The 21st Century Speech Language Pathologist and Integrated Services in Classrooms

Speech language therapy services are traditionally viewed as taking place within a specialized room or location. The speech language pathologist might see a child individually or in a small group of children in a special location often called the Speech Room.

This type of intervention model is called “pull-out” since the child is removed from the classroom curriculum for a specific amount of time. There will always be a need for some children to receive at least partial services using this model. This setting is used for formal assessment procedures, for certain interventions that might be difficult to manage in a classroom setting, and for certain students who need an environment that is quieter and contains less distraction than their normal classroom.

The downside of this model is that some children do not generalize skill usage to the classroom, home, and community. Some children with ASD may even think that the new skills should only be used in the Speech Room and are resistant to efforts to get them to use new communicative behaviors in other situations. Of course, if a more restricted or quiet environment is necessary for the early learning phases of skill acquisition, then the disadvantages of pull-out must be diminished by active planning to ensure generalization over time and place.

In contrast to the use of a Speech Room, speech language pathologists moved into classrooms decades ago to provide some or all services in this setting; this change of location for service delivery occurred more extensively in some districts than in others.

Often the first step in many districts involved intervention within pre-school or special education self-contained classrooms. With each step forward into the classrooms, new information was learned and new roles added in order to enhance children’s learning and functional outcomes.

In this brief article, classroom roles will be explained and examples provided to aid understanding. Although the roles are discussed separately, in actuality, it is more common to have a combination of roles in order to provide effective intervention.

Some people use a more global term of “integrated services” to signify the multiple roles. Multiple options are needed in order to best customize programs to meet the needs of children with varying specific challenges such as ASD.

Many interventions that were provided in the Speech Room could also be offered within the classroom environment. The advantage of offering pull-out therapy in the classroom is that it is less disruptive than having the child transition to another environment. Unless practice is integrated into classroom use outside of the speech time setting, however, generalization could still remain a problem.

An example of direct service using this approach might involve working with a student on verbally using the/-ed/ past tense marker during conversations (This skill is supportive of reading, writing, and social interaction competencies but is not directly tied to specific curricular activities.)

Integrated therapy is somewhat different in focus although it also occurs in the classroom. It is sometimes called “push-in” as therapy goals are embedded into the curriculum and the SLP may be supporting a variety of children in particular activities; this model is more powerful when combined with other variations. It may be easier to see the comparison to pull out therapy with a few examples.

Example # 1. The SLP introduces a game for a small group of preschool children that focuses on comprehension of simple common directions which are frequently used in the classroom. The peers act as models, coaches, cheerleaders, and picture holders for the visual supports for the child with ASD. With training, the peers will generalize this support to daily classroom routines.

Example # 2. The SLP and a child with ASD in a general education classroom read a portion of a unit chapter together. The teacher had provided the SLP with a few advance discussion questions. The student practices raising his hand and answering the questions with adequate information and an appropriate rate of speech. Later during the actual class discussion, the student practices raising his hand, answering a rehearsed response only when called upon, and monitoring his talking so that it is not so fast that others do not comprehend his message.

The SLP might also teach the whole class specific lessons because of particular expertise in that subject area. For example, the SLP might teach the class about particular social skills such as recognizing when it is one’s turn to talk, sound awareness, specific concepts such as pronouns, vocabulary repertoire building associated with cooking lessons, or how the class can support a child who uses an augmentative communication device. While teaching a whole class is more common practice in special education classrooms, it can also be used in general education classrooms.

Although this overlaps somewhat with discussion of the roles associated with working with teachers that will be discussed in the next section of this article, it is important to note the SLP and teacher can co-teach the students in a classroom. Either lessons are divided into teachable segments or the class can be divided into groups with each group receiving exposure to similar content or one group led by the SLP receiving a little more needed support in the language area.

The SLP might also coach children by providing prompts, feedback, encouragement, and information during regularly scheduled classroom activities. For example, the SLP might support a child with ASD before, during, and after a field trip with advance preparation in terms of vocabulary, teaching/coaching during the trip, and concept, sequence review, and journaling after the event.

For other endeavors, the SLP will initially support many class members. For example, during creative writing class, he or she might first check on the student with documented needs, provide instruction, prompts and visual supports, and then move on to help non-IEP students who also have difficulties writing with adequate detail.

Integrated therapy also involves writing IEP goals that not only relate to the curriculum but which may require the listing of multiple implementers. For example, an objective might be that Joshua, a 5th grader, will demonstrate ability to use selected curricular vocabulary words from each social studies unit.

Achievement could be monitored and measured by the student’s ability to perform functional skills such as writing a paragraph incorporating the vocabulary, constructing a semantic web for each word (a visual graphic) or by using the vocabulary appropriately in a brief oral report.

While the teacher and aides may provide intervention across the school day, the SLP would retain responsibility for reaching the language/literacy objectives and the reporting. The SLP needs to do more than provide therapy focused on an individual student in order to accomplish the broader outcome. Thus, other roles must also become part of the intervention program for a child with ASD and his/her classmates.

Working with students is currently viewed as only part of the equation when providing integrated intervention services. Working with the classroom teacher(s) and paraprofessionals is equally important when the end goal is that of automaticity and generalization of language, communication, and literacy skills by students with ASD.

The SLPs can play a variety of roles depending on the learning/support needs of the students, especially those with IEPs, the classroom context, and the needs of the classroom staff. Teachers and SLPs have some skill sets that are different from each other and others that overlap but which might be used differently by each professional.

The classroom teacher has expertise in curriculum, classroom management, and group instruction while the SLP has knowledge about individual language and communication development, language/communication disabilities, and individualized intervention strategies. It is the marriage of the two sets of complimentary professional skills that can add power to an integrated services model.

The first step of providing services in the classroom involves the building of a working collaborative relationship between the two professionals. Sometimes, the relationship may begin in a very indirect way as the SLP contributes helpful suggestions about the behavioral or instructional challenges of a student. Particularly in a large school, specific classroom teachers may not personally know the SLP and may initially be unaware of the benefits of such a partnership.

The classroom is still the teacher’s domain and he/she has to feel comfortable with, and a need to share space, adjust schedules, alter strategies, acknowledge challenges, and allocate time for discussion/communication exchanges with the SLP if integrated services is to become installed as a formal intervention approach. Often each party quickly finds that the rewards of the partnership (i.e., instructional and performance benefits for the students with IEPs, the other students, and staff), easily outweigh the initial hurdles of establishing a good working relationship and scheduling collaborative time.

Consultation is one way of a SLP initially working with a teacher or a team within a classroom focus. Consultation services are more typically problem oriented.

For example, the SLP might be observing the student with ASD in various school environments in order to note behavioral situations that might have an underlying communication component. The information might be shared back with the team as it tries to develop an appropriate positive behavior support program. The SLP might also consult with the teacher about concerns such as generalization of reading skills.

Other options for more limited consultation might include a teacher wanting an observation and feedback on how to more effectively frame instruction for the children with language impairments or how to facilitate more communicative involvement of the children who use augmentative communication systems.

The collaborative role opens doors for a more intensive, on-going involvement with the educational staff than the consultative role. The term “collaboration” suggests a partnership and willingness to work with one another. The two can focus on improving communication support for many curricular areas for all students for the core level of instruction (an RTI strategy that will be described later), targeting skills for a select group of students, or focusing on students with specific challenges that could benefit from the experience and skills of an SLP.

From collaboration might come roles such as:

• Data collection. The SLP might, for example, outline how each day’s activities could be targeted as communication opportunities for the child with ASD who has limited verbal communication skills. The SLP may design and demonstrate data collection forms that are easy to manage while providing a snapshot of the implementation that occurs while he or she is not in the classroom. A weekly or bi-monthly review of data by the SLP and classroom teacher will allow each to know if IEP goals are being met or if restructuring of the opportunities, materials, or staff strategies are needed. Multiple factors often need to be tracked for a singular IEP goal. Data sampling should occur on a systematic rotating basis across numerous situations and environments. Information about initiation and prompting levels/types used by the teacher will also be important for monitoring progress and effectiveness.
   
• Demonstration materials and lessons. The SLP, for example, might design AAC materials that could facilitate lesson or curricular participation by the student and demonstrate, for the classroom staff, how to utilize the materials. He or she can also outline factors for the classroom staff to remember when they design materials or implement key strategies on their own (For example, staff might need to remember that the size of display pictures and their arrangement are important considerations in order to insure successful use by a particular student).
  
  The underlying goal is to assist the classroom staff in integrating communication training and IEP goals into the entire school day and not just for the time that the SLP is in attendance. This will produce more learning of the desired skills and generalization.
   
• Coaching. The SLP might coach the teacher or aide as he/she tries to apply the strategies demonstrated or discussed by the SLP. The coaching could be generic or relegated to particular classroom situations. The classroom teacher may be able to continue the coaching of the paraprofessionals once he or she feels comfortable in coaching about communication implementation.
   
• Mentoring. The SLP could provide on-going mentorship to the teacher about communication skills as well as many other topics. Behavioral issues and classroom communication patterns may be priorities, for example.
   
• Co-Teaching. The SLP might also routinely co-teach or team-teach the class or smaller groups. The teacher, in turn, may coach, demonstrate, and mentor the SLP about how to improve classroom management for these situations, if there is a need.

Particularly at the secondary school level, a given student has multiple teachers who need to provide instruction, support, and opportunities for generalization of identified skills. While a SLP might wish to contact each teacher about the integrated service roles, sometimes this approach is not practical.

For certain topics, it is more efficient to provide in-service training for the staff or for certain core groups of personnel that could include the aides, job coaches, kitchen and maintenance staff, and bus drivers. Sometimes email is used to provide certain information or strategies to the broader school staff. As a consequence, new opportunities to be involved in classrooms, in community based curriculum, and on job sites might result.

Finding sufficient and convenient times to work with families is a challenge but a necessary extension of the intervention programs with students. Parents need to be aware of how they can support their child at home and in the community. Parents need demonstration training, coaching, information, and on-going support. With the aid of technology, this has become a little easier but it has not solved the problem of time for preparation, contact, and documentation.

A frequent comment offered by SLPs in the schools is that school principals and special education directors must believe in the value of the multiple roles and the workload model or integrated services may not be optimally effective or occur at all. Not only does the administration need to allow the SLP to schedule planning time, for example, but this must also occur for the teachers. Everyone must remember the limitations of only providing pull-out direct services and why integrated services can be a better option for many students and particular skills.

As school districts explore the Response to Instruction movement (RTI), they will want to foster these broader roles by SLPs. In the RTI model, there is an effort to improve instruction for ALL students by using research-based components. SLPs can be an invaluable resource at all levels of the RTI model, although the exact roles for SLPs may vary by school district.

For those students that do not respond to an enriched core or base curriculum, school staff will try an intensive short term period of utilization of different research or evidence-based strategies for those general education students who are still struggling with reading and/or math. If intensive instruction is not successful, then the student may be referred for a more comprehensive evaluation and the need for special education services might be considered.

Speech language pathologists might also bring a different perspective when there is a concern about meeting state curriculum standards with specific children or a broader grade level framework. It makes sense to consider the speech, language, communication, and literacy components of curriculum and classroom instruction as efforts are made by school districts to improve educational outcomes. It also seems logical to access the services of individuals trained in those areas, (i.e., SLPs).

The SLP can play multiple roles in the intervention and curricular programs which impact individual students, whole classes of students, and instructional staff. Utilization of this resource is dependent on administrative support for the various roles and teacher desire for such collaboration. SLPs understand the value of integrated services and are ready to fulfill the various roles. Parents, teachers, and administrators can acknowledge their desire for broader services and work together with SLPs to actually make it happen. Embracing integrated services means the various parties adopt a more comprehensive view of speech services that extends beyond pull-out services and that each understands the need for time allotment for teachers and SLPs to accomplish the broader goals.

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