12. SLP Dismissal / Exits

Once a child is made eligible for school speech therapy, aggressive use of least restrictive environment (LRE) should begin immediately to move that child toward dismissal. Try to reduce service time, restrictions and workload in an ethical manner from the very beginning.

DROP THE PULL-OUT MODEL

A school speech therapist who does “pull out” treatment 100% of the time is not following the least restrictive environment requirements of IDEA 2004. LRE contexts should be graded so that most children quickly move away from out-of-classroom instruction to consultation, support and dismissal. Combine pull out with consultation. Try collaboration. Use pre-service programs. Tune into the “progress in the general curriculum” criterion as a guidepoint.

IEP teams are more likely to accept an absolute dismissal from special education when intervention is graded away from direct service, including homework assignments and teacher consultation. More data are then available to justify dismissal.

CASE MANAGEMENT MODEL

The direct service model should be replaced by a case-management model. It gives emphasis to exit strategies using a variety of methods and contexts in a progressive and flexible manner. It lets the school speech therapist use time creatively to find relevant interventions as the child advances.

A case management approach can start with a cover statement in the IEP as to service requirements:

Service — “Minimum 50 minutes per month: goal performance assessment, direct training, teacher consultation, progress review, homework, pre-service programming.”

The cover statement does not jettison direct intervention for a few children who need a jump start. But it does allow time for intelligent re-assessment and review. It reduces the go-go stress of the weekly direct service schedule.

“Justification,” you ask?

IDEA 2004 states there must be annual goals for progress in the general curriculum, and the child must demonstrate progress yearly. It does not say — HOW? –that progress should be achieved. Pull out intervention is only one technique. Pushing a child properly into general education pre-intervention programming is another. Sending out homework assignments is another.

“When developing the intervention plan, the team should take into consideration the full spectrum of service delivery options when deciding which options are appropriate for meeting the individual needs of the child. It may be appropriate to provide a mix of options, e.g., classroom-based, individual pull-out, and consultation, to help the child establish basic speech-language skills, examine attitudes and beliefs, and apply skills in various contexts. In addition, these options should be reviewed and changed over time as needed, as the child’s needs change” (Kathleen Whitmire, SLP).

Here is an example of the caseload approach:

A 4th grade child with a neglected moderate hearing loss was supposed to receive pull out treatment for speech reading and articulation. The SLP recommended audiological assessment for possible hearing-aid use. The school secretary, principal, mother and teacher thought later there had been some kind of miracle. With aids the boy was immediately able to follow everything in his class perfectly. He was bright and had trained himself to speech read without instruction. Direct service was dropped and teacher consultation was initiated to enhance classroom support. The boy no longer had to be pulled out of class in front of the other children, and he was very much aware of their looks. His direct service time was reduced and the SLP was free to do other things. Everybody won!

CHANGING ROLE

“Isn’t pull out the best model,” you ask?

In 2008, Cirrin and Gillam published a review article suggesting there is no evidence of pull-out’s superiority over other service delivery methods. What’s more, there was no data showing that a particular number of direct sessions per week is optimal (Cirrin, F. M., & Gillam, R. B., Language intervention practices for school-age children with spoken language disorders: A systematic review. Language, Speech, and Hearing Services in Schools, 39, 110-137, 2008). This opens the door to flexible management.

With the changing role of the school speech-language pathologist in the U. S., a case-management model is just better for doing all the things an SLP has to do. It might be true that evidence-based, preschool programs, in which SLP participate collaboratively, might well reduce overidentifications, cut down on needless direct service, be more effective, increase communication with teachers, limit LRE constraints, and reduce workload, all at the same time. There is no need for dismissals when at-risk children are never placed in special education in the first place.

Are you open to it?

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