Inclusive Speech-Language Services in the Schools

Katelynn Carroll, M.S.Ed., CCC-SLP

Katie Giglio, M.S., CCC-SLP

What are inclusive services?

• Providing services in the student’s everyday environment (i.e., classroom)
• Keeping students with peers
• Providing direct support by “pushing-in”
• Providing indirect support by collaborating with teachers
• Supporting all students (not just those with speech/language services)

Why provide inclusive services?

• Least restrictive environment
• Student’s don’t miss academic time/content
• SLP is immersed in curriculum, knows what students need to know
• SLP knows what non-identified students are doing. What’s “normal?”
• Functional

What does the research stay?

Evidence-Based Systematic Review: Effects of Different Service Delivery Models on Communication Outcomes for Elementary School–Age Children

“We found no studies that met our criteria that investigated outcomes for students who received regularly scheduled face-to-face direct intervention services within their general or special education classroom compared with treatment of the same type and intensity in pullout settings.” (Cirrin et al., 2010)

Systematic Review Findings (Cirrin et al., 2010)

• Some evidence suggests that classroom-based services are at least as effective as pull out intervention for some language goals�
• Classroom-based services may promote generalization�
• SLPs must:
• Collect data
• Monitor effectiveness of intervention for each student
• Use all branches of EBP

Evidence Based Practice

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American Speech-Language-Hearing Association. (2005). Evidence-based practice in communication disorders [Position Statement]. Available from www.asha.org/policy.

What works in school-based language intervention?

• Language intervention within the classroom was effective for teaching vocabulary (Throneburg, Calvert, Sturm, Paramboukas, & Paul, 2000).

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• Contextualized Language Intervention was more effective than Decontextualized Language Intervention (Gillam, Gillam, & Reece, 2012).

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• Classroom-based vocabulary instruction led to improved vocabulary gains (Gillam, Olsezewski, Fargo, & Gillam, 2014).��

What should school-age language intervention include? (Wallach, 2014)

• Clinical practice at school-age levels should focus on:�
• Knowledge based intervention goals that help students connect known and new information�
• Balancing content knowledge and awareness of text structure in functional, authentic tasks that are applicable across grades and subjects�
• Language goals that connect to the classroom curriculum �

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What are SLPs doing? (Brandel & Loeb, 2011)

• SLP Survey: Program intensity & service delivery models in the schools:

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*Except for preschool-most severe (individual outside the classroom) and high school-most severe (self-contained classroom).

Types of Inclusive Services

• More than just “pushing-in”
• Well-planned, individualized, and collaborative
• May look different across students, classrooms, even day to day
• Borrow from co-teaching models (Friend, Reising, & Cook, 1993)
• Lead and support
• Station teaching
• Parallel teaching
• Alternative teaching
• Team teaching

Lead and Support

• Teacher leads, SLP supports

Station Teaching

• Teacher and SLP each work with a small group of students on different activities
• May include TA led or student led (independent) stations
• Students rotate through each station

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Parallel Teaching

• Teacher and SLP plan instruction together
• Teacher and SLP split students in half and each take a group
• Provide similar instruction; content must be the same

Alternative Teaching

• SLP takes a small group of students to teach the same lesson
• Similar to a pull-out S/L session, except that students are still getting classroom content instruction

Team Teaching

• SLP and teacher provide coordinated instruction
• Teachers truly act as a team

Pitfalls of inclusive services

• Not enough time to collaborate
• Poor teacher-SLP working relationship
• SLP hesitant to “jump in” (or teacher annoyed by it)
• SLP assumes role of TA

What works?

• School level supports:
• Clustering
• Block scheduling
• Tutorial, Study Hall
• Team planning/collaboration time in schedule
• Start early
• Begin conversation before writing the IEP
• Technology
• Google Platform
• Powtoon

Building the Collaborative Relationship

• Divide tasks/labor
• Assign self to area of expertise
• Showcase your value
• Ask, “How can I help you?”
• Speak up!

Example: “I need to work directly with Johnny two times this week on vocabulary and sentence structure. Let’s do stations on Tuesday so I can work with him in a group on the science vocabulary and lead and support Wednesday so I can help him on the independent writing assignment. “

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It’s not working...

• Some students need smaller group, direct instruction
• Some students have goals that are not suited for this model
• Articulation, voice, fluency (unless working on generalization)
• Working on basic language concepts, not ready to apply to curriculum
• Attention difficulties - can’t focus in larger group
• Student resistant
• Won’t accept help in front of peers
• Example: student refusal in whole group, but worked well 1:1

Sample Lessons

Science Vocabulary Stations

Which One Is It? �Measure vs. Estimate: Decide whether each statement is an example of measuring or estimating. ��Measure → to find the exact amount of something��Estimate → to make a careful guess��1. There are 12 dogs at the park. �� measure estimate���2. I saw about 20 students in the classroom.�� measure estimate���3. The block weighs exactly 25 grams. �� measure estimate�

Executive Functioning - Alternative or Team Teaching

Executive Functioning

(Ylvisaker & Feeney, 1998)

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http://www.projectlearnet.org/pdfs/3_LEARNet_Tutorial_Self_Regulation_Issues.pdf

Executive Functioning Skills

Directions: Look over the checklist below. Check anything on here you would like to improve this year.

You may check as many as you would like.

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I would like to get better at:

• Listening to directions the first time they are given
• Completing all of my homework by myself
• Handing in my homework on time
• Controlling my body so I don’t get yelled at in class
• Paying attention when a teacher is talking
• Taking notes
• Keeping organized
• Asking for help when I am confused
• Using specific strategies to help me when I am stuck
• Reading more independently
• Remembering important information
• Get started on a task in class
• Focusing on small details
• Focusing on the big picture
• Managing the time it takes me to complete something
• Working neatly
• Showing my work in math
• Switching from one activity to another without getting distracted or off task
• Explaining my thoughts or questions to someone else
• Working on more than one thing at a time (multi-tasking)
• Other: ______________________________________________________

Padlet

Writing - Constructed Response

Writing Prompt:

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What are the attributes of the protagonist in

Gary D. Schmidt’s

The Wednesday Wars?

Plan:

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• Review vocabulary

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• Planning Sheet
• Identify attributes
• Find evidence

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• Writing Template

Restate the question

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Answer the question

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Text evidence

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Analysis

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Text evidence

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Analysis

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Summarize

Other Supports

• Checklists for assignments
• Graphic organizers
• Modify Notes, Tests, Quizzes, Labs
• Simplify language
• Simplify format
• Bigger fonts
• More spacing
• Add visuals

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Name ___________________________________ Date __________________

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Short Answer Writing Checklist

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________ I echoed the question or used a topic sentence.

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________ I made a valid inference or claim.

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________ I had a first relevant detail or piece of evidence.

________ I explained my first detail or evidence.

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________ I chose a detail that best supports my claim or inference.

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________ I had a second relevant detail or piece of evidence.

________ I explained my second detail or evidence.

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________ I chose a detail that best supports my claim or inference.

________ I used transition words in my paragraph.

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________ I had evidence of analysis or a conclusion statement.

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________ I used complete sentences with capitals and punctuation.

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In this writing piece you….

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Next time, my goal is to….

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How can I collect data in the classroom?

• Data collection in the classroom setting needs to be different than that in the therapy room
• Number of trials: mentally plan to probe a certain number of times
• Data collection tools: charts, sticky notes, whiteboard
• Use work samples
• Shift your focus away from discrete trials and accuracy
• Focus on levels of support

Rubrics

https://www.teacherspayteachers.com/Product/Language-Rubrics-A-Progress-Monitoring-and-Data-Tracking-Tool-1448115

Rubrics

Is this enough? Is it too qualitative?

It may be. Consider using the rubric daily, plus probe for more quantitative data as needed.

• Create written tasks to use as work sample/assessment
• Pick a student a day - every Wednesday be sure to probe Ava to monitor a specific goal

What should I put on the IEP?

• Inclusive services CAN be related services
• Be specific
• Location
• Delivery recommendations

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Documentation & Regulations

• Is it a related service?
• Am I meeting student ratios?
• Did I work with that student for the allotted amount of time?
• Does it match what the IEP says?
• Is it Medicaid eligible?

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Student:Teacher Ratios - Is it a related service?

“When a related service is provided to a number of students at the same time, the number of students in the group shall not exceed five students per teacher or specialist.” -NYSED Regulations of the Commissioner of Education - Parts 200 and 201 / Section 200.1

Is it a related service? (Ratios)

✓ parallel teaching with special education teacher; total students = 10

✗ parallel teaching with regular education teacher; total students = 25

✓ alternative teaching with teacher; total students = 25; SLP group = 5

✓ lead and support; total students = 12; SLP supports 4 students

✗ lead and support; total students = 12; SLP supports 6 students

✓ team teaching with special education teach; total students = 10

✗ team teaching with special education teacher; total students = 11

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Is it a related service? (Service duration)

Station Teaching

✓ SLP works with a group of 5 students for at least 30 minutes

✗ SLP works with multiple groups of 5 students for less than 30 minutes

✓ SLP follows group of 5 students to each station (3 stations x 10 minutes each)

Is it Medicaid eligible?

From: NYSED Medicaid in Education School Supportive Health Services Program Questions and Answers (2010, updated 2015) http://www.oms.nysed.gov/medicaid/q_and_a/q_and_a_combined_7_21_15.pdf

Q. Are integrated (push-in) speech therapy services reimbursable by Medicaid?

A. Therapy provided in this setting may only be billed to Medicaid if the servicing provider can document the occurrence of appropriate one-on-one or group (sized up to five students*) services provided and meet all other Medicaid billing documentation requirements. Classroom instruction is not a Medicaid reimbursable service, regardless of the amount of time spent instructing the Medicaid eligible student.

Group Activity - Think-Pair-Share

Questions?