Posted in SLP Issues in Education

Models of Service Delivery

We recently discussed four models of service delivery in class (ranked from least integrative to most integrative): Multidisciplinary, Consultation, Interdisciplinary, and Transdisciplinary. Various factors seem to determine which model is best to use at the school board, classroom, or client-level, such as considerations related to caseload or the amount of resources available. After our discussion in class today, I thought I would summarize each model and discuss the advantages and disadvantages of each type. Some of the information provided regarding these models was obtained from an article by Salima Suleman and colleagues (cited below).

Multidisciplinary Model
Summary:
• Characterized by a division between professionals (i.e., teacher and SLP), with little to no communication between professionals
• Professionals work directly with the same population
• The pullout model is an example of a multidisciplinary model
Advantages:
• Beneficial for children who may need one-on-one attention in order to focus during therapy sessions
• Easier to document interaction with child and monitor progress across each session
• Some communication disorders better addressed with pull out model (i.e., articulation disorders)
• Can better control environment (i.e., quiet setting, free of distractions, private, etc.)
Disadvantages:
• Lack of inter-disciplinary communication may not maximize child’s success (i.e., if strategies are only being utilized during therapy, even though majority of time is spent in classroom)
• Time-consuming and inefficient to employ the pull out model with a large caseload

Consultation Model
Summary:
• This model involves a referral system, where experts are called in to comment on and make recommendations on a case
• One-way transfer of information
• One professional is the expert (i.e., SLP) providing information to the other (i.e., teacher)
• One professional may not work directly with the population
• This model can take the form of…
Modeling: The intervention agent (i.e., teacher) observes the expert (i.e., SLP) completing a task so that they can later implement it on their own
Coaching: The consultant offers support and tips to the intervention agent
Scaffolding: Both professionals engage in dialogue
Fading: The expert withdraws support as the intervention agent becomes more confident in his/her abilities
Advantages:
• Inter-disciplinary communication allows both professionals to discuss observations and progress related to the child, and means the child has the support of both professionals
• More efficient mode of service delivery than multidisciplinary model (can provide service to more children)
• Modelling allows for classroom integration of the SLP and allows the SLP to become familiar with the classroom setting in which the child must learn and communicate
• The child will be provided with more models than if a multidisciplinary approach was used (since the teacher spends more time with the child in the classroom and can now provide models)
• It may be easier to transition to an interdisciplinary model or transdisciplinary model in the future if a consultative approach is used first, since the SLP and teacher have had previous inter-professional contact
Disadvantages:
• The expert’s advice may not be adopted by the other professional (i.e., teacher may not use strategies suggested by SLP) or the advice may be carried out incorrectly
• The classroom environment may not be conducive to productivity if it is too chaotic for the child to focus and learn from the models presented
• It may be more difficult to monitor the child’s progress since the SLP is not seeing him/her regularly

Interdisciplinary Model
Summary:
• This model involves professionals working together and engaging in two-way communication
• Each profession maintains their own unique role
• Professionals work directly with the same population
• In the classroom, this model can take the form of…
One-teach/One-drift: One professional takes on the primary teaching duties, while the other one helps individual students)
One-teach/One-observe: One professional takes on the primary teaching duties, while the other observes
Station Teaching: Each professional teaches at a separate center
Remedial Teaching: One professional re-teaches previously taught material
Supplemental Teaching: One professional teaches the same material but in a new way and with new materials
Advantages:
• Each professional’s expertise can shine since they each carry out their distinct role, but inter-professional contact still allows for information to be shared
• Since both professionals work with the same population, observations can easily be shared and discussed between both parties
• The SLP can become familiar with the classroom setting in which the child must learn and communicate
Disadvantages:
• Both professionals need to take time to determine how they will coordinate duties within the classroom
• It may be easier for teacher to take the lead role more often
• May be difficult to implement over large caseloads which span multiple grade levels (insufficient time to coordinate with several teachers in multiple classrooms)

Transdisciplinary Model
Summary:
• This model involves a large amount of professional overlap and professionals sharing roles and responsibilities
• Professionals work directly with the same population
• Requires extensive communication because professionals are assuming the roles of professionals in other disciplines (i.e., SLP taking on role of teacher, and vice versa)
• Model can take the form of…
Parallel Teaching
Team/Co-teaching
Advantages:
• Each professional has the opportunity to learn about another discipline
• Since one professional may not be as clearly identified as the “SLP”, this model may draw attention away from the specific children who need SLP services
Disadvantages:
• Some professionals may only be comfortable in their own distinct role or find it difficult to adopt another role
• This model requires a great deal of collaboration and is time-consuming for both professionals
• Both professionals will need additional training
• Difficult to implement in areas with a scarcity of SLPs and large caseloads

Reflecting on these Models
After my school board placement, I gained experience implementing the multidisciplinary and consultation models. I enjoyed utilizing the multidisciplinary or “pull out” approach because it allowed me to focus my attention on one to three children at a time, in a controlled setting. In the pull out model I felt the children were able to focus solely on their speech and language without being distracted by other classroom activities. However, in schools with larger caseloads I quickly saw how this pull out approach was inefficient, since we have a narrow time frame available to see many children between lunch, recesses, and assemblies. I liked how the consultative model brought teachers into the mix, since many were receptive to implementing strategies for their students with communication disorders. However, after observing the demands which teachers were managing during busy school days, I could see how speech and language goals could be forgotten when trying to address the curriculum and other school activities. Thus, I think consistent follow-up is an important piece to the consultative model. Although I didn’t observe the inter-disciplinary model, I think it would certainly be feasible to implement certain sessions using this model (i.e., a social-emotional literacy unit). Similarly, if the caseload and resources would allow it, I think the transdisciplinary model would be a wonderful way to develop inter-professional collaboration skills.

For more information, check out these additional resources:

Suleman, S., McFarlane, L., Pollock, K., Schneider, P., Leroy, C., & Skoczylas, M. (2014). Collaboration: More than “working together” an exploratory study to determine effect of interprofessional education on awareness and application of models of specialized service delivery by student speech-language pathologists and teachers. Canadian Journal of Speech-Language Pathology & Audiology, 37(4), 298.

Swenson, N. C. & Williams, V. (2015). How to Collaborate: Five Steps for Success. Perspectives on School-Based Issues, 16(4), 122-130.

CASLPO Reference Guide for Speech-Language Pathologists Employed in the School Board Setting: http://www.caslpo.com/sites/default/uploads/files/GU_EN_SLP_in_School_Board_Setting.pdf

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