there to “fix” what the school therapist is doing wrong, which, let’s face it, sets a defensive tone before the meeting has even begun. If the intention of having the clinical SLP attend is true collaboration, and sharing of information, it can be a great thing to get all interested parties together. School therapy is a different animal than clinical therapy, but almost all of the school SLPs I’ve met are conscientious caring professionals doing the best they can within the system they are obligated to work. Play nice everybody! We’re all after the same goal.
I agree with you-I think I’ve written before about why outpatient therapists need to be really, really careful about any recommendations that they make for the schools. I think it comes from a good place-trying to problem solve with the parent-but they forget that the schools are already doing the same things. Personally, if a parent asks me about something that is going on at the school, I ask them to sign a release and then I speak with the school therapist directly.
Liked your post a lot. Personally, I do not understand how speech sound errors that were left uncorrected would NOT start having an impact on a person, either socially or professionally. I agree that we are the ONLY professionals in schools with training on how to remediate that. There are other professionals who work on language skills, such as classroom teachers in language arts, Resource room teachers, and Response to Intervention teachers, so why not have them give some services in the language area first, before identifying those students (just an idea). I also think that students with Autism that are already in Special Classes get too many services, as they are already in a more restrictive environment with a teacher uniquely qualified to work on needs relating to the Autism. We need to work more in collaboration with them, in my opinion.
OK, enough of my perspective, and back to writing the four IEP’s due this week!
Thank you! I definitely agree with rethinking how we are servicing students in the schools is important!