Service Delivery Models: Direct Service, Indirect Service, and Workload
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When most people think speech and language pathology they think of working on articulation in a tiny treatment room. Not only do SLPs do more than articulation, we also do a lot more than face to face service in a sterile / controlled environment. There are many different kinds of service delivery models available to us as clinicians, and yet somehow the “2x30 direct service” (or what have you) has become the “standard” in many work settings. And yet, indirect service is one of the most powerful service delivery models out there. As clinicians it is important for us to remember the different kinds of service delivery models, what components go into service delivery, and what variables we should consider when choosing a service delivery model for our client.
And just wait till we get started on how service delivery impacts workload.
Providing direct service? That contributes to workload
Indirect service? Also contributes to workload.
Writing assessments? Workload.
Insurance? Workload.
Billing? Wrkload.
Prepping up / breaking down / cleaning after a session? Wrkload.
Programming SGDs? Wrk ld.
Bus duty? load.
Loads and loads and loads. Do service delivery models impact our workloads as clinicians and vice versa? You betcha. Should we, as a field, embrace a workload model instead of a caseload model? You. Bet. Cha.
In this episode we review components of service delivery, define direct and indirect service, and discuss how these different variables interact with workload across work settings. Come join us, be our nerdy friends, and have a laugh or two.
Learning Outcomes
Identify at least 2 components that are involved in service delivery within common pediatric treatment environments (e.g., schools)
Identify at least 2 differences between direct and indirect service and what factors might indicate a need for each type of service
Describe a workload approach to caseload and identify how service delivery components and variables are likely to impact workload
References
Brandel, J., & Loeb, D. F. (2011). Program Intensity and Service Delivery Models in the Schools: SLP Survey Results. Language, Speech, and Hearing Services in Schools, 42(4), 461-490. doi:doi:10.1044/0161-1461(2011/10-0019
Case-Smith, J., & Holland, T. (2009). Making Decisions About Service Delivery in Early Childhood Programs. Language, Speech, and Hearing Services in Schools, 40(4), 416-423. doi:doi:10.1044/0161-1461(2009/08-0023)
Cirrin, F. M., Schooling, T. L., Nelson, N. W., Diehl, S. F., Flynn, P. F., Staskowski, M., . . . Adamczyk, D. F. (2010a). Evidence-Based Systematic Review: Effects of Different Service Delivery Models on Communication Outcomes for Elementary School–Age Children. Language, Speech, and Hearing Services in Schools, 41(3), 233-264. doi:doi:10.1044/0161-1461(2009/08-0128)
Cirrin, F. M., Schooling, T. L., Nelson, N. W., Diehl, S. F., Flynn, P. F., Staskowski, M., . . . Adamczyk, D. F. (2010b). Evidence-Based Systematic Review: Effects of Different Service Delivery Models on Communication Outcomes for Elementary School–Age Children. Language, Speech, and Hearing Services in Schools, 41(3), 233-264. doi:doi:10.1044/0161-1461(2009/08-0128)
Farquharson, K., Tambyraja, S. R., & Justice, L. M. (2020). Contributions to Gain in Speech Sound Production Accuracy for Children With Speech Sound Disorders: Exploring Child and Therapy Factors. Language, Speech, and Hearing Services in Schools, 51(2), 457-468. doi:doi:10.1044/2019_LSHSS-19-00079
Soto, X., Seven, Y., McKenna, M., Madsen, K., Peters-Sanders, L., Kelley, E. S., & Goldstein, H. (2020). Iterative Development of a Home Review Program to Promote Preschoolers' Vocabulary Skills: Social Validity and Learning Outcomes. Language, Speech, and Hearing Services in Schools, 51(2), 371-389. doi:doi:10.1044/2019_LSHSS-19-00011
Online Resources
ASHA Resources on Service Delivery Models: https://www.asha.org/SLP/schools/School-Based-Service-Delivery-in-Speech-Language-Pathology/
Caseload/Workload Key Issues: https://www.asha.org/PRPSpecificTopic.aspx?folderid=8589934681§ion=Key_Issues
Implementation Guide: A Workload Analysis Approach for Establishing Speech-Language Caseload Standards in the Schools: https://www.asha.org/slp/schools/implementation-guide/
The 3:1 Model - One of Many Workload Solutions to Improve Students’ Success: https://leader.pubs.asha.org/doi/10.1044/leader.scm.24052019.36
Overloaded with Tasks? Show them the Numbers: https://leader.pubs.asha.org/doi/10.1044/leader.ftr2.24082019.56
Workload Approach: A Paradigm Shift for Positive Impact on Student Outcomes: https://www.asha.org/uploadedFiles/ASHA/Practice_Portal/Professional_Issues/Caseload_and_Workload/APTA-ASHA-AOTA-Joint-Doc-Workload-Approach-Schools.pdf
Direct v. Consultative - brief write up: https://www.asha.org/njc/types-of-services/
Disclosures:
Kate Grandbois financial disclosures: Kate is the owner / founder of Grandbois Therapy + Consulting, LLC and co-founder of SLP Nerdcast. Kate Grandbois non-financial disclosures: Kate is a member of ASHA, SIG 12, and serves on the AAC Advisory Group for Massachusetts Advocates for Children. She is also a member of the Berkshire Association for Behavior Analysis and Therapy (BABAT), MassABA, the Association for Behavior Analysis International (ABAI) and the corresponding Speech Pathology and Applied Behavior Analysis SIG.
Amy Wonkka financial disclosures: Kate is an employee of a public school system and co-founder of SLP Nerdcast. Amy Wonkka non-financial disclosures: Amy is a member of ASHA, SIG 12, and serves on the AAC Advisory Group for Massachusetts Advocates for Children.
Time Ordered Agenda:
10 minutes: Introductions and disclosures
10 minutes: Discussion of components that are involved in service delivery within common pediatric treatment environments (e.g., schools)
20 minutes: Discussions of differences between direct and indirect service and what factors might indicate a need for each type of service
15 minutes: Discussions of a workload approach to caseload and how service delivery components and variables are likely to impact workload
5 minutes: Overview, discussion, and closing
Disclaimer
The contents of this episode are not meant to replace clinical advice. SLP Nerdcast, its hosts and 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! Wed love to hear from you!
This course is offered for .1 ASHA CEU (Introductory Level, Professional Area)