Death of the SLP “Pull Out” Model

For 100 years school SLPs have relied on the pull out method of service delivery.  It is tradition!  And one almost impossible to change.  The readers of this post will make a mental note but will not change their behavior.  In 2010 they will report for the new school year with the same mind-set to provide direct service.  They will likely feel held back by large caseloads and dependency on administrators to provide more SLP help.  Some will BURN OUT!

Experts will mask the problem using polite speech: “School SLPs now have many creative opportunities to adapt their service delivery to the unique needs of the children in their caseloads.”   They will see impossible challenges and exotic ideas as “exciting possibilities.”

From prior posts here are the facts:

1.  “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 were 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). ”  There is nothing holding back SLPs from making changes in service delivery.

Window looking out.

2. If SLPs use pull out all the time they are ignoring federal regulations, specifically, Least Restrictive Environment (LRE).  Throughout our posts we have documented the “opportunities” to grade placements to make service delivery more manageable and reduce caseload size while doing the right thing.

3. We are facing Response To Intervention (RTI) and other collaborative systems coming at us fast.  Do we realize we have to surrender half of our pull out time to do mandated cooperative programs?  We must move away from direct service toward collaboration.

4. Do we consider that Collaborative Programs might produce better results than direct service programs?

Of course, pull out is not literally dead.  But it is only one effective strategy among many for Total Case Management.

Update

This continues to be a popular post. ASHA in 2013 is soliciting opinion on pull out, and did so through its Facebook site. In 2007 we see another study addressed issues:

Classroom-Based Versus Pull-out Interventions: A Review of the Experimental Evidence
McGinty, A. S., & Justice, L. M. (2007). 
EBP Briefs, 1, 1-14.

Found only 3 studies meeting the selection criteria for review. ”

“The fact that only three studies were able to meet design-based evidence standards for inclusion in this review highlights the dearth of evidence regarding various service delivery models, and the lack of a clear effect for classroom-based over pull-out intervention in one of the three studies suggests the need for future, rigorous evaluations of classroom-based models of therapy for more conclusive answers” (p. 12).”

http://www.asha.org/Members/ebp/compendium/reviews/Classroom-Based-Versus-Pull-out-Interventions–A-Review-of-the-Experimental-Evidence.htm

October 2014 Update

We continue to track this issue, and now see it relates to the CAA accreditation process for sustaining excellence in graduate education. Clearly CAA cannot address second-order change and service delivery is one example. It micro=manages accreditation in terms of small strands of procedure and practice standards. So far we have found no evidence that it can address “the big picture” as to major trends requiring significant reorganization of academic preparation. Lip service is paid to evidence-based standards and practices.

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