Varied Service Delivery

What Is Varied Service Delivery (VSD)?

Our patients, students, and clients have many needs addressed in their sessions. Not one type of service delivery model fits all patients, students, and clients. Therefore, varying service delivery models means tailoring how you implement/provide audiology and speech-language interventions in the following ways to better meet everyone’s needs:

modifying intervention methods
shifting therapy settings
alternating between different types of groupings
changing treatment frequency
adapting duration of sessions

Different Types of VSD Models

Audiologists and speech-language pathologists (SLPs) vary service delivery by engaging in the following practices.

Modifying the dosage of the services

frequency
intensity
duration

Modifying the setting for the session

in a therapy room
outside a therapy room
in a naturalistic setting (e.g., home, work site, etc.)

Changing the service delivery methods used, such as any of the following:

individual therapy
group therapy
co-treatment
skilled maintenance
telepractice
consultation

Benefits of VSD

There are many potential benefits of varying service delivery to support outcomes and promote generalization of skills beyond the therapy sessions. These benefits include

increasing the efficiency of services;
meeting the scheduling needs of everyone involved;
addressing limited progress;
facilitating the achievement of goals;
promoting peer modeling;
improving generalization/carryover of skills; and
maintaining skills following direct interventions.

Service Delivery Method	Potential Benefits
Individual therapy	Teaches discrete skills Allows many opportunities for multiple trials Reduces distractions and pressure Provides personalization and undivided attention
Group therapy	Reduces feelings of isolation Uses a more natural environment, which could reduce anxiety for the patient/student Provides opportunities for peer feedback/modeling as well as socialization Improves time management for clinician Assesses progress in a more complex environment
Co-treatment	Allows the patient/student to apply skills in other contexts Provides a more holistic approach, addressing multiple areas of needs simultaneously Reduces the number of sessions for patient/student Encourages collaborative planning and support of treatment goals Improves time management for patient/student Patient benefit for ADLs (interrelation between different goals that are being addressed)
Telepractice	Provides increased access (e.g., remote areas/homebound patients) Allows for work on functional goals in the home Extends carryover of skills via facilitator training as well as family or care partner training Provides flexibility—for example: services can be asynchronous or synchronous services can be delivered in various forms: individual, group, and/or consultative (“a service delivery within a service delivery”) Allows ease of incorporating facilitators Increases access for consultation across professionals/disciplines without geographic limitations
Consultation	Promotes carryover and generalization of skills Engages in parent/care partner training Allows for periodic monitoring (indirect) Allows time to maintain and calibrate equipment (e.g., AAC devices)

Decision Making Around VSD Models

To help you think through considerations around providing services via different models, and to reflect on your own practice, ASHA has developed a resource to help you get started. The Thinking Through Varied Service Delivery Models [PDF] resource provides samples by work/practice setting to show how different models could look in your workplace. Factors that support the implementation and success of VSD include:

administrative support
positive interprofessional collaborative practice
adequate time for planning
readiness and/or appropriateness of the client/patient/student

Reimbursement Implications

The person’s needs, clinical appropriateness, and evidence-based practice drive service delivery option choices. Although all of these models of service delivery may be appropriate, your options for an individual case may be limited depending on payer policies and related coding constraints. Learn more about payer influences at Modes of Service Delivery for Speech-Language Pathology.

Varied Service Delivery When Supervising Graduate Students and Assistants

When SLPs are supervising speech-language pathology assistants (SLPAs) and graduate students, those SLPs need to provide support and guidance regarding the implementation of VSD models. ASHA has developed resources and suggested guidance for SLPAs and graduate students [PDF]—to help explain the purpose and outcomes of modifying service delivery models in speech-language pathology practice settings.