August 1, 2013 Features

SIGnatures: Push-In Services: Making the 'Impossible' Possible

Push-in services are touted as efficient and time-saving, but many SLPs report not including them. The reasons are varied, but there are ways to persevere and integrate this method smoothly.

Special Interest Group 16, School-based Issues

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The school setting offers many great rewards, but also many challenges. As we talk to school-based speech-language pathologists around the country, we continue to hear about to the challenges they face developing and delivering services. ASHA's school surveys reinforce this concern, as we see that providers spend an average of 19 hours weekly in pull-out service and only six hours in push-in direct intervention.

Push-In Services: Making the ‘Impossible’ Possible

School-based SLPs often struggle to adequately serve all the students on their caseloads, and that's where the "push-in" services model comes in, helping SLPs boost efficiency by reaching many students at once, right in the classroom. It also helps to have teachers support the goals addressed by the SLP throughout the school day. However, ASHA's school survey data show that this model has been slow to catch on, as compared with the traditional pull-out services model.

And that's too bad. Although not enough research has been conducted on the topic of school service delivery, what has been done suggests classroom-based services:

  • Help students to generalize communication skills and show academic progress.
  • Allow both the SLP and the classroom teacher to be aware of and respond to students' varying responses to different settings and communication partners—and to collaborate in their responses.
  • Enable SLPs to change the type, frequency, amount and location of services throughout the school year, based on student needs.

If push-in services are so clearly helpful, then why aren't more SLPs doing it? The answers are complex and include issues of time, training, acceptance, and understanding of roles and responsibilities. The more we can convince ourselves and other school staff of the value of push-in services—and educate ourselves and others on how it can work—the more we can hope to truly deliver services to students in their classrooms.

What's the holdup?

The demands on an SLP's time are extensive. An SLP must provide direct and indirect services, acquire general education materials to embed into treatment, consult and collaborate with classroom teachers, and document and monitor progress, among other responsibilities. Many SLPs also spend time on general education initiatives such as response to intervention, screening and professional learning communities.

SLPs report that students with moderate to severe disabilities most commonly receive direct services outside of the classroom two or three times a week in 20- to 30-minute groups. Students with mild disabilities receive direct services once a week in 20- to 30-minute groups, also outside the classroom.

Clearly factors other than student needs are driving the slow adoption of push-in and other alternative service-delivery models. One such factor is teachers' and administrators' willingness to accept alternative models. School professionals more easily understand and accept SLPs' work in a pull-out context on objectives understood to be "speech," such as articulation and fluency treatment. (However, SLPs who deliver some services in the classroom report that teachers better understand what they do.)

Some SLPs may doubt the availability of opportunities to work in the classroom or their ability to address a range of communication disorders there. Other complications include the fact that students with communication disorders often aren't assigned to the same general education classroom, and a perception that eliciting desired responses to intervention from students can be difficult in the classroom setting.

And then there's training. Although some training programs emphasize a variety of service-delivery models, many new SLPs report a lack of training on how to create a schedule. Also, many universities report difficulties finding opportunities for students to work in classroom settings. Further, programs may not have provided instruction on topics such as collaboration models, behavior management, universal design for learning, large-group instructional strategies and other classroom-related areas.

What SLPs need

In our surveys, SLPs report needing a number of supportive elements to help expand beyond pull-out services. Among them are:

  1. Reasonable caseloads. A caseload that is reasonable and assigned in consideration of full workload demands allows time for more staff consultation and collaboration, parent training, planning, data collection, and other paperwork.
  2. Access to materials. Having copies of lesson plans, textbooks and the full curriculum helps SLPs integrate the Common Core State Standards and other classroom objectives into their treatment.
  3. Professional development. School administrators need to provide high-quality professional development on topics specific to SLPs (for example, clinical issues) as well as topics relevant to all team members.
  4. Administrative support. Decision-makers' understanding of the unique skills of the various team members results in increased access to instructional and assessment materials, inclusion in communication and training, consideration in assigning students to specific classrooms, and support in IEP meetings.
  5. Parent training. Helping parents understand the value of the full range of service delivery options often results in less resistance and better outcomes.
  6. Delineation of roles and responsibilities. One of the biggest concerns expressed by school-based SLPs is "No one really understands what I do!" They also express concerns about being viewed as a classroom assistant rather than a professional partner when moving into the classroom to deliver services. SLPs need to educate other professionals on their unique skills and expertise, and the school climate needs to encourage open communication among team members and discourage territorial protectiveness.
  7. Familiarity with the evidence regarding service-delivery models. SLPs can work with researchers to generate the evidence necessary to drive decisions about service delivery.
  8. Confidence in our professional skills as SLPs. It's important for us to know that we make good decisions and effectively deliver services in whatever dosage and location best fits students.

No one service delivery option has been identified as the most successful in driving student achievement. Understanding a student's full range of needs, evaluating the classroom climate and demands, knowing what the curriculum requires of the student, and evaluating what supports are necessary for the student to succeed should drive selection of service models. This subject begs for additional research! It is a topic that should be integrated in graduate and undergraduate programs.

Lastly, lifelong learning is an integral part of our professional life. Students and practicing professionals need to expand their thinking and skill base to provide dynamic service delivery. Learning more about how, when and where we deliver services, and how we collaborate and consult with other school-based professionals, is critical to our students' success. Such understanding better equips us to deliver quality services in new ways.

Deborah Dixon, MA, CCC-SLP, is ASHA director of school services.

cite as: Dixon, D. (2013, August 01). SIGnatures: Push-In Services: Making the 'Impossible' Possible : Special Interest Group 16, School-based Issues. The ASHA Leader.


Brandel, J., & Loeb, D. F. (2011). Program intensity and service models in the schools: SLP Survey Results. Language, Speech, and Hearing Services in Schools, 42, 461–490.

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