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This Week’s Episode: Service Delivery Options for School-Based SLPs
This month, I’ve had the pleasure of speaking with BeckyAnn Harker all about service delivery, tips, and strategies to help us schedule smarter in the schools. BeckyAnn is a school-based SLP near Youngstown, Ohio, and she has 24 years of clinic and school-based experience. She is currently a doctoral student in special education at Kent State University, and she’s very interested in caseload management and vocabulary intervention. For this podseries, we will be focusing on her caseload management expertise!
In last week’s episode, BeckyAnn and I discussed a brief intro to smarter scheduling for school-based SLPs and today we are going to be reviewing different service delivery options. We ended our discussion last week chatting about RTI or response to intervention. BeckyAnn will tell us a little bit more about what RTI is and what that could look like.
Let’s get to it!
Key Takeaways + Topics Covered
Shift to adopt RTI
✓ If SLPs do RTI it can save 6-10 hours of paperwork
Shift service time
✓About the quality of the minutes, you have with the kids. Not the amount of time.
✓ Students don’t miss as much class.
✨ Shifting service time! Speedy Speech or 5-minute artic drills (Kuhn, 2006)
✨ 150 repetitions in 15-20 minute INDIVIDUAL sessions- remediated in 6 hours of tx. (Bruce et al., 2018)
✨ For those who needed an IEP (more severe), remediated in 53 hours, less than the district average of 83 hours which is 3 years! (Bruce et al., 2018)
✨ Plante et al. (2019) found no difference b/w 15 and 30 minutes if 24 exemplars were used.
✨ The number of repetitions matters when remediating speech sounds and other errors and is more important than the number of minutes spent in a session.
Shift service setting (e.g., in classroom)
✓ The student doesn’t lose as much time in the classroom
Shift group size
✓ You can be flexible
ASHA Leader: BeckyAnn Harker Can We Break From 30-Minute Group Sessions in Schools?
ASHA Leader: Jennifer Taps RTI Services for Children With Mild Articulation Needs: Four Years of Data
SPEEDY SPEECH: Efficient Service Delivery for Articulation Errors (Kuhn, 2006)
Laurel Bruce A Team Approach to Response to Intervention for Speech Sound Errors in the School Setting
Plant et al., (2019) Treatment Efficiency.
Next Up in this Pod Series
6/7/22: An Intro to Smarter Scheduling for School-Based SLps
6/14/22: A Quick Review of Service Delivery Options for School-Based SLPs
6/21/22: How to Navigate Alternative Scheduling for School-Based SLPs
6/28/22: How to Start Using Smarter Scheduling for School-Based SLPs
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Thanks so much!
Hello there and welcome to the SLP Now podcast, where we share practical therapy tips and ideas for busy speech language pathologists. Grab your favorite beverage and sit back as we dive into this episode. Welcome back to the podcast. We are going to continue the service delivery discussion with BeckyAnn Harker. If you missed our episode last week, definitely head to the previous episode so that you can get caught up on our discussion. And today we are going to be reviewing different service delivery options. So we ended our discussion last week, chatting about RTI or response to intervention, BeckyAnn, can you tell us a little bit more about what RTI is and what that could look like?
BeckyAnn Harker: Sure. So most schools should be doing RTI or response to intervention as part of their academic and behavioral interventions with PBIS, positive behavior interventions and support. And I know in my district, we were told we had to follow RTI, we had to follow the process, but nobody ever told us what that meant or how we fit into that because we don't fit in quite the same way. There's no tutors doing the interventions for us. And so I've been really trying to figure out how to make this work in my head. I actually end up doing the interventions, the teacher has some concerns about a kid or in kindergarten we screen all of these children. And so we are often the first ones to find some issues, but I will do some interventions on my own and then sometimes those kids have bigger issues and so they get academic testing and then we will also follow along with that, do our testing. Or I just will make the decision, I guess, to go to further testing if we need to.
BeckyAnn Harker: But honestly, the kids that just have some speech sound errors, I will just see them usually individually, sometimes in very small groups to just drill some sounds, some things I had found, because I've done some research looking into RTI for speech pathologists and there are some things that have come up like the amount of paperwork that it actually saves us if we do RTI. Someone had said six to 10 hours of paperwork that it would save us. Now think about, even if that's five kids that you have in RTI, that could be 50 hours of paperwork through the whole ETR process, IEP process, progress reports, all of the stuff that goes with that. So just saving that many hours sounds really good to me.
BeckyAnn Harker: So that's a big push for me. And the other thing that we had talked about in the last episode is just that these kids may not actually meet the qualifications for therapy yet they still need it. And so this is a way that it eases my mind. Yes, it does happen sometimes that if things get really, really busy, we're doing state testing this week, for example, and I have been helping to do state testing. The kids in RTI are probably not going to be the first ones I make sure I see this week, but it's okay. It's okay because they're getting help throughout and as I have said, nobody's ever died from not having one week of speech therapy. They'll probably be okay for the week.
Speaker 1: Yeah. I love the idea of using five minute sessions to work on articulation for our RTI students. Can you tell us a little bit more about what that would look like?
BeckyAnn Harker: Yes. And so I'm also a big fan of this five minute artic drill. So it's been called speedy speech. It's been called five minute artic drills. It's been called all kinds of things and for the articulation kids, especially... So really in five minutes I usually do 10, I'm not going to lie. I feel guilty, five minutes just doesn't seem like enough. And kids still will come and talk to you and so we waste a few minutes of chit chat and making friends, but then you can just drill sounds. And if you can get 50, 100 repetitions within 10 minutes, then send them back to class. It's no longer than a bathroom break. They're not missing a ton of class. I call it drill and kill and go back to class and you see improvements that way. You're not having to juggle between those groups of those other kids with other language needs perhaps.
BeckyAnn Harker: so within that five or 10 minutes, you can really get the kid to meet their goals a lot faster. There's some statistics too on how the five minutes drills can save... One study had them remediated their sounds in six hours of therapy. So that's kind of the RTI, don't put them on your caseload and have an ETR and an IEP and all these minutes you have to do, if you can actually fix it in six hours. And another study, even with kids who were more severe and they were put on an IEP and they had more sound issues. It still took less time. It took like 53 hours over time to remediate those sounds versus their district average of 83 hours, which is three years that you're having a kid on an IEP to work on sounds. It's kind of a long time in my opinion.
Speaker 1: Yeah. So that's 30 hours saved, that's like getting those kids off of your caseload, back into the classroom, back into least restrictive environment a year sooner.
BeckyAnn Harker: Correct.
Speaker 1: That's incredible.
BeckyAnn Harker: Right. But we should be doing this. That's what I think.
Speaker 1: Yeah. And we'll share the citations for those articles in the show notes. I think that particular article was from Bruce et al. 2018.
BeckyAnn Harker: That was, yes.
Speaker 1: Okay. So that was an example for articulation where the RTI students who had those shorter individual sessions remediated much more quickly. And then for the students who were more severe and needed that IEP, we saved 30 hours of treatment time using that approach. Have you seen studies outside of articulation? Does this apply to other areas?
BeckyAnn Harker: So Plant et al. in 2019 also found that there's no difference between 15 and 30 minutes of therapy. This was for grammar when they're working on morpho-syntax, they did 24 exemplars. So they practiced 24 times, they were able to... Or 24 different words and they were able to do the exact same amount of good in half the time. So I don't know why we have this magic number of 30 minutes. It's in our head, it's in our psyche. I think it comes from the medical model. And if you think about it, if you're going to take your kid to a clinic to be seen, you're not going to just sit there for 10 minutes and then turn around and go home and do that every week.
BeckyAnn Harker: So that 30 minute, doctors seem to block in 30 minutes. I think some people will bill in 30 minute increments. And so I don't know, that's just gotten into our psyche, but if you can do it in half the time, if you can treat grammar in 15 minutes, if you can treat articulation in five or 10 minutes, then I am all on board with that.
Speaker 1: So it sounds like the takeaway is that with the grammar study, if we got those exemplars, it doesn't matter if it's in 15 versus 30 minutes, just like the number of targets that matters, not the amount of time.
BeckyAnn Harker: Correct. And how I schedule my life right now is I'm thinking more about getting the activity done, the amount of repetitions done. So that could take a half an hour. I'm not going to say I never see kids for a half an hour. Sometimes it does. Sometimes it takes longer depending on what the activity is and what we're doing, but it should be about the quality and not the quantity. I hate watching that clock.
Speaker 1: Yeah, like what can we do to fill in these extra minutes?
BeckyAnn Harker: Right. What if you're done in 20 minutes, you're like, I still got 10 minutes to go. And now you're just wasting time or you start another activity, which then isn't done in time. So it's all about the quality of the minutes that you do have with those kids.
Speaker 1: Yeah. And I think that one of the benefits that I saw to using these shorter sessions, I love what you said about the students don't have to miss as much class. It doesn't have as much of an impact. And we don't need a lot of fluff when we're doing these shorter sessions. A student can attend for five to 10 minutes without needing extra reinforcers and a ton of behavior management. They can focus for that amount of time and we can just get super high quality therapy with lots and lots of repetitions and little to no fluff.
BeckyAnn Harker: Right, I will bring a blank worksheet that has little pictures, whatever on it. And in the session we're choosing our targets, we're practicing, we're saying them in words and sentence and I will be writing those words down. So then they have homework within that 10 minutes. It's individualized for them, for what they needed, what they were working on. And they're kind of watching, sometimes I'll have the kids write it and so they have the homework to take home with them from what they were just practicing with me.
Speaker 1: Wow. Double whamy. I love it.
BeckyAnn Harker: Yeah.
Speaker 1: Make their homework during the super short session.
BeckyAnn Harker: Yes. Be efficient.
Speaker 1: Yeah. I love it. So what does this look like in terms of the logistics? So next week, we'll chat more about how to navigate scheduling, but if the sessions are so short, do you go to the speech room? What does your setting look like? Are you in the classroom, in the hallway? Can you just paint the picture of the basics?
BeckyAnn Harker: Sure. it's flexible. So I guess my theme, I just try to be flexible, flexible in my group size, flexible in the amount of minutes that I spend, flexible in what I do. So we will be talking about how I do block scheduling. So I kind of block by teacher and then I will go to that classroom. So during that time, if they're in the middle of an activity, I'm not going to pull a kid. How many times do you go to the classroom, even though they know that their time is at 10:30, but they're hardcore in the middle of a language lesson or a math lesson, but it's your time and so you take them and pull them from that. So I don't do that. I try to find a time within that block.
BeckyAnn Harker: So I'll go to the classroom, if they are in the middle of a project or a thing, I will stand there and I will help. I'll help my students. Sometimes it's a little bit of a waste of time because I'm... Kind of, I'm just listening and seeing what the teacher's doing, but I also know what's going on in that classroom. So then I can reinforce that if I end up pulling the students out, but sometimes I work right there. Sometimes we'll go in the hallway. I'm fortunate to have a couple of work rooms. So I have my office, but there's also a workroom on the other end of the hallway, the other wing. So I'll just pull a kid in there and practice for 10 minutes and then send them back. So it's kind of all of the above.
Speaker 1: Yeah. That's perfect. I love it. Thank you so much for helping us picture what that would look like a little bit more. And I think that's a really good overview of some of the different service delivery options that we might have available to us. And when we're getting strategic and helping students make more rapid progress and giving ourselves less paperwork. And so in the next episode, we'll dive into one of the biggest questions I think that we get is how do we actually navigate scheduling with this? Thanks for listening to the SLP Now podcast. If you enjoyed this episode, please share with your SLP friends and don't forget to subscribe to the podcast to get the latest episode sent directly to you. See you next time.
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