[00:00:00] 

Intro

Kate Grandbois: [00:00:00] Welcome to SLP Nerd Cast. I'm Kate. And I'm Amy. And we appreciate you tuning in. In our podcast, we will review and provide commentary on resources, literature, and discussed issues related to the field of speech language pathology. You can use 

this podcast for ASHA Professional Development. For more information about us and certification maintenance hours, go to our website, www.slpnerdcast.com.

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Amy Wonkka: to teach 

Kate Grandbois: us. 

Amy Wonkka: Just a quick disclaimer, the contents of this episode are not meant to replace clinical advice.

SLP Nerd Cast. Its hosts and its guests do not represent or endorse specific products or procedures mentioned during our episodes, unless otherwise stated, we are not PhDs, but we do research our material. We do our best to provide a thorough review and fair representation of each topic that we tackle.

That being said, it is always likely that there is an article we've missed or another perspective that isn't shared. If you have something to add to the conversation, please email us. We would love to hear from you. Before we get 

Kate Grandbois: started in today's episodes, financial and Non-Financial disclosures, um, I am the owner and founder of Grand Wa Therapy and Consulting, LLC and co-founder of SLP Nerd Cast.

Amy Wonka is an employee of a public school system and co-founder of [00:02:00] SLP Nerd Cast. Uh, we are both members of SIG 12 and both serve on the a a C advisory group from Massachusetts Advocates for Children. I am a member of the Berkshire Association for Behavior Analysis and Therapy, mass, a BA, the Association for Behavior Analysis International and the corresponding Speech Language Pathology and Applied Behavior Analysis Special Interest Group.

Amy Wonkka: Uh, what are we talking about today? Today we are talking about service delivery models, especially service delivery models in schools. 

Kate Grandbois: So when we say service delivery models, we are basically talking about what in general. 

Amy Wonkka: We're talking about a few different things, right? We're thinking about frequency and duration.

We're thinking about the place where the service takes place. We're thinking about indirect versus direct, so we're thinking about a lot of different variables that together make up what your service looks like, 

Kate Grandbois: and why did we choose this topic? I 

Amy Wonkka: think that sometimes we forget that there are more options than like [00:03:00] two times 30 or one times 30.

Kate Grandbois: I have something to admit. 

Amy Wonkka: Yeah. What is that? 

Kate Grandbois: I didn't know a lot of this information before we researched this episode, so I think that's absolutely true. I've been practicing, I've been a licensed speech pathologist for 13 years, and as we researched different types of service, service delivery models and best practices and ethics and, you know, things that are related to this, I, I was a little embarrassed by how little I knew about the different kinds of service delivery out there.

Amy Wonkka: Well, and I think it's interesting, and we'll talk about this throughout this podcast, but part of that I think connects back to the specifics of your work environment, um, and one of, kind of the ongoing themes throughout. This discussion that we're gonna have today is, you know, our place as speech pathologists in our work environments to help bring forward that information so that not only other speech pathologists are aware of these different service delivery options, but other team [00:04:00] members and more importantly, administrators of these different programs are aware of the range of service types that can be provided as well as the potential benefits to those different, um, approaches depending upon the individual client needs.

Kate Grandbois: And I don't think that you said this yet, but we did say that the majority of this informa the information in this episode is related to schools, but there are a lot of variables that can be applied to different components of service delivery models. And those variables are very applicable to different settings.

So just 'cause we're talking about it in schools doesn't mean that you can't consider some of these variables if you're in private practice or working in an outpatient setting. 

Amy Wonkka: I felt the same way as I was doing the reading to prepare for this episode. I felt exactly that. You know, I think that there, that this thought process, while a lot of what we're talking about, the articles that we read are really geared toward a school-based speech pathologist.

I think that they're important things for, they, they would've been important things for me to know and think about when I was working in outpatient or [00:05:00] in private practice. You know, so I think that there are important pieces to take away, regardless of your current work environment. 

Kate Grandbois: And I think the funding source is a variable also.

And that's not really something that we are gonna review a lot today in terms of the literature and what's out there. But, you know, if you're working in an outpatient setting, your funding source could dictate what kind of service delivery or what setting your, you know, you are allowed to do service delivery in.

So 

Announcer: mm-hmm. 

Kate Grandbois: Their service delivery in general can be, you know, have a lot of different things, have a lot of different components depending on, on where you work. And we're gonna talk mostly about things in schools, but. Keep in mind it can be applicable to a lot of different settings. 

Amy Wonkka: Agreed. So what are our learning objectives?

Oh, I was just 

Kate Grandbois: about to say learning objectives. Okay. Learning objective number one, explain the components that are involved in service delivery when common, um, within common pediatric treatment environments. Number two, explain the difference between direct and indirect [00:06:00] service and what factors might indicate a need for which type of service and learning.

Objective number three, describe a workload approach to caseload and identify how service delivery components and variables are likely to impact workload. I'm excited for that last one. I hope that that'll be good. Um, so in terms of the first learning objective, number one, explain the components that are involved in service delivery within common pediatric treatment environments.

Um, so ASHA has a lot of resources about service delivery. The bulk of what we're gonna talk about in terms of this first learning objective comes directly from the ASHA website, a page entitled School-Based Service Delivery in Speech Language Pathology. There is a link on our site. I'm pretty sure this information is up to date.

We're recording this episode in July of 2020. Um, so if you are interested in doing some more reading or doing a deeper dive, I definitely will direct you to there and [00:07:00] give credit to all the things that we're supporting. This. Uh, first learning objective are pulled directly from that, directly from that page.

So according to this reference, um, there are service delivery is a dynamic process and it involves a handful of different variables. And changing the different variables in this dynamic process will change the process, will change the service delivery, 

Amy Wonkka: right? And, and kind of to encapsulate all of that information.

Service delivery is, is where you do it. It's how you do it. Mm-hmm. 

Announcer: It's 

Amy Wonkka: how often and for how long you do it. 

Announcer: Mm-hmm. 

Amy Wonkka: And then kind of for how long, more broadly, like zooming back, like how, how long are you in treatment? 

Kate Grandbois: You know, are you wondering how long is your 

Amy Wonkka: session? 

Kate Grandbois: Right, right. Um, so according to this reference, this resource, those components are broken down into looking at the treatment setting.

So this could be the classroom therapy [00:08:00] room, vocational pl, uh, you know, place of employment, um, other naturalistic environment, the home. Um, an example, you know, this could be like push in or pull out in schools. 

Amy Wonkka: And also when you think about your IEP, often this is delineated on your service grid. So depending upon the state that you're in, all of our IEPs look a little bit different in the United States.

But typically you have different places where your service is. Um. Is documented. And one of those would be in the general education environment. Another one would be in a substantially separate environment. So that's also kind of the broader environment as to where you're providing those services. Right?

Kate Grandbois: Um, so treatment, treatment setting. And then there's format, which is individual, small group. What is the lay of the land in terms of the kind of service delivery that you are providing? 

Amy Wonkka: And if you look in an IEP just thinking about school service delivery, often you'll [00:09:00] find that information. If your IEPs have, um, a methodology section that might talk about that.

It might talk about the type, the what format that looks like when you're providing that service. 

Kate Grandbois: Yes. So the third one is intensity. The amount of time that is spent in each treatment session. So an example of this would be thinking about frequent short sessions or longer sessions that are less frequent.

Amy Wonkka: And I think that this is one place where, you know, in, in schools, but also in outpatient and other places where you're, you know, following along with a third party funding source, we're maybe not entering into the conversation thinking as flexibly about this parameter as possibly we should. 

Kate Grandbois: Agreed.

Completely agreed. And I think that this is again, where the old standard, like the way we do it this way, because we've always done this way right, sort of falls into this, right, into this category. Um, and I know depending on where you work, there could be some [00:10:00] ethical considerations about administrators telling you, well, we give three times 30 for mm-hmm.

Kids with this diagnosis. And that is wrong. It's not the way it's supposed to be. The, you know, the intensity and frequency of your service delivery. Sh and we'll talk about this a little bit more, should be. Very specifically matched to the needs and profile of the student or client that you are serving.

Mm-hmm. So to recap a little bit, treatment setting, format, intensity, frequency, and duration. And this is sort of what Amy was getting at before, like how long the, the length of treatment that you've been, that you've received. So I think a good comparison here would be pt. So you, you were in treatment for four weeks for your sprained ankle and then you're discharged.

Yeah. In that example, four weeks would be duration. I think for some of our more complex learners or um, some of our more emergent learners, this piece of duration gets lost because my old outpatient clinic, you know, we referred to them as lifers. They had been in [00:11:00] therapy with us for years and years through, you know, through the.

Through their entire elementary school experience. Mm-hmm. They were coming every Tuesday at two o'clock or, or whatever. Um, so sometimes in pediatrics, I think that component of duration can sort of fall through the cracks, but it is something that should be considered when you're thinking about, um, components of service delivery.

So as a states that choosing service delivery is a flu, it should be a fluid process. Um, on the page that I described, they cite a lot of literature describing how important it it is to understand the different kinds of service delivery models and to sort of break away from that traditional, we do it this way just because we've always done it this way.

Or really thinking about it, thinking about it critically outside of the norms of your workplace setting. Um. The, this site and about all of this literature really does highlight that student outcomes are improved when factor, when these different components of service delivery are used [00:12:00] flexibly. When they're reviewed regularly and when they're changed specifically, um, when they're changed because of a direct relationship with the student needs.

And this, this component was like a surprise to me, but also not a surprise. I think as clinicians, we change our programming, we change our materials, we change our goals and objectives. We change all kinds of things related to the specific needs of the client and how they're progressing and how, you know, they're about how things are, are moving along.

So on the one hand it's not surprising, but on the other hand, I think thinking about customizing service delivery based on an ongoing basis, based on the needs of your client is not something that we as clinicians do automatically. 

Amy Wonkka: Well, and I, you know, I think this is such. Interesting and powerful point because I think often service delivery feels somewhat set by the institution.

Mm-hmm. Right. Regardless of where you are. And I think back to working outpatient, you know, outpatient, you're [00:13:00] very bounded by the third payer party system and, and how that works out and what you're able to do and not able to do. Um, and in schools, speech pathologists are, you know, schools are. Critically underfunded and the, the number of speech pathologists who have more students on their caseload than they're able to actually adequately provide a flexible service delivery model for is far outweighs the reverse.

Kate Grandbois: Um, the number of times I've heard colleagues and friends say, well, I see, you know, these five kids in a group because I have a caseload of 140 and I can't physically, it's disgusting. Yeah. I can't physically treat each of these individual students, and so I have to, my service delivery has to be in a group.

Setting. 

Amy Wonkka: And when you step back and look at that, it's, it's a real challenge because ethically we should, we shouldn't be doing that, right? We shouldn't be doing that. That shouldn't, that shouldn't be a deciding factor in service delivery. Um, so I think, you know, this is [00:14:00] a really, this is a really interesting point to kind of ponder the idea of that being as fluid of a process as writing your goals and objectives.

And I think, you know, when we get together and thinking about school-based, where you're writing all of these things as a team as opposed to something like outpatient or private practice where you're sort of making those with input from, you know, some stakeholders but not necessarily a larger group. Uh, it, it's interesting to think about, okay, if you come back to the table and a person hasn't met their goals and objectives, do you, should you approach service delivery options with the same flexibility that you would in potentially rewriting that goal?

So it, I think that that's a very interesting thought and I. Not necessarily how it plays out in a lot of places, and maybe we need to be more aware as clinicians that this is something we should be thinking about a hundred percent as as part of the decision making process. 

Kate Grandbois: So the different components of service delivery, the treatment setting, format, intensity, frequency, and duration, are all going to be [00:15:00] affected by a lot of different fa uh, by a lot of different factors, one of which is age.

So if you're talking about birth to three, IDEA, part C dictates that services need to be family centered. And they need to take place in the natural environment. That shouldn't be a surprise to anyone who spent any time in early intervention on the floor in the home. Right. Um, that changes though between ages three and 21.

So Part B of IDEA dictates that preschoolers and school age students, Rick, um, be provided with a free and appropriate education, which is the acronym for that is FAPE in case, if any, anyone has heard the term FAPE free and appropriate education. It also dictates that those students be educated in the least restrictive environment.

So then it becomes in terms of thinking about service delivery, what is the least restrictive environment for service delivery and how do you need to consider that when constructing your service delivery? You can definitely make the argument that a pullout session where you're taking the kid out of their regular [00:16:00] educational environment into your speech resource room or your speech room, or your office or wherever it is, is a more restrictive environment than pushing into the classroom.

Um, so there's all of these different components to think about in terms of what is dictated by IDEA when you're choose, when you're choosing service delivery. 

Amy Wonkka: Well, and I think back to the point of it being a continuum of service delivery options. That's where, you know, you could almost make yourself like a, like a.

A timeline type graphic that is the continuum of restrictiveness of environments. And perhaps when you have a student who's learning some skills for the first time, they do need that, you know, outpatient type, level of restrictive environment, quiet space, no distractions. And then perhaps you move toward that continuum of less restrictive environment to sort of generalize those skills.

And if we are not thinking flexibly about what our service delivery looks like, we are going to be sort of locked into something that is [00:17:00] not necessarily ideal service delivery over over the duration. 

Kate Grandbois: Right, exactly. Perhaps. Um, so Asha gives us a nice long list of different things that we need to consider, um, when deciding on these variables of service delivery.

One of them is age, another is student progress and changing needs throughout the year. Um, and this is throughout the school year. If you're working in an outpatient clinic, throughout however long research, um, you are, you know, identify, you have identified as the course of treatment or the duration of treatment, your service delivery should change as your student or client changes.

So as you see changing needs, it's really your response. It's really important for you to consider whether or not the service delivery needs to change along with the student. I think a great example of this is generalization of skill. That's something I think probably comes up a lot. So you've taught little Johnny.

You've taught Johnny how to, I don't know, X, Y, and Z, whatever skill it is you're [00:18:00] teaching in your quiet white room with no distractions down the hall in the speech office, and it's time to generalize. Please don't generalize by giving him a different game or a different set of materials. Consider changing your service delivery and do push in in the classroom or go into the home or go with them to Dunking Donuts or go with them into a different setting.

You know, think about changing that setting variable to general to help facilitate generalizing that skill in a novel environment. That's just an example. It's one way that you could change your service delivery, but I think that's a common one. 

Amy Wonkka: Yeah, and I think, you know, along with that is different types of service delivery, right?

You could shift from a direct service delivery where you're the person providing the service to an indirect service delivery, which we'll talk more about later. Uh, but I agree we should constantly be assessing kind of the overarching goal of our goals outside of our. Restricted environment. 

Kate Grandbois: I just thought of another one.

Format. What is that format? So if you, you taught you're teaching social skills and [00:19:00] you've taught Johnny how to like so beautifully, ask a reciprocal question or make an eye gauge shift towards a communication partner and an exchange, or take turns, try switching to a group. You can't practice social skills.

Mm-hmm. Without peers. You can't practice social skills without social opportunity. That's another way to consider, you know, that's another common, um, theme in pediatrics, I think. 

Amy Wonkka: Or you're running your pediatric group and your client is doing a great job in this small, highly controlled, structured group that's, you know, maybe 30 minutes in duration.

Consider moving that group into the broader classroom. Now you're gonna run your group with 30 kids instead of four. Or the chaos or of the 

Kate Grandbois: playground. Mm-hmm. The chaos of the playground. I don't know if you've ever had the experience of treating on a playground. 

Amy Wonkka: It's intense. Yes. It's, it's 

Kate Grandbois: such, I personally have found it a challenge.

If there's any listeners out there who think it's really easy, please, 

Amy Wonkka: please let know respond. We'd 

Kate Grandbois: like to interview you. Please share, send email. In my personal [00:20:00] experience and doing treatment on a playground and facilitating some of these things with the noise and the, and the insanity of, of play can be, I find a personal professional challenge.

Amy Wonkka: But the, but the, I think that the great point that is embedded in that challenge is the idea that we, we should try those challenges be, particularly if we're asking other people to totally generalize those skills. It's very, it's one thing to say, this works in my, in this one particular environment for this one particular duration, in this one particular format where we're doing it with this level of intensity.

Um, those, those tips and tricks that are super effective in that area of service delivery are not necessarily gonna translate and be as helpful. In a different type of service delivery. So by getting out on the playground, it can help just troubleshoot and make sure that either those stra, you know, you might need to come up with new strategies for the new, um, format.

Totally. And treatment setting. 

Kate Grandbois: Um, I'm gonna [00:21:00] just run through a quick list here. I have some other things to consider, um, in terms of when to change your variables of service delivery. Um, access to the curriculum and the different state standards. Mm-hmm. Depending on where you live, specific demands in the classroom might dictate different changes to service delivery, changes in the community, family dynamics, fam, family changes, um, changes or requests from the stakeholders.

Um, cultural considerations, um, are really important. The ASHA website directs people to the bilingual service delivery and cultural competence information components on their site. Team decision making. Um, this sort of sent me down a hold. Asha also has an interprofessional education and interprofessional practice portal resource for mm-hmm.

Um, team decision making that I found to be tremendously helpful. 

Amy Wonkka: Well, and in one of the more recent revisions of our code of ethics, they added a component about that. Yes. Like, that's a relatively new addition to the code of ethics. So it's a big, [00:22:00] it's a big deal. Yeah. I 

Kate Grandbois: mean, it made me give, it gave me all the happy feelings.

Um. So, yes, team decision making is a variable that could change, uh, the way you're thinking about your service delivery. On this page, there are a number, number of evidence-based practice studies that have been conducted looking at the different service delivery models. We're not gonna go through all of them.

There's a lot of authors cited here with a lot of really great research about the different components of service delivery. I encourage everyone listening to go through that list of research and do some nerdy reading if you are so, um, inclined to learn more about the literature supporting different, um mm-hmm.

Types of service delivery. Um, I wanna talk quickly about, I also wanna talk about setting. Yeah. So we've talked about this a little bit, thinking about our speech room being the place where we provide direct service in our, you know, we've got our. We love speech signs on the walls. Mm-hmm. And our like caribou [00:23:00] game that we bought on eBay for so many, so many 

Amy Wonkka: dollars.

Carib could something who knew, dunno, annoying. 

Kate Grandbois: Um, but there's so much more to a setting when considering appropriate service delivery. So, and each setting has different pros and cons. Um, so your quiet room is controlled. Um, it's free of distraction. It might be a great place for teaching certain skills, but there are fewer opportunities for generalization.

Um, when you pull a student out of the classroom, you reducing their instructional time and possibly reducing time with peers. Um, another component is the integrated or in-class service delivery model. So, pros for this. You're working closely with other staff. You have great opportunities for collaboration and cross pollination of ideas and issues.

Um. The not so great things about this though is that could be a busy and noisy environment. You have less control over a distracting stimuli. Those are things that you, depending on the profile of your student, might be really, really [00:24:00] important variables to modify. 

Amy Wonkka: And even within that, you know, when we think about some of those other factors from the beginning, like your format, you can, there's a lot of variability even within those two, like pull out versus push in sessions.

Um, depending on if it's individual, if it's small group. I think you're also trying to weigh the balance, particularly when you're school-based, all the time is coming from somewhere. So you also wanna be weighing, perhaps your client could acquire the skill in both environments, but if your personal data, you know, and their clinical history demonstrates that they're more likely to acquire that skill in, you know, a month rather than three months in the.

Quieter environment, then making that choice to provide those services in the more restrictive environment might be the right choice. And it's a conversation that people are having. It's, they're all team decisions when you're looking at a school-based, uh, service provision. But thinking about those variables as well, you [00:25:00] know, okay, well perhaps we could acquire more skills in a shorter duration if we're working within this particular setting and with these particular.

Types of frequency and intensity. So they're all things to be weighed in the consideration process. 

Kate Grandbois: Totally agree. Um, we're entering into the portion of our research that was news to me. So I'm, I, I don't know if this was, any of these things were news to you, but so we've just reviewed, you know, pull out, you know, doing your treatment session in your sterile white room or your speech resource room, or your office or wherever, integrating in your closet.

Amy Wonkka: Or your, like vestibule of the women's room or, you know, depending upon your environment. I mean, like you're, you're kind of hoping for a sterile weight office, but the women's room, um, worked in some weird places. Oh my God. Is that true? Um, not, not in the vestibule women's, but yeah, I've been in a closet with a boiler and no windows at all, and storage materials.

Um, oh my 

Kate Grandbois: God. 

Amy Wonkka: Yeah. 

Kate Grandbois: [00:26:00] Oh, that's wild. Yeah, that never happened to me. Good lord. Yeah. Well, well done. No, seriously. Yeah. Um, so again, just to sort of recap, pull out speech room, speech office, boiler, basement, wherever you, wherever you are, wherever you are told to work on your own one-on-one with one-on-one with your client integrated or class in class services, or a push-in model where you're doing it in a more naturalistic environment or in an educational setting.

Then there was supportive teaching, which I had never heard of. So this website, and I'm just directly quoting the ASHA website that we've referred to. The link is on our thing. Um. A combination of pullout services and direct teaching within the classroom. So I have never, I had never personally been a part of a situation where the speech pathologist is given an opportunity to teach in the classroom in s in, in supporting the classroom teacher.

I thought that was really interesting. Then there's complimentary teaching where the classroom teacher presents the [00:27:00] curriculum content as the primary instructor and the SLP assists with specific assists specific students with work completion. Also, a very interesting model that I was not aware of, station teaching, never heard of this one either.

Instructional material is divided into parts with the SLP and the classroom teacher. Each taking a group of students, students rotate to each station or learning center for instruction. This sort of reminded me of like the preschool stations that my kids had, um, in their, in their preschool environments.

I'm not sure if that's that's accurate or not, but it's what it, what it reminded me of. Parallel teaching where the students are divided and the classroom teacher and the SLP each instruct a design, a designated group of students simultaneously with the SLP, taking the group of students that needs more modification of content or slower pacing in order to master the educational content.

Thought that was a really interesting model too. Team teaching the SLP and the classroom teacher teach the academic content together, [00:28:00] allowing each professional to provide his or her expertise. I had never heard of that. Have you heard of any of these? I'm just listing a bunch of, yeah, I've 

Amy Wonkka: done, so I've done a number of these.

I think part of your, this being novel is because of your work environments, because you have, you. Have you've been, worked, been like a public school staff or a charter school to public 

Kate Grandbois: schools, like way back in the day. Yeah. But I have never been an employee. I have never been an employee of a public school.

Yeah. So this is probably my own limitation, but this is why this is so great. 'cause I'm learning new things. Right. It's good to learn new things. So, um, let me finish reading this list and then maybe with, with your experience, you can tell us what, what you think about some of these things. Um, there was team teaching, I think I went, I went mm-hmm.

Over that already. Supplemental teaching one person, usually the teacher presents the lesson in a standard format while the other person, usually the SLP adapts the lesson for different students. Um, this is all, again, just to cite the reference, this is all coming [00:29:00] from, um, the ASHA website with the ar with the article called School-Based Service Delivery and Speech Language Pathology.

The link will be, will be up there. I'm, I'm. The, all of those definitions were a direct quote just for the sake of saying it. Um, what do you think about those different teaching models in your experience, service delivery models? 

Amy Wonkka: So I think all of those models have a lot of merit and a lot of challenges in the school system.

So having worked in a number of public schools and like, sort of in different geographic areas in the country, um, and also charter schools, um, it, a lot of doing, a lot of those well is really dependent on funding and time. 

Announcer: Mm-hmm. When 

Amy Wonkka: you look at the more involved teaching methods, like co-teaching, I think they called it team teaching, but, but co-teaching where you're basically, you have two teachers and one of the teachers is speech language pathologist and one of the teachers is a.

He's an educator, um, a grade level educator, [00:30:00] you, there's a lot of planning that needs to go into that in order to have that be an effective modality. It can certainly be an effective modality, but it's essentially hiring. What the school's doing is essentially hiring two teachers to teach one classroom.

Um, when you are looking at sort of stations or something like that, or having the, the SLP come in and sort of be a guest, a guest lecturer, essentially, right? So maybe the SLP comes in and takes lead on a lesson about pragmatics or social skills. That's something that you'll see a lot. Um, when you're doing something like that, you still need time to do that connected indirect service so that the speech language pathologist has time to connect with the teacher and provide the consultation, because ultimately why, why you would use an approach like that is so that then the teacher can carry over the.

Primary content from that lesson across all of the students' school day. So if you are, you know, using some type of pro-social curriculum [00:31:00] and the speech pathologist perhaps leading that lesson in your classroom, you need to have the educator, first of all, there for the lesson, but also there for the planning of the lesson.

Announcer: Mm-hmm. 

Amy Wonkka: Um, and, and really taking an active role in carrying over the, the key points throughout the school day or the school week. Um, station teaching is, that's good point. You know, that's a little bit more straightforward. You could just kind of come in and do a standalone activity. I agree with you. I think often that lends itself better to kind of the lower earlier grades, but you could also make a point for that, perhaps in an upper level English language arts type class.

But these are all important service delivery. Approaches to be aware of and to know that they are an option. I think it's also really important to understand when you're exploring these ideas, that you certainly need administrative buy-in and you need, uh, buy-in from your. Co co-teacher. So you both really [00:32:00] need to be mm-hmm.

Open to being flexible, working with one another. I have a 

Kate Grandbois: good collaborative relationship, all of that kind of stuff. Mm-hmm. For 

Amy Wonkka: sure, for sure. 

Kate Grandbois: The last, um, the last setting that they review in this article is Telepractice, which we have all had a, a hot minute to adjust to in the last couple of months. Oh my goodness.

But that is, you know, a different setting to consider and I think it will be interesting moving forward how this, you know, embracing telepractice through this pandemic, um, 'cause we're recording this in July of 2020, right. Is, um, you know, is gonna change how people culturally embrace the use of telepractice and using telepractice as a, as a service delivery model.

Amy Wonkka: Um. Well, and I think as somebody who's, who's jumped in with the rest of the speech pathologists in the world to, to learning a lot more about telepractice than you ever thought that you would. Um, one thing that has come up for me is the idea that in some areas of the country, in some geographic locations, they're actually accessing telepractice, [00:33:00] perhaps is the primary modality.

Mm-hmm. For speech language pathology services for students. So it's going to depend on where you are. You know, if you're in a rural location, you may already be using telepractice with the telepractice facilitator. And then telepractice itself to me kind of bumps up as an additional layer to those considerations that we were thinking about at the beginning.

You know, you're thinking about your treatment setting, but where are you receiving that telepractice and in what format? Um mm-hmm. And with what intensity, frequency, and duration. 

Kate Grandbois: Telepractice is, is gonna be interesting, I think. Mm-hmm. No question. Um, so moving on, one of the last components to consi, one of the last variables to consider in service delivery is scheduling.

So loosely referred to how often you are like scheduling, you are not to use, not to use the term in the definition of the term, but how often you are scheduling your therapy sessions. That's right. For our frequent listeners, I have been teased once before, but having a third grade ability to define terms because I, [00:34:00] using definit, the word in the definition, I think everybody understands what I mean when I say scheduling is scheduling, scheduling, scheduling is scheduling your clients.

Um, there's selecting time and Right, right. So there's the traditional weekly schedule. There's a receding schedule, um, where direct service is more frequent and then reduces over time. There's a cyclical schedule where the SLP provides service for a, an amount of time and then follows up with no service.

This is, um, something that comes up a lot, at least I've been reading a lot recently that I think is a very, um, it's becoming more common is something called the three to one model. The three to one model is an example of a cyclical schedule. For those of you who don't know, the three to one model is the, um, where there is direct services provided for three weeks in a row, and then the fourth is, um, the fourth.

One, it's it's indirect service on the fourth week of the month. Um, [00:35:00] so this is very casually referred to as the three to one model. That is an example of a cyclical schedule. Um, there are collaborative schedules where the, um, schedule is, is based around observations, meetings, sharing information, um, collective and collaborative discussions around the student.

There's a block schedule, which I haven't worked in middle schools or high schools very often, but, um, this, these kinds of schedules follow a middle school or high schools master block schedule where the sessions are, might be longer than you would typically see in a pediatric IEP, but they're less frequent.

So it sort of jives with the way that the middle school or high school is operating in general. Um, blast or burst schedules where the SLP provides short and intense services, um, and. This allows the SLP to provide individual direct service with less time to [00:36:00] travel around the therapy room. Um, I mean, to travel from the therapy room into the different lo different locations.

And then finally, group size. So the, if you're using, um, group scheduling, then it's gonna be affected by a lot of different variables, like the grade level, similar, um, IEP goals and objectives, different, you know, varying levels, varying levels of, um, need, et cetera, et cetera. So the, just to sort of recap the first learning objective, there are a lot of variables that go into, um, service delivery, which means that you have a lot of flexibility in tweaking each of these individual variables.

Um, and we are gonna talk more about scheduling as it relates to workflow, workload, workload or workflow, workload, workload, workload. Ta-da, ta-da. Moving on. Objective number two. What is objective number two? Direct and indirect services. Yes. Direct and indirect services. 

Amy Wonkka: So that's another important consideration, [00:37:00] right?

Should you be providing direct service? Should you be providing indirect service is a combination of both, really. What's best? So when we think about direct service, I think that that's what most people picture when they picture a speech and language session, right? It's the SLP providing services to a client, face-to-face, synchronous.

It's happening in real time. Now, that could be as, as I've learned through all of my telepractice education recently, that could include virtual face-to-face, synchronous service mm-hmm. Is direct service. So the speech pathologist could be providing service to the client through a virtual platform. Um, you know, this is, this is what you think about when you think about traditional treatment, when you think about evaluations, the conducting of the evaluation, not the writing.

Um. And it's not the only kind of service delivery. Often it really should be supported by some indirect service or at least indirect activities. And this can be confusing for administrators to understand, you know, we [00:38:00] have productivity requirements in healthcare or outpatient, we are, you know, working toward a rationale for a workload model instead of a caseload model in school environments.

But sometimes what I've found, just having worked in a number of different environments is there really is sort of this misplaced emphasis on direct service as sort of the only service that matters. And so that brings us to indirect service. 

Kate Grandbois: Indirect service. What is indirect service? 

Amy Wonkka: I mean, it's consult, right?

I mean, that's what we think of with consult. That's what I think of. Yeah. Right. That's what I mean. That's what I think of also. So it's service delivery, it's clinical in nature. So indirect service is different from. Indirect activities. Mm-hmm. And I think that that's something for us to, to kind of wrap our heads around.

So when we're having these conversations with administrators or other people, um, you have indirect clinical service, which is really ongoing, ongoing support, communication, consultation with [00:39:00] specific team members, staff training, those types of things that are very client specific and face-to-face with somebody else.

Um, and indirect service can be really, really relevant. It can be relevant for clients who are working on pragmatics express or receptive language complex communicators. You know, really anybody who's getting support from other communication partners in order to be successful in generalizing their target skills outside of that kind of sterile therapy room.

Mm-hmm. Or, you know, therapy room full. Boilers and mice and dust, which, you know, like wherever your therapy Horrible. Yeah, it was, it was not great. Um, I, 

Kate Grandbois: I, if anyone out there is listening to this and has a story about the weirdest place that you've conducted therapy Yes. I would love to compile. That would be a fun list.

That might have to be, for those of you who had a tragic list have been following us, I learned how to use Instagram. We learned how to use Instagram. Mm-hmm. That might have to be like an Instagram poll. Yeah. Whereas the where, okay. Sorry, I've just hijacked this whole thing because I think that's, that's really interesting.

Amy Wonkka: But anyway, 

Kate Grandbois: as you were [00:40:00] saying. 

Amy Wonkka: Yeah. So, so, so when we're thinking about that direct service that takes place either in that room or in a broader, you know, less restrictive environment, um, the piece that goes along with that would be the indirect service. And when you were talking earlier, Kate, about the different types of.

Collaboration and, and co-teaching sort of that can happen. This indirect service is a required component of that. Mm-hmm. So the direct service piece is the SLP, perhaps teaching the lesson or co-teaching the lesson or running a center. That's the direct, that's the face-to-face. The indirect is all the components that happen between the SLP and the teacher or the other educators or the paraprofessionals before that happens and after that happens on an ongoing basis to make sure that, that that one brief direct moment is carried through into all of these different tasks and is actually effective.

Uh, I think a huge, a huge challenge for indirect service is that it's not a billable service. 

Announcer: Mm-hmm. A 

Amy Wonkka: lot [00:41:00] of the time it's not a billable service. And I mean, I can't think of any. Environment where I've been in a billable situation and that's been billable. 

Kate Grandbois: I think it depends on your funding source. So this is a billable service if you have private pay, right?

I guess that's true. You know, I think, you know, if you, it's possible, but it's not considered a billable, billable service through Medicaid or through insurance, which is I think what sets the standard. And we had said this in our collaborating with BCBA's episode. If anybody is interested in organizing boots on the ground for advocacy around getting billable codes for indirect service, that would be a tremendous, tremendous addition to, um, our practice.

Amy Wonkka: Well, because, you know, I think that the lack of ability to pursue reimbursement for these services can lead to a misperception that indirect services aren't necessary or as important as direct service. And I, yes, I disagree very much. Yes, I disagree. Oh, 

Kate Grandbois: I have very, very big feelings about that. I think some of the best [00:42:00] cross pollination and best components of what we do as a field happen through indirect service in terms of collaboration, interdisciplinary structures, you know, team approach to treatment, all those kinds of things.

Amy Wonkka: And I think as somebody who has worked in a lot of different environments, the understanding of the importance of indirect service is, is very. It's very varied depending upon where you work. But you know, like if you step back and think about your work environment, are you somebody who has time in your schedule to connect with other team members or outside providers to provide training or other types of consultation?

Or are you expected to do that during your lunch or after work? Right? Uh, if you're in a school, do you write those services into your IEPs? Is consultative service considered when you're building your schedule, right? Or do they say, oh, just book all of your direct service and like, do the consult in passing when you have a minute, right?

Uh, if you're in outpatient or you're in private practice, does, does your. [00:43:00] Productivity model, account for indirect service. In your, in your building of your schedule, are you expected to make that phone call? You're, you're a pediatric outpatient, you know, clinician. Um, are you expected to call all of the speech therapists for all of the students in your entire caseload during all of your lunch breaks, or are you gonna do that at night?

I would be willing to put 

Kate Grandbois: money on the fact that that's not, that's not built into the schedules of people having worked in, in a couple of different outpatient and, and looked at the budgets of those. Of those, mm-hmm. The kinds of models. I mean, it's not a billable service, which is just a crime. 

Amy Wonkka: Be because it's related to clinician to, uh, excuse me, it's related to client outcomes.

So I think that that's the important piece there. And why I personally feel like it, it should be a billable service. It should be a service that we look at as just as important as direct service. Um, which takes us next to the, in kind of indirect activities that aren't necessarily directly connected to your client.

It's not a consultation, but there are also things that you need to do [00:44:00] as a speech language pathologist, right? So wherever you work, there's some kind of paperwork. Perhaps there's a mountain of paperwork that's like burying you over time, right? Just like so much paperwork. Um, you may have billing, staff meetings, all of those other things.

Those wouldn't be considered indirect clinical services. But we'll talk more about those when we get into kind of the last learning objective about workload. But just so you have in your mind a separation, a clear separation between, there's a lot of indirect things we do. Only some of those are indirect clinical 

Announcer: mm-hmm.

Amy Wonkka: Services. Um. So, okay. We've got all of these different things that we're thinking about when we're thinking about service delivery. How on earth do you figure out what is best for your client? 

Kate Grandbois: I don't know.

I'm just a speech pathologist.

Amy Wonkka: Well, I don't know the answer for everybody's client, but I know, I know. 

Kate Grandbois: I don't know. I have no idea. It's a complex, dynamic [00:45:00] process. 

Amy Wonkka: It's, it's a complex, dynamic process. And if you know us, you know, we love Joy Z Ball's set Framework. Um, you have 

Kate Grandbois: that episode, it's the best episode ever. Oh, you should. 

Amy Wonkka: It's so good.

She's so good. So, so the set framework is, is a framework for considering assistive technology. Um, but I, I agree with her and I feel like it's also a framework for life. And so I kind of use that framework to approach any sort of big complex problem with lots of different pieces. And I think this is one of those, right?

So mm-hmm. So there's a lot of different variables that you need to kind of examine to make an informed decision about what you're doing moving forward with a particular client, or to revise your initial thoughts about what made the most sense because they've changed or some variable has changed. Um.

So if you're not familiar with it, listen to the podcast. She's the best. Um, but it stands for Student Environment, task and Tools. So here, you know, if we take the first step of that acronym and we think about the student or the client, we're thinking about what are their individual [00:46:00] needs, right? So we're using an evidence-based approach.

We're integrating the existing literature. Um, if you're not familiar with Ashe's, evidence maps, they can be really helpful. So if you're looking up, you know, particular areas that you're targeting in therapy, you can get sort of a synopsis of the key research out there. Um, so maybe you find some literature, maybe you don't.

Either way, you're integrating that with your particular clinical knowledge, your experience as a clinician, and also your experience with your unique individual client. So what has worked well for them in the past? And think about service delivery models there, right? Think about those, those same variables like does it matter where the, you know, what the environment is?

How does this person, uh, once they've acquired a skill, is it really easy for them to sort of just start using it in different environments with different people? Is that something that needs to be scaffolded? If it does, are there supports that need to be in place that the communication partners need to be made aware of?

And if so, [00:47:00] think, think about indirect service there. That's, that's kind of an indicator that you should be considering some degree of indirect service. Um, think about the environment. So that second letter in her framework, the environment. And not just your work environment. So I think this is a piece that's relevant no matter where you're working.

So if you're an outpatient, and particularly if you're in pediatrics, think about all the different places you want your person, your, your client to be successful. Right? You won't, it doesn't really matter if they're just successful with you. I mean, that's lovely. No, 

Kate Grandbois: no. That's not the point of our jobs. If they're just successful with you, then you have not done your job correct.

That is not, that is not rehabilitation. It's not. 

Amy Wonkka: And I think it's, it's a bigger challenge. And I always felt that this is a bigger challenge when I was working in those environments, because you're not as ingrained in, in your client's other environments in their life. Like you, you may have a nice amount of contact with the parent or the caregiver, uh, but you, but [00:48:00] you don't know what their classroom looks like, and you don't know what different groups they're in.

You don't even know what their playground looks like. Or, you know, what, what are the cool games that kids are playing these days? Right? Like, you, you don't know any of those pieces. So you're, you're at a disadvantage for in, in a lot of ways, but as much as you can inform yourself about those different environments, think about the important pieces to enhance their functional outcomes across those different environments.

Then you're thinking about those tasks, like what exactly is it that you want them to do? And again, you know, being aware of the environment you might be working on, you know, maybe you've been using some social thinking strategies. You run an outpatient small group, right? You have an outpatient small group.

And you're working on whole body listening, it's awesome. It's going super well. You have certain cues that you're using, you have explicit instruction that you're using that's making this group environment successful for your client, and you're like, oh, this is great. I would like them to do it all the time, all the places with all the people, because we want our clients to be [00:49:00] successful, um, and help them have positive, meaningful change in their lives.

Um, go figure. So when you think, right, right. So when you think about the environment, you know you want this success all the time. If you don't have some level of indirect service there. How are, how are you gonna communicate this? I 

Kate Grandbois: know. I just, it boggles my mind that this, that indirect service is not a, a larger, and I think I have a twisted view because I'm also A, B, CBA and, and indirect service for BCBAs is a massive, massive piece of their jobs.

And it's billable. It's such an interesting perspective. It's, it's billable. And so as a speech pathologist also, it's like the guys, there's so much value in direct service. Why aren't we doing this more? Why aren't we embracing this as like a, as a major fundamental component of what we have to offer teams, what we have to offer families, what we have to offer our clients.

I, I, I think we need, we definitely need more advocacy in this area. 

Amy Wonkka: Well, I agree. I mean, I think as a whole, when we advocate as a group [00:50:00] speech language pathologist for the services that our clients really need, we are helping to further the field. So, you know, perhaps your administrators, maybe you're in a productivity driven model and, and they don't understand or they don't.

Really care about the importance of indirect services. Uh, you know, I think that we really need to keep having the conversation again and again to just help shift the culture more broadly toward an understanding that both direct and indirect service delivery approaches are meaningful and important.

And that is also a continuum depending on an individual client's needs. So, you know, some ways that you can just think about are, can you collect some data? Are there data points that you can collect on an individual client basis that maybe connects with different types of service delivery? Mm-hmm. Maybe you just start having the conversation that there are these different types of service delivery and it exists on a continuum, and that your ultimate goal is positive outcomes for your clients across [00:51:00] environments.

Um, but I think. As a whole, the more often we bring it up, you know, and it might not be in the conversation that I have my, with my administrator or the conversation the SLP after me has, but perhaps, you know, the next SLP who has that same conversation again, is going to, going to breakthrough. And I think also we as the group should think about building our skills and perhaps, you know, becoming part of administrative teams in different environments too, and help shift the, shift the movement that way.

But the movement, I think we're onto workload. The movement. Indirect, 

Kate Grandbois: indirect, indirect service 

Amy Wonkka: movement. 

Kate Grandbois: Indirect service movement. Um, okay, learning objective number three, workload. Workload, specifically. I'm looking for my notes here. To read the actual learning objective, describe a workload approach to caseload and identify how service delivery components and variables are likely to impact workload.

Amy Wonkka: Mm-hmm. Asha has some great resources on workload. Their workload [00:52:00] content is very focused on school-based settings. Again, I, I think there are unique variables that are certainly specific to being in a school setting, but some of that information might be helpful in facilitating a conversation regardless of your work environment.

Mm-hmm. They've got some really nice documentation. They've got some good tools up there. Um, so now I'm gonna, I'm gonna, I'm gonna be Kate. What is a workload? It's, it's the work. It's the work that you do. Wait a minute. 

Kate Grandbois: You can't say a bad definition and then say that it's me. That's 

Amy Wonkka: spread, man, I using, no, it's just using the de the word in the definition.

I, I got it. I know. Workload is work. It's the work that you do. It's the load. It's all the load carry with your work. If you put all of your work into a wheelbarrow, that would be, it's the load workload. The word. Oh, 

Kate Grandbois: maturity. 

Amy Wonkka: Yeah. Workload is important. [00:53:00] It's super important. Um, and when we think about how it relates to service delivery, right?

We have, Asha has a really nice like visual depiction of this, but essentially, you know, you have direct service, you have indirect service, but then there's all of these other things, right? And all of these other things vary depending on your work environment, but you know, direct service. Yeah. That's workload, indirect service.

Workload, yep. Writing up assessments and insurance. Reauthorizations. Workload, but you couldn't guess. 

Kate Grandbois: Workload, 

Amy Wonkka: submitting, billing. Workload. Workload, attending staff meetings. Workload. Workload. You modify, mix the materials. Workload, it's so much, it's so much things. 

Kate Grandbois: There's 

Amy Wonkka: so much, so much things, so much, so many things.

So many things. Oh boy. We're falling apart at the end here. Um, there's a lot of stuff, anything from, from bus duty to like cleaning up after your session. Like these are all tasks that you need to do during your day of [00:54:00] work, which is a load. So, so why did Asha come out with a workload approach to caseload?

I mean, it makes 

Kate Grandbois: perfect 

Amy Wonkka: sense. 

Kate Grandbois: It does. That's the way it should be. That is the way it should be because, and that is the way it's for like so 

Amy Wonkka: many other jobs also. Yes. 

Kate Grandbois: Well, and I, I feel like I'm not gonna articulate this well, but I feel like our job isn't, you know, we're not being paid by like, some people, like let's say you're a contractor and you're paid by the number of items that you produce, right?

We shouldn't be, our productivity shouldn't be on the number of people that we treat. It should be on the amount of, not all, not all student is created equal. Not all client is created equal. There are so many different components. It's not like we're in an assembly line and we get paid for every button that we attach to a pair of pants.

I don't think of a better analogy, but you know, this is not a field where our output is driven by production of items. Right? Right. So [00:55:00] why are, why are we, why is it by caseload instead of not by workload? It makes perfect sense to me. I don't think I articulated that well. But I'm passionately waving my hands because I feel so awkward.

I can see 

Amy Wonkka: that. And I feel passion. I strongly, strongly about it. I, I am there with you. I agree. I mean, caseload doesn't even begin to describe it. It really doesn't. True. Right. And I, I, I feel like part of it is because we place an overemphasis on direct service, right? So when all you're thinking about is direct service, then maybe that's the only thing that employers are considering is the direct service portion of the job.

Or maybe you're somewhere that, that does understand and acknowledge that the importance of indirect service, which is fantastic. And definitely there are many places that do. Um, 

Kate Grandbois: I think that you're in a place that doesn't, you can take these resources mm-hmm. The actual workload resources to your administration or to the rest of your department and try and advocate for change.

Amy Wonkka: Right. And there are some other helpful documents just to draw your [00:56:00] attention. In 2014, the American Occupational Therapy Association, American Physical Therapy Association, and Asha came out with a joint statement about workload. And they, I mean, basically they're making the point that caseload doesn't adequately capture all the services, like mm-hmm.

Anybody who's worked as therapist is aware it doesn't. Um, and so when you're thinking about services you're providing, particularly in a school environment, we really need to be advocating as a group for a shift toward workload. And here we are, you know, they, they wrote that statement in 2014, and here we are, and it's 2020.

And I don't think that the workload approach is nearly as widely adopted as it should be. Right. Um, and. You know, this, this statement, the resources from asha, they're all geared towards schools, but having worked in a lot of different outpatient pediatric settings, I, you know, my personal bias is that this thinking should be applied to some degree in those environments as well.

And I recognize you're, you're striking a balance between revenue and you need to have enough money coming in to sustain your [00:57:00] business. Um, but the current medical model really does lend itself to like fragmented and poorly coordinated services for clients who are receiving services across multiple environments.

And that's unfortunate, 

Kate Grandbois: which is another reason to advocate for billing, for being able to bill for all of these other things we do that are not direct service. Right. It's all tied together. It's all one big messy pile. 

Amy Wonkka: Yeah, because I mean, think about, I, I've been on both sides of, of that dynamic. I've been the outpatient therapist and I've been the school-based provider and.

Everybody wants to be able to connect. You wanna be able to connect, you wanna be able to work collaboratively as a team. You want to be able to be using the same cues or at least know that somebody is using certain cues in a certain environment. Um, and that's, that's really a place for indirect service.

So we'll, we be direct you back to Ash's practice portal on caseload and workload for nitty gritty details. And again, like helpful links to other resources. But key takeaways [00:58:00] that feel quite common sense to me, um, would be that students who are seen by SLPs with smaller caseloads tend to make more progress.

Kate Grandbois: Mm-hmm. 

Amy Wonkka: I believe that. And why do you believe that, Kate? 

Kate Grandbois: I don't know. Because it's common sense. 

Amy Wonkka: It's common sense, right? So time it comes back to time. If you don't, 'cause I 

Kate Grandbois: mean, the example that I gave before of a colleague of mine who had a caseload of 140, and she had to see them in groups because she had no other choice.

She's only one person. She can't physically be in a million different places. At the same time, those students didn't get in the customization of service delivery that specifically matched their needs. So, you know, if you have a workload that is totally unreasonable, then you're not gonna be putting your own clinical resources to match the needs of a client.

I said that very articulately, but the short answer is that it is. The short answer is that it makes sense. It's just common sense. 

Amy Wonkka: Well, it's common sense and all [00:59:00] of these, the reason that we've connected all of these topics together in this talk is because they're interconnected, right? If your workload is out of control, you are not able to apply the critical thinking skills that you should be applying to your service delivery consideration, and decision making.

That should be a variable that you are allowed to consider and modify as needed on an individualized basis. But if your workload's outta control, all of your ability to make active decisions in that entire parameter of therapy are gone out the window. 

Announcer: Right? 

Amy Wonkka: Um, okay, so that one makes sense. The students who have SLPs with smaller caseloads tend to be making more progress probably because they're receiving more individualized service, but, uh, SLPs with higher caseloads have a harder time keeping their staff.

Kate Grandbois: I'm not a shocker. I mean, do I need to, do I need to break that down? I don't think so. I think that's pretty reasonable. 

Amy Wonkka: Again. Makes sense. Also, if you're [01:00:00] listening and you're a speech pathologist, we went into the field because we wanna help people. And so if your workload is keeping you from applying clinical decision making to the full continuum of service delivery options available, 

Kate Grandbois: which prevents you from reaching your professional goals and 

Amy Wonkka: is not aligned with your professional values, and you have your clients who should be making progress, but they aren't, how does that make you feel?

Picky? Yeah. Bad. Bye. It Peace. Yeah. Gonna find another job because this job just like, hurts my heart. Um, or, oh, that was sad. Hurts my heart. Oh, it's, yeah, I, it just makes me angry. The flip side of that is like, or you are struggling, you're bringing home hours and hours of work every night. You're working every weekend.

Mm-hmm. You're, how does that make you feel burnt out? Like maybe you don't even, maybe you don't stay in that job, maybe you don't even stay in our field. So, I mean, 

Kate Grandbois: it's no news flash that turn that burnout and turnover is a, is an issue in general [01:01:00] in our field at, at large. Yep. Um, and you know, I think that these are all interrelated variables.

Yeah. It's not, it's not, you know, isolated. It's not an isolated issue. So 

Amy Wonkka: if you're not using a workload approach, start with a practice portal, get more information about why you should be, and then think about the specifics of your work environment and how you might go about shifting your policies a bit.

So you might speak with, or even join an administrative team of your district's union if you're in a school. Oh, good one. Um, most school-based SLPs aren't, are, are part of a union but aren't part of. The in charge part of the union and the people who are, are educators and don't understand how our licensure requirements or intervention approaches are different from teachers.

So that's one thing to think about. You can also think about like. What I think of as like sort of bridge options. So these are the scheduling pieces that Kate mentioned earlier. You know, you if you're, if you're locked into a super rigid, two times 30 direct service type of model, you know, think about just [01:02:00] moving toward other things like a faded schedule.

So maybe more intense services, initially planned reduction of service. Maybe you start with a larger proportion of direct service. You reduce that. You increase indirect service, um, playing with your duration of your session or your, what, what is the word they use? They use a different word for that, but how long or short your sessions are and how frequent your sessions are.

So something like, you know, 10 minute articul drills or doing things like that, which may even be part of RTI in your 

Kate Grandbois: intensity is, is the word that they use. Intensity. 

Amy Wonkka: That's the one. Yeah. Thank you. The amount of time spent in each treatment session, 

Kate Grandbois: intensity. 

Amy Wonkka: And then another option would be a defined indirect week option.

So like the three one model that Kate talked about, where you've got direct services happening every three weeks, and then a fourth week is indirect. Um, when you're having your discussions with your stakeholders like administrators, but that also includes parents and guardians. Mm-hmm. If we're thinking about school-based providers, you wanna be informed, you wanna be prepared to discuss why it makes sense for the client, and so that's your student [01:03:00] and why this flexibility is important and connect it back to specific student outcomes.

So we're not doing this because we are whiners and, and we have too much work to do at home, or we're doing it because a combination of direct and indirect service delivery options and the ability to tackle all of the components of your workload in your workday actually are connected with increased student outcomes.

Right. So ch but change is hard. Especially institutional change. So when you're talking about a big shift in the way people think about services, that might be hard and that might be scary for people. Mm-hmm. That might be hard and scary for other SLPs that that might not be something that everybody just jumps on board with.

So share the information you have. You know, in like the classics, like keep it as jargon free as you can be organized, and make it clear that the reason you're doing it is to help use this whole continuum of service delivery options to make sure that you're providing the most effective and efficient service for the [01:04:00] client and the other professionals on the team.

So I think taking a bit of perspective for the stakeholders and the other people and making sure that you're making it clear about this continuum of service delivery and all of these different things that perhaps people aren't actively thinking about as much as they should. And, and helping bring people on board with the idea that we, these are things we should all be thinking about and having conversations about.

At the very least, if you're in a school annually when you're doing an IEP. Um, but really it should be sort of an ongoing consideration. 

Kate Grandbois: I think that was very eloquently said. 

Amy Wonkka: Oh, thanks buddy. 

Kate Grandbois: You're welcome. Well done. Um, I think that pretty much wraps us up. I think I say that at the end of every single episode also.

I think you might, but I think it's just a script, honestly, people, there's no magic happening here. Um, well, thank you for joining us. If you have any questions about this episode, please reach out to us anytime, [email protected]. You can, um, send us a message on any of our [01:05:00] social media platforms. We love hearing from you.

If you feel so inclined, leave us a review, leave us a comment. Um, you know, we are nerdy friends. 

Amy Wonkka: Yeah. We reach, reach out when you want and tell us the weird places where you've worked and help. Help me feel better about my boiler room experience, which I'm telling Kate did not happen. 

Kate Grandbois: Hopefully. No, I never did.

Um, so that's, that's that. All right. Bye guys. Bye everyone.