Program Intensity and Service Delivery Models in Schools: SLP Survey Results PDF

LSHSS Article Program Intensity and Service Delivery Models in the Schools: SLP Survey Results Jayne Brandel a and Diane Frome Loeb b Purpose: School-base...

LSHSS Article Program Intensity and Service Delivery Models in the Schools: SLP Survey Results Jayne Brandel a and Diane Frome Loeb b Purpose: School-based speech-language pathologists (SLPs) caseload with severe to moderate disabilities participated in routinely work with team members to make recommendations intervention 2–3 times a week for 20–30 min in groups outside of regarding an intervention program’s intensity and method the classroom. Students with the least severe disability received of service delivery for children with speech and language im- intervention 1 time a week for 20–30 min in groups outside pairments. In this study, student, SLP, and workplace charac- of the classroom. teristics that may influence SLPs’ recommendations were Conclusion: The limited variety of intervention program inten- examined. sities and service delivery models used suggests that student Method: Almost 2,000 school-based SLPs completed an online characteristics may not be the most important factor considered survey about the factors they consider when making recom- when making intervention recommendations, as reported mendations regarding program intensity and service delivery by the SLPs. Instead, caseload size and years of practice appear model that students on their caseloads receive. to influence SLPs’ recommendations regarding which program Results: SLPs reported that student characteristics, rather than intensity and service delivery models to use. SLP or workplace characteristics, were the factors they con- sidered the most when making these recommendations. How- ever, these same SLPs reported that current students on their Key Words: school intervention, service delivery, dosage, survey T hroughout the school year, more than 85,000 speech- including the frequency, length, and service delivery model, language pathologists (SLPs) work with teachers, within the public schools (ASHA, 2005; Individuals with principals, paraprofessionals, parents, and other Disabilities Education Act [IDEA], 2004; No Child Left school professionals to determine the best learning environ- Behind [NCLB], 2001). Unfortunately, there are few studies ment for students with communication needs (American available to guide how to make recommendations with re- Speech-Language-Hearing Association [ASHA], 2010). spect to the effects of different service delivery models on How are these recommendations made by the team in a outcomes for school-age children (Cirrin et al., 2010). Spe- way that meets the needs of each student? In this study, we cifically, Cirrin et al. found only five studies to include in their sought to learn what factors SLPs consider when determining evidence-based systematic review of the literature from the the program intensity (i.e., the length of time for each session past 30 years. Of those studies that did qualify, the authors and the frequency of sessions) and service delivery model concluded that there was insufficient evidence to guide SLPs to use for the students they serve. in their recommendations. In recent years, there has been an increased emphasis from Specific information about particular aspects of interven- both federal legislation and ASHA for SLPs to use research tion is also needed. Multiple researchers (Cirrin & Gillam, when making recommendations regarding intervention, 2008; McCauley & Fey, 2006; Ukrainetz, 2009; Warren, Fey, & Yoder, 2007) have noted the need for more information a Fort Hays State University, Hays, KS regarding the intensity, duration, and delivery of services b The University of Kansas, Lawrence for speech and language interventions. Program intensity is Correspondence to Jayne Brandel: [email protected] rarely reported within the current body of research (Baumann, Editor: Marilyn Nippold 2009; Hoffman, 2009; Proctor-Williams, 2009; Ukrainetz, Associate Editor: Shari Robertson 2009; Warren et al., 2007). One study by Ukrainetz, Ross, and Received March 17, 2010 Harm (2009) evaluated the effects of a high-intensity inter- Revision received September 4, 2010 vention versus a low-intensity intervention for kindergarten Accepted January 22, 2011 students with mild to moderate deficits in phonemic aware- DOI: 10.1044/0161-1461(2011/10-0019) ness. The students participated in either 30-min sessions 1 LANGUAGE, SPEECH, AND HEARING SERVICES IN SCHOOLS Vol. 42 461–490 October 2011 * American Speech-Language-Hearing Association 461 time a week for 24 weeks (low intensity) or 30-min sessions A Model of Factors Impacting SLP 3 times a week for 8 weeks (high intensity). Students in both Recommendations for Service Delivery groups made similar gains. The largest amount of progress was noted for students with moderate deficits. In addition, There are several possible factors that may influence an the authors (Ukrainetz et al., 2009) noted that students with SLP’s recommendation for the program intensity and ser- mild deficits made gains following classroom instruction only vice delivery model used. Figure 1 illustrates a three-part that were comparable to the gains made by students in the model, developed by the authors, that is based on ASHA’s intervention groups. The study by Ukrainetz et al. points to (2000) 14 factors that should be considered when deter- the interaction between student characteristics (i.e., severity mining the appropriate program intensity and service delivery of disorder), mode of service delivery, and time needed for model to be used with students. This model, referred to as intervention gains. Unfortunately, their study is one of the few the school-based intervention decision-making (SIDM) available to guide SLPs when making recommendations to model, consists of three domains: (a) student, (b) SLP, and the individualized education program (IEP) team. Cirrin et al. (c) workplace. (2010) concluded that because of the lack of research re- Student domain. The program intensity and service garding the efficacy of varying service delivery models, SLPs delivery model in which a student participates should be must rely on data they gather themselves and the needs of determined by the student’s needs and “based on the need to each student as mandated in IDEA (2004). provide a free, appropriate public education for each student in the least-restrictive environment” (ASHA, 2000, p. 32). The necessity for students to participate in intervention in Current Practice the least restrictive environment is also present within the A recent study by Mullen and Schooling (2010) sheds mandates of IDEA (2004). The student factors provided in light on the types of services that are being provided to stu- Figure 1 are based on the recommendations of ASHA and, dents with communication needs in schools. They found if followed, are consistent with the requirements of IDEA, that of those students receiving services, 74% were currently which mandate that an array of speech, language, and hearing participating in speech and/or language services for 21–30 min services be available for students within the public school each session, and 78% were seen 2 times a week (Mullen setting in order to provide services in the student’s least & Schooling, 2010). Group intervention outside of the class- restrictive environment. room was reported for 91% of the students participating in speech and language intervention. These data suggest a lack of variation in the services that are provided to students in the schools. This lack of variation in speech and language ser- Figure 1. School-based intervention decision-making model (SIDM). vices appears at odds with ASHA’s recommendation that no single service delivery model should be used within a school setting (ASHA, 2000) and the mandate present within IDEA (2004) for students to participate in services within the least restrictive environment. That is, for some students, the least restrictive environment may be the classroom setting, not outside of the classroom. The Mullen and Schooling (2010) study provides current data for what is occurring in the public schools with respect to service delivery with speech sound production, spoken language comprehension, and spoken language production disorders. However, this study was not designed to detail the differences in service delivery based on the severity (i.e., mild, moderate, or severe) or type (i.e., reading, language, autism) of the student’s disorder. In addition, the National Outcomes Measurement System data evaluated by Mullen and Schooling did not include participants from each of the 50 states and the District of Columbia, and the majority of respondents were from a few large school districts. The current study was con- ducted in an effort to address these limitations and increase our understanding of how SLPs make recommendations regarding the intensity of services and service delivery model used. To do this, we examined factors that may impact the recom- mendations made by SLPs working in schools. 462 LANGUAGE, SPEECH, AND HEARING SERVICES IN SCHOOLS Vol. 42 461–490 October 2011  SLP domain. Characteristics of the SLP may also influence Our study improves on earlier studies in that it provides an program intensity and service delivery model recommenda- exploratory examination of possible factors associated with tions. An SLP’s clinical training, years of experience in the recommendations for program intensity and service delivery schools, year of graduation with a master’s degree, and model using a rudimentary framework, the SIDM model. relationship with coworkers may all impact student place- Previous studies (ASHA, 2008; Katz et al., 2010; Mullen & ment recommendations. For example, Katz, Maag, Fallon, Schooling, 2010) report data collected from caseloads that Blenkarn, and Smith (2010) found that SLPs with fewer reflect broad categories of data. In our data collection, we years of experience were more likely than SLPs with more asked SLPs the reasons why they made the recommenda- years of experience to perceive their caseload as being tions they did, and then asked them for specific information manageable. Zipoli and Kennedy (2005) surveyed SLPs about the program intensities and service delivery models and found that integrated research and clinical guidelines they were currently providing to students with mild, moderate, during their clinical fellowship year positively impacted their and severe disabilities with a range of communication dis- use of evidence-based resources later. However, no studies abilities at various ages and grades on their caseload. These have directly evaluated the other factors within this portion of components of our study set it apart from previous studies. the SIDM model that may impact SLPs’ recommendations The purpose of this study was to examine the factors regarding program intensity and service delivery model. within the three domains of the SIDM model that influenced Workplace domain. Factors within the workplace are a the recommendations of SLPs when they participated on an third variable that may influence the program intensity and ser- IEP team engaged in making decisions related to intervention. vice delivery model a student receives. Workload size, caseload Specifically, four questions were asked: size, administrative support, and the IEP team are all compo- & What are the dominant factors that influence SLPs’ nents of the workplace and can influence an SLP’s recom- recommendations to their IEP teams regarding their mendations. Of the factors included in the workplace domain, students’ program intensity and service delivery models caseload size and administrative support have been found for intervention? to impact the type of service delivery model an SLP chooses & What factors within the student domain (i.e., severity, to use. A survey by Dowden et al. (2006) of Washington state grade level, and disability) of the SIDM model are SLPs working in schools found that the type of interven- associated with the SLPs’ program intensity and service tion (group vs. individual) students received was related to delivery model recommendations to the IEP team for the size of the SLP’s caseload. SLPs who had larger case- students on their caseload? loads provided more group intervention, and SLPs who had & What factors within the SLP domain of the SIDM smaller caseloads provided more individual intervention. In model are associated with the SLPs’ program intensity addition to caseload, the support of administrators has also and service delivery model recommendations to the IEP been shown to impact whether a variety of service delivery team for students on their caseload? models are employed. Praisner (2003) and Salisbury (2006) found that the more supportive the administration, the more & What factors within the workplace domain of the SIDM likely for intervention to take place inside the classroom. model are associated with the SLPs’ program intensity and service delivery model recommendations to the IEP team for students on their caseload? It was predicted that caseload size, one of the factors within PURPOSE OF THE STUDY the workplace domain, would have the greatest impact on Despite reports of a lack of heterogeneity in the amount SLPs’ recommendations based on previously reported ASHA of intervention and the location of intervention reported in data and other research (ASHA, 2008; Dowden et al., 2006). previous studies (ASHA, 2008; Mullen & Schooling, 2010), However, it was unknown if the workplace domain would there are limitations in regard to what is known about current have a greater effect on SLPs’ recommendations than the practice within the schools. For example, the ASHA 2008 student or SLP domains. Schools Survey did not provide any information regarding the proportion of group intervention sessions compared to indi- vidual intervention sessions. In addition, neither the ASHA surveys nor Mullen and Schooling (2010) provided insight on METHOD which factors might influence SLPs to use primarily the same Participants place and time for intervention services (i.e., outside of the classroom for 20–30 min per week). Although Katz et al. A total of 9,868 SLPs were e-mailed an invitation to par- (2010) provided insight on SLPs’ views regarding the appro- ticipate in a survey. The SLPs were employed in the pub- priateness of their caseload, they did not provide information lic schools and had their certificate of clinical competence. regarding the program intensity and service delivery model The SLPs were randomly selected from each of the 50 states recommended by the SLPs. and the District of Columbia using the ASHA website Brandel & Frome Loeb: Program Intensity and Service Delivery 463 membership directory. The number of SLPs chosen to par- school (not including colleges/universities). Using these ticipate per state was based on the percentage of the U.S. data and the formula provided by Dillman et al. for obtaining population within each state. The SLPs were identified using a representative sample, our study needed 1,048 respondents randomly selected zip codes from each state until the speci- for a 95% confidence interval with a ±3% margin of error. fied number of SLPs from that state was identified. This This number of participants was obtained. process was completed by a graduate student in order to Potential participants were contacted up to four times in ensure the anonymity of the participating SLPs. order to minimize nonresponse error. Lastly, the fourth type Of the 9,868 potential participants, 8,246 remained after of error, measurement error, was minimized through the use eliminating the 458 persons who used the option of being of the Internet throughout the time the survey was adminis- eliminated from the survey pool and the 1,164 SLPs who tered. Use of the Internet survey allowed for automatic cal- were either no longer employed in the public schools or did culation and summation of responses. not have a current e-mail address. A total of 1,897 SLPs completed the questionnaire, resulting in a 23.01% response Follow-up E-mail rate. This response rate was within the recommended re- sponse rate of between 20% and 24% for web-only surveys In addition to completing the online questionnaire, all (Sax, Gilmartin, & Bryant, 2003). SLPs were asked if they would be willing to participate in a follow-up e-mail of interview questions. Of the 645 SLPs who indicated they would answer additional questions via Procedure e-mail, 50 were randomly selected to receive the follow-up A questionnaire was developed to evaluate the contribu- e-mail. Twenty SLPs returned the completed questions, tions of the three domains in the SIDM model. Initial versions which asked them to provide their opinion as to why little of the questionnaire were modified as a result of input from variation was observed in the program intensity and service a focus group of four ASHA-certified SLPs who were cur- delivery model in which intervention was provided. The rently employed in schools. Following changes made based follow-up e-mails were de-identified upon receipt and ana- on the suggestions of the focus group, a pilot study with lyzed for similar themes across responders by the primary 77 SLPs (response rate of 42%) in northeast Kansas was author, with the ability to request more information in order to conducted to evaluate the ability of the tool to answer the clarify any unclear responses. proposed research questions. The resulting questionnaire SIDM model: Characteristics of the SLP domain. SLPs (Appendix A) included three sections: (a) demographic from all 50 states and the District of Columbia responded to information, (b) program intensity (referred to as time in the survey and had an average of 15 years of experience the questionnaire), and (c) service delivery model (referred working within schools (SD = 9.09 years; range = 1–42 years). to as place in the questionnaire). Approximately 52.0% of the SLPs worked in suburban Human subjects approval was granted by the University of schools, 24.0% in urban schools, and 24.0% in rural schools. Kansas Institutional Review Board, and the online question- These terms were not defined within the survey but were naire was administered to SLPs working within the public left for the SLPs completing the survey to determine (as is the schools using the survey engine SurveyMonkey (www. practice of ASHA when conducting their school surveys). surveymonkey.com). Between October and December of Eighty-one percent of the SLPs surveyed worked full time. 2008, SLPs were e-mailed an invitation to participate in the During graduate school, 92.1% of the SLPs had provided research study that explained the purpose of the study and intervention in an individual session outside of the classroom, that all responses would be anonymous. Upon completion and 87.5% had provided intervention in a group session of the questionnaire, SLPs were asked if they would be outside of the classroom (see Table 1). willing to participate in a follow-up e-mail of interview SIDM model: Characteristics of the workplace domain. questions (Appendix B). The provision of their e-mail After adjusting for those SLPs who were working part time, the address in response to this question was noted as their SLPs’ average caseload size was 50.72 students (SD = 26.08). consent to participate in the follow-up interview. One potential weakness to our study was the caseload size of Questionnaire validity. Dillman, Smyth, and Christian the SLPs who participated in the study. The SLPs in our study (2009) described four potential errors that surveys must reported a mean caseload that was higher than the national address. Coverage error occurs when not everyone in a pop- level reported by Katz et al. (2010; 50.72 vs. 48.8, respec- ulation has an equal opportunity to participate in the survey. tively). However, it should be noted that Katz et al.’s sample This was minimized by randomly selecting the participants size did not meet the standards for the Dillman et al. (2009) from all ASHA-certified SLPs. Another potential concern formula that we used. Furthermore, our caseload size is is sampling error, which happens when a person surveys similar to that reported by the ASHA 2010 Schools Survey a portion of the desired population rather than everyone. median of 50. According to the 2009 ASHA membership data, there were For the total number of students participating in speech 59,980 SLPs who reported being employed in an educational and language services, SLPs reported the greatest percentage 464 LANGUAGE, SPEECH, AND HEARING SERVICES IN SCHOOLS Vol. 42 461–490 October 2011 Table 1. Speech-language pathologist (SLP) domain: Type of use the service delivery model necessary for their students service delivery models experienced during graduate school to improve their speech and/or language skills. training. Response Response RESULTS Type of service delivery model frequency count The data were analyzed using descriptive and parametric Individual session outside the classroom 92.1% 1,687 procedures (depending on the research question) using Group session outside of the classroom 87.5% 1,602 SPSS Version 14.0. Questions 1 and 2 were analyzed using Consultation 62.8% 1,150 descriptive statistics. This method was chosen due to the Preschool classroom based 42.2% 773 exploratory nature of the study in that little information was Delivering elementary intervention 32.6% 597 available in previous studies that evaluated all of these in classroom but independent of the classroom teacher variables within the same study. Questions 3 and 4 used Elementary classroom based with 24.2% 443 multinomial logistic regression to evaluate the relationship shared teaching between the program intensity and service delivery model Middle and high school intervention 21.1% 387 used and selected SLP and workplace variables. independent of classroom teacher Middle and high school classroom 8.9% 163 based with shared teaching SLPs’ Opinions on Which Factors Influenced Their Program Intensity and Service Delivery Model Recommendations (Question 1) as being elementary students (64.8%) followed by pre- SLPs were asked to select the three most important school students (15.5%), junior high/middle school students characteristics out of the 14 student, SLP, and workplace (12.2%), and high school students (7.4%). The greatest characteristics within the SIDM model they considered percentage of students participated in group intervention when making recommendations to the IEP team regard- (73.0%) as compared to individual intervention (18.1%). In ing which program intensity and service delivery model addition, more students were seen outside of the classroom to use for a specific student (Table 3). Factors associated on average (M = 37.03, SD = 10.9) than inside the classroom (Table 2). The majority of SLPs reported that their adminis- Table 3. Percentage of SLPs who selected each of the school- trators were supportive of their service delivery model based intervention decision-making model (SIDM) characteristics recommendations. Specifically, 83% of the SLPs reported as their top three considerations. that their administrators permitted them to provide inter- vention for the program intensity necessary to make gains. In addition, 91% of the SLPs indicated that they were able to Service Program delivery SLP and workplace options intensity models Table 2. Workplace domain: Percentage of students seen in the various types of service delivery models. Nature and severity of the student’s disorder (S) 67.7 51.9 The student’s communication needs in 53.0 46.8 relation to his or her general education curriculum (S) Percentage of students The student’s strengths, needs, and emerging 30.6 27.6 Intervention on caseload abilities (S) Caseload size (W) 23.9 20.0 The student’s age and developmental level (S) 23.5 16.9 Type IEP team input (W) 15.3 14.2 Individual 18.12 Workload size (W) 10.8 14.0 Group 73.08 The motivation and attitude of the student (S) 7.7 6.9 Place Clinical training (SLP) 3.4 6.7 Shared teaching in classroom 12.08 Relationship with school personnel (SLP) 3.1 5.5 Students seen in classroom 9.34 Administrative support (SLP) 1.7 5.0 (not shared teaching) The need for peer modeling (S) 1.6 4.6 Students seen outside of the classroom 74.06 Professional development (SLP) 1.6 3.2 Resource room 10.02 Years worked in schools (SLP) 1.3 1.8 Self-contained classroom 21.12 Note. S = student domain; W = workplace domain; SLP = speech- Note. Students may have been listed in multiple places. Therefore, language pathologist domain, IEP = individualized education the percentages will not necessarily total 100. program. Brandel & Frome Loeb: Program Intensity and Service Delivery 465 with the students’ characteristics were selected most often. currently on the caseloads of the SLPs most often took part Specifically, we found that the nature and severity of the in intervention 1 time a week for 20–30 min regardless of student’s disorder; the student’s communication needs in their grade (Figure 4). The use of consultation was higher relation to his or her general education curriculum; and for middle school/junior high (31.2%) and high school the students’ strengths, needs, and emerging abilities were students (22.86%) with the least severe disability. This ac- most often selected as impacting SLP recommendations counted for the larger number of responses in the “other” regarding which program intensity and service delivery category. model to use. Program intensity by disability and severity. SLPs also were asked to specify the program intensity for students with specified disabilities of varying severity levels (Figure 5, 6, Student Factors Associated With the Program and 7). The eight disabilities selected were based on the Intensity and Service Delivery Model ASHA 2008 Schools Survey. Regardless of disability type, students with moderate and severe disabilities participated Recommended for Students (Question 2) in intervention 2–3 times a week for 20–30 min most often Program intensity by grade and severity. SLPs were (Figures 5 and 6). In contrast, students with the least se- asked to provide information for specific students on their vere disability were seen for intervention 1 time a week for caseload regarding how often that student participated in 20–30 min (Figure 7). intervention. Figures 2, 3, and 4 illustrate the program in- Service delivery model by grade and severity. Students tensity provided to students in a specified grade with the with the most severe disability in kindergarten through mid- most, moderate, and least severe disabilities. Because con- dle school were primarily provided intervention in groups sultation and block scheduling were not used frequently, outside of the classroom. Preschoolers with the most severe these options were combined with “other” in order to disability were more likely to receive individual intervention simplify the presentation of data. Students in preschool outside of the classroom, and high schoolers with the most through middle school with the most severe disability (Fig- severe disability were seen in either the self-contained class- ure 2) most often took part in intervention 2–3 times a week room or individual intervention outside of the classroom for 20–30 min. This was also the case for students with a (Table 4). In contrast, students with a moderate disability or moderate disability in preschool through fifth grade (Fig- the least severe disability most often received intervention in ure 3). However, middle school and high school students groups outside of the classroom. with a moderate disability were more often seen 1 time a Service delivery model by disability and severity. Stu- week for 20–30 min. Students with the least severe disability dents with the most severe articulation disorder, pervasive Figure 2. Intervention program intensity by grade for students with the most severe disability. 466 LANGUAGE, SPEECH, AND HEARING SERVICES IN SCHOOLS Vol. 42 461–490 October 2011  Figure 3. Intervention program intensity by grade for students with a moderate disability. developmental disorder (PDD), or augmentative and a group outside of the classroom regardless of their alternative communication (AAC) devices most often diagnosis. participated in intervention individually outside of the classroom (Table 5). In contrast, students with other types Follow-up E-mail of disabilities were seen in a group outside of the class- room. Overall, SLPs reported that students with moderate Some general themes emerged from the content of the and least severe disabilities took part in intervention in follow-up e-mails. First, with respect to program intensity, Figure 4. Intervention program intensity by grade for students with the least severe disability. Brandel & Frome Loeb: Program Intensity and Service Delivery 467  Figure 5. Intervention program intensity by disability for students with the most severe disability. Note. PDD = pervasive developmental disorder, LD = language disorder, MR/DD = mental retardation/ developmental disability, AAC = augmentative and alternative communication, and SLI = specific language impairment. 11 SLPs indicated that scheduling impacted the frequency 20–30 min was an appropriate program intensity to provide and length of intervention, with 10 SLPs suggesting that intervention. teachers preferred intervention to be provided twice a week When asked why SLPs most often provide intervention in for 20–30 min. Two SLPs stated that 2–3 times a week for a group outside of the classroom, seven of the SLPs said that Figure 6. Intervention program intensity by disability for students with a moderate disability. 468 LANGUAGE, SPEECH, AND HEARING SERVICES IN SCHOOLS Vol. 42 461–490 October 2011  Figure 7. Intervention program intensity by disability for students with the least severe disability. scheduling difficulties caused them to use group intervention paperwork, billing) impacted their recommendation regard- outside of the classroom. As with time, five SLPs also noted ing the service delivery model used. Finally, two SLPs re- that teachers preferred this service delivery model, and the ported that in-class intervention took more time to provide, size of their workload (e.g., caseload, meetings, school duties, and intervention outside of the classroom was more practical. Table 4. Service delivery model used according to grade level and severity of disability. Individual outside Group outside Self-contained In the Resource Disability level of the classroom of the classroom classroom classroom room Other Most severe (N = 1,381) Preschool 38.17% 19.44% 19.58% 15.35% 3.10% 4.37% K–2nd 25.77% 47.63% 12.06% 5.31% 5.46% 3.56% 3rd–5th 18.45% 56.28% 11.41% 5.32% 5.62% 2.92% Middle school/Junior high 26.28% 34.06% 22.87% 5.60% 6.81% 4.38% High school 28.90% 19.77% 29.66% 8.75% 6.84% 6.08% Moderately severe (N = 1,372) Preschool 20.48% 43.64% 10.88% 17.94% 3.39% 3.67% K–2nd 8.67% 72.83% 4.63% 6.25% 4.97% 2.64% 3rd–5th 6.00% 75.78% 3.94% 6.25% 5.64% 2.39% Middle school/Junior high 13.29% 58.04% 9.32% 8.39% 8.16% 2.80% High school 22.22% 41.67% 14.29% 7.94% 8.33% 5.56% Least severe (N = 1,364) Preschool 12.89% 44.88% 8.70% 25.31% 3.42% 4.81% K–2nd 5.66% 69.18% 3.11% 13.76% 4.32% 3.97% 3rd–5th 5.65% 69.92% 2.78% 12.34% 5.07% 4.24% Middle school/Junior high 12.53% 53.98% 5.78% 16.87% 5.06% 5.78% High school 17.37% 41.10% 8.90% 15.68% 6.36% 10.59% Note. Bolded percentages were the ones selected most often by the respondents. Brandel & Frome Loeb: Program Intensity and Service Delivery 469  Table 5. Service delivery model used according to disability and severity of disability. Individual outside Group outside Self-contained In the Resource Disability level of the classroom of the classroom classroom classroom room Other Most severe (N = 1,353) Articulation 41.76% 41.26% 5.33% 3.94% 5.00% 2.71% PDD 30.19% 27.16% 23.88% 11.07% 3.63% 4.07% Pragmatics 11.67% 52.31% 12.31% 14.44% 4.54% 4.72% LD 13.35% 59.73% 7.24% 7.54% 8.05% 4.08% MR/DD 18.55% 38.99% 24.80% 9.33% 4.86% 3.47% AAC 32.80% 16.01% 29.63% 12.43% 3.84% 5.29% Reading/ Writing 11.42% 53.68% 4.85% 15.34% 6.57% 8.14% SLI 16.16% 58.89% 6.57% 9.29% 5.25% 3.84% Moderately severe (N = 1,343) Articulation 13.79% 70.89% 3.39% 4.19% 5.00% 2.74% PDD 12.16% 55.15% 14.10% 11.01% 3.88% 3.70% Pragmatics 4.74% 62.99% 9.02% 14.31% 4.28% 4.65% LD 5.54% 70.26% 4.76% 8.84% 7.09% 3.50% MR/DD 7.45% 57.19% 17.00% 9.44% 5.35% 3.57% AAC 18.17% 36.97% 21.33% 13.59% 4.42% 5.53% Reading/ Writing 5.05% 61.93% 3.82% 15.44% 6.57% 7.19% SLI 6.97% 71.15% 4.51% 8.24% 5.59% 3.53% Least severe (N = 1,351) Articulation 8.42% 65.03% 2.45% 14.54% 4.08% 5.47% PDD 5.48% 54.74% 9.87% 19.74% 4.09% 6.08% Pragmatics 3.09% 55.68% 6.47% 23.80% 3.88% 7.07% LD 4.26% 62.88% 3.35% 17.55% 7.10% 4.87% MR/DD 4.75% 57.01% 14.01% 14.85% 5.23% 4.16% AAC 10.62% 41.59% 18.05% 19.65% 3.36% 6.73% Reading/ Writing 3.86% 52.01% 2.58% 26.73% 5.96% 8.86% SLI 4.76% 63.93% 3.34% 17.63% 5.17% 5.17% Note. Bolded percentages were the ones selected most often by the respondents. PDD = pervasive developmental disorder, LD = language disorder, MR/DD = mental retardation/developmental disability, AAC = augmentative and alternative communication, and SLI = specific language impairment. SLP and Workplace Factors Associated With would not have been enough responses in each category to SLP Recommendations Regarding Program result in reliable conclusions. Clinical experiences during Intensity and Service Delivery Model graduate school training were selected to determine if a connection existed between experiences in graduate school (Questions 3 and 4) and recommendations when working professionally. The year The third research question was evaluated using a multi- of graduation was selected because of the possible relation- nomial logistic regression because it allowed simultaneous ship with the SLP’s clinical training experience. Professional evaluation of the independent variables within the two development was evaluated by including the number of years domains of the SIDM model (SLP and workplace) while the SLP had worked in schools. also taking into account a student’s grade, disability, and/or The only workplace factor that was evaluated using lo- severity of disorder. Multinomial logistic regression estimates gistic regression was caseload size. Caseload size was eval- the effects of the independent variables and the likelihood uated for two reasons. First, the results of previous research that SLPs’ recommendations regarding the program intensity suggested that caseload size would be a factor that would and service delivery model were impacted by the dependent impact SLPs’ recommendations (Dowden et al., 2006). Sec- variables. ond, SLPs reported that the majority of their time each week From the SLP domain, the SLP’s graduate school train- was spent providing direct intervention (ASHA, 2008). ing, year of graduation, and number of years worked in the Therefore, the workload factor that most directly impacts schools were included in the analyses. Little variation was SLPs’ service delivery recommendations is most likely to reported in regard to the SLP’s relationship with coworkers. be the size of their caseload. For our purposes, the adjusted Therefore, this was not included in the analyses because there caseload size was used for analysis in order to account 470 LANGUAGE, SPEECH, AND HEARING SERVICES IN SCHOOLS Vol. 42 461–490 October 2011 for some SLPs working part time. Other variables such as a factor (Tables 8 and 9). The SLP’s clinical training ex- administrative support and team input were not included in periences as well as his or her year of graduation with a the analysis because little variation was reported on these master’s degree also significantly impacted recommenda- questions within the questionnaire, resulting in too few in- tions regarding the place for intervention. SLPs who had stances of SLPs within each cell in order to obtain reliable experience with shared teaching with a middle school data results using logistic regression. teacher during their graduate school training were 6 times The included variables were evaluated with the model more likely to provide intervention within the resource fit (a =.05) using the most often reported program intensity room. In regard to the SLP’s year of graduation, the more for each grade level and disability as the reference category. recently an SLP had graduated (increase in year of gradua- Likelihood ratio tests were completed to determine if the tion), the more likely he or she was to provide intervention variables contributed significantly (a =.01) to the SLPs’ to the least severe kindergartner in a group outside of the recommendations regarding the amount of time or place classroom. students participated in intervention. If the independent var- iables were observed to be significant (a =.01) within the likelihood ratio tests, they were evaluated further. An alpha DISCUSSION level of.01 was selected to be used for the likelihood ratio test as well as with the parameter estimates due to the large This study was a first attempt to understand what factors number of analyses that were conducted. influence SLPs’ recommendations to IEP team members Factors impacting program intensity. In regard to pro- regarding which program intensity and service delivery gram intensity, adjusted caseload size was found to be a sig- model to use when providing school-based intervention. nificant factor most often (Table 6). Adjusted caseload size We created the SIDM model to frame our survey questions was significant for SLPs who selected 1 time a week for and found that the top three SLP selections were consistent 20–30 min and SLPs who selected 2 or more times a week with the student domain of the SIDM model and concerned for 45–60 min. Odds ratios (i.e., exp(b)) > 1.0 indicate a individualizing intervention for students’ needs. This indi- higher likelihood of selecting the comparison category (e.g., cates that SLPs believe that their recommendations are aligned 1 time a week for 20–30 min); odds ratios < 1.0 indicate a with the policies set forth by ASHA and IDEA in that the higher likelihood of membership in the reference category needs of the individual student impact their recommenda- (e.g., 2–3 times a week for 20–30 min). Therefore, for stu- tions. Interestingly, the remaining part of our study results dents in preschool with the most severe disability, the SLP highlighted different domains from the SIDM model. The data was more likely (1.017 times) to select 1 time a week for from the same SLPs’ caseloads indicated little variability 20–30 min as his or her adjusted caseload size increased a across disabilities and severity level with respect to program unit. In this case, a unit increase in the adjusted caseload size intensity and service delivery model. As predicted, caseload is the addition of one more student. Thus, an SLP with a size, which is a workplace domain factor, influenced pro- caseload size of 80 students would be 30.51 times more likely gram intensity; however, only in preschool settings with the to select 1 time a week for 20–30 min over 2–3 times a week children with the most severe disabilities. Specifically, we for 20–30 min as compared to an SLP with a caseload size found that as the caseload size of preschool children with of 50 students. Overall, the data indicated that as adjusted severe communication disabilities increased, the recom- caseload size increased, it was 0.898 to 1.031 times more likely mended program intensity decreased. We also found that that the students would receive intervention for smaller two characteristics of the SLP domain, clinical experience amounts of time. and year of graduation, influenced the type of service de- Other factors that impacted program intensity were the livery model SLPs recommended. SLPs who had graduate SLP’s year of graduation and the number of years that he experiences with shared teaching were more likely to pro- or she had worked in the schools (Table 7). SLPs who had vide intervention in resource rooms. Further, SLPs who graduated more recently, as well as SLPs with more experi- were recent graduates were more likely to deliver services ence working within the schools, were more likely to pro- to kindergartners with the least severe communication dis- vide intervention to their student with a severe or moderate orders outside of the classroom. disability for 2–3 times a week for 20–30 min and 1 time a Our findings add to the previous literature, which had week for 20–30 min as opposed to “other” (an amount of time found that the workplace domain of caseload size influenced not specified within the questionnaire options). In addition, the type of service delivery model SLPs recommended. How- the least severe students were more likely to receive inter- ever, we did not provide converging evidence that caseload vention once a week for 20–30 min if their SLP had graduated size influenced the provision of group or individual services recently instead of “other.” as previous ASHA (2002, 2006) studies reported. This is Factors impacting service delivery model. In regard to probably due to the design of our study in that we did not the service delivery model used, the multinomial logistic compare large and small caseloads with group and individ- regression indicated that adjusted caseload size was again ual services. We also did not provide converging evidence Brandel & Frome Loeb: Program Intensity and Service Delivery 471  Table 6. Parameter estimates for program intensity by grade. Disability level B SE exp(b) Child with most severe disability Preschoola 1 time a week for 20–30 min Adjusted caseload.017**.005 1.017 2 or more times a week for 45–60 min Adjusted caseload –.020**.006.981 Kindergartena 1 time a week for 45–60 min Year of grad –.089**.031.915 Years worked in school –.161**.043.852 Child with moderate disability Preschoola 1 time a week for 20–30 min Adjusted caseload.014**.005 1.014 2 or more times a week for 45–60 min Adjusted caseload –.024**.009.976 Other Adjusted caseload.022.008 1.022 Junior high / Middle schoolb 2–3 times a week for 20–30 min Adjusted caseload –.022**.007.978 1 time a week for 45–60 min Adjusted caseload –.025**.008.975 2 or more times a week for 45–60 min Adjusted caseload –.037**.012.964 High schoolb 2–3 times a week for 20–30 min Adjusted caseload –.023**.009.978 2 or more times a week for 45–60 min Adjusted caseload –.107**.029.898 Child with a least severe disability Kindergartenc 2–3 times a week for 20–30 min Adjusted caseload –.013**.005.987 2 or more times a week for 45–60 min Adjusted caseload –.056**.017.946 Fourthc 2–3 times a week for 20–30 min Adjusted caseload –.016*.006.984 Consultation Adjusted caseload.013*.005 1.013 Fifthc 2–3 times a week for 20–30 min Adjusted caseload –.025**.007.975 1 time a week for 45–60 min Adjusted caseload –.061*.023.941 High schoolc 2–3 times a week for 20–30 min Adjusted caseload –.052**.016.949 Note. B = regression weight, SE = standard error, and exp(b) = odds ratio. a The reference category is 2–3 times a week for 20–30 min. bThe reference category is 1 time a week for 20–30 min. cThe reference category is 1 time a week for 20–30 min. *Indicates significance level of.01. **Indicates significance level of.001. 472 LANGUAGE, SPEECH, AND HEARING SERVICES IN SCHOOLS Vol. 42 461–490 October 2011 Table 7. Parameter estimates for program intensity by type (2010), providing some validity to our findings. In the re- of disability. mainder of this article, we hypothesize as to why we believe this homogeneity was present, possible steps that our clinical training programs might take in the future, limitations of Disability level B SE exp(b) our study, and directions for future research. Child with most severe disability Articulationa Lack of Variation in Program Intensity Other Year earned MA degree –.064**.018.938 In our survey, SLPs reported that the primary consider- Years worked in school –.063*.020.939 ation for determining program intensity for their students Child with least severe disability was the nature and severity of the students’ disorders. Given PDDa this, we expected to see much more variety in the types of Other interventions recommended by SLPs. Instead, the primary Year earned MA degree –.086.029.917 program intensity was 1 or 2 times a week for 20–30 min. a The primary difference between disability severity and pro- The reference category is 2–3 times a week for 20–30 min. gram intensity was that the students with the least severe *Indicates significance level of.01. **Indicates significance level disability were seen 1 time a week and the students with of.001. moderate and severe disabilities were seen 2 times a week. This finding would be in keeping with the untested tenet that “more is better” by providing more intervention for regarding the influence of administrators given the limited students with more communication needs. Yet this same logic variability in responses that we had in this domain. Future was not present with high school students. Regardless of studies are needed to determine the role these characteristics severity, all high school students received intervention 1 time play in the recommendations for intervention. a week for 20–30 min. The latter finding of program intensity Although the SLPs’ views were consistent with the student with high school students and the overall finding of little domain of the SIDM model, which would promote individ- variation in program intensity, especially between students ualized intervention and lead to more heterogeneous program with moderate disability and students with severe disability, intensity and service delivery models, data from the SLPs’ are difficult to reconcile with the report that program intensity actual caseload practice indicated very little heterogeneity. is based strongly on the nature and severity of the students’ The homogeneity of our program intensity and service de- disorders. livery model data was similar to that of Mullens and Schooling One possible explanation for our findings may be related to the student’s communication needs in relation to his or her general education program, which was the second most Table 8. Parameter estimates for service delivery model often selected consideration in the SIDM model. Recall that by grade. SLPs chose this factor 53% of the time in regard to recom- mendations for program intensity and 46.8% of the time in regard to recommendations for service delivery model. An Disability level B SE exp(b) important part of the SLP’s role is to help the student access the curriculum. If the SLP is working toward helping the Most severe disability student be successful in his or her classroom, the program Preschoola intensity and service delivery model reported by SLPs in Group outside the classroom this study may be sufficient to do so. That is, when inter- Adjusted caseload.021**.006 1.021 Resource room vention consists of assisting with the vocabulary from class, Adjusted caseload.030*.011 1.031 helping with note taking, or improving the student’s ability Other to participate in group discussions, 20–30 min 2–3 times a Adjusted caseload.026**.008 1.026 week may be adequate program intensity. However, it is not Least severe disability known if this would be an adequate program intensity, and Kindergartenb future research is needed to validate this possibility. Other Year of graduation –.126**.033.882 a Lack of Variation in Service Delivery Model Reference category is individually outside of the classroom. b Reference category is group outside of the classroom. As with program intensity, the SLPs reported that in their *Indicates significance level of.01. **Indicates significance level opinion, child domain characteristics most frequently guided of.001. their recommendations to the IEP team for which service Brandel & Frome Loeb: Program Intensity and Service Delivery 473  Table 9. Parameter estimates for service delivery model by disability. Disability level B SE exp(b) Most severe disability Articulationa Group outside the classroom Adjusted caseload.014**.004 1.014 In the classroom Adjusted caseload –.051**.011.950 Resource room Adjusted caseload.015*.006 1.015 Other Adjusted caseload.020**.005 1.020 PDDa Resource room Training 1-on-1 outside the classroom –1.829**.515.161 Group outside the classroom Training 1-on-1 outside the classroom –.882**.333.414 Moderate disability Articulationb 1-on-1 outside the classroom Adjusted caseload –.029**.006.971 In the classroom Adjusted caseload –.041**.010.959 PDDb Resource room Shared teaching with middle school teacher 1.798**.565 6.039 1-on-1 outside the classroom Shared teaching with middle school teacher.970**.372 2.639 a Reference category is individually outside of the classroom. bReference category is group outside of the classroom. *Indicates significance level of.01. **Indicates significance level of.001. delivery model to use. However, in most instances, regardless school level. In contrast, 92.1% of the SLPs had administered of severity, grade, or type of disorder, students were seen individual intervention outside of the classroom, and 87.5% in a group outside of the classroom. This was clearly the had provided intervention in a group outside of the classroom. preferred service delivery model. The question is, Why? More research is needed to examine the effect that varying Given the SLPs’ reports of consideration for general curric- the training experiences of future SLPs has on the types of ulum needs, it was surprising that more intervention was not service delivery models used later in practice. conducted in the classroom. As can be seen in Table 4, Closer examination of data concerning the service deliv- preschoolers had the highest level of classroom interven- ery model used with students with different disabilities also tion rates—at È15% for those with moderate and severe reveals interesting insights regarding in-classroom and disabilities. However, once the severity level declined to least outside-of-classroom intervention. Students with reading/ severe (Tables 6 and 7), SLPs reported a higher number of writing, pragmatic/social, PDD, and AAC devices were seen students receiving classroom-based services across a num- more frequently in their classrooms for intervention com- ber of grades. In general, though, classroom-based services pared to students with other disabilities (Table 7). However, were reported less often than intervention in a group out- these students were more likely to be seen in the classroom side of the classroom. This finding would appear to coincide if their disability was least severe. When their disability with the clinical training experiences reported by the SLPs was moderate or severe, the likelihood of intervention tak- during their graduate school training. Less than 25% of the ing place in the classroom was much lower. It is difficult to SLPs reported having experienced classroom-based inter- know the reasons why intervention outside of the classroom vention at the elementary level, and less than 10% reported was so often a preferred service delivery model. However, having experienced intervention at the middle and/or high it is clear that as a profession, these are answers we need to 474 LANGUAGE, SPEECH, AND HEARING SERVICES IN SCHOOLS Vol. 42 461–490 October 2011 pursue if we are to improve the decision-making process Conclusion for our intervention models and, subsequently, the outcomes for the students we serve. IDEA requires IEP teams to individualize the program Students with moderate or least severe disabilities were intensity based on the student’s needs and to provide interven- seen in a group a majority of the time across grades and across tion within the student’s least restrictive environment. Based disabilities. However, students with the most severe articu- on the results of this questionnaire, students in schools pre- lation disorder, social/pragmatic disorder, PDD, or AAC dominantly participate in intervention 2–3 times a week in devices were more likely to participate in intervention indi- groups outside of the classroom. Large caseloads may explain vidually outside of the classroom. It is important to determine the need to provide intervention within groups. The large what factors associated with these disorders made it more amount of intervention that takes place outside of the class- likely that individual intervention was preferred. We can room requires explanation that is not within the scope of this speculate that this may have been because they required study and yet is important for future study. Whereas caseload individual instruction time; however, future studies are size and SLP characteristics may account for this homoge- needed to support this hypothesis. neity in service delivery model across severity levels, there are two other possible explanations for the lack of diversity in the type of service delivery model used. Implications for Clinical Training First, SLPs may believe that this program intensity and SLP characteristics may have influenced the service de- service delivery model are appropriate for a student to make livery model the SLPs recommended to the IEP team. As adequate gains. There was some limited confirmation of this shown in Table 1, most SLPs experienced individual or group explanation from the e-mail follow-up questions, in which intervention outside of the classroom during their clinical two SLPs indicated that 2–3 times a week for 20–30 min in training. These same practices were prevalent in our survey groups outside of the classroom was sufficient. Unfortu- results. It seems logical that if we expect our graduates to nately, to our knowledge, there are no efficacy studies that use different service models within the schools, then we have evaluated the claim that 2–3 times a week for 20–30 min should provide them with a variety of experiences during in group settings outside of the classroom is an effective their clinical training. This suggestion is further supported by service delivery model. Therefore, there is a need for efficacy our finding of the increased likelihood of intervention in studies to evaluate whether students who are currently re- the resource room with those SLPs who had shared teaching ceiving speech and language services within the schools are experiences during their graduate clinical practica. When not only making adequate progress on their goals, but are also we send our graduate students to field study sites and they improving their performance within the general education conduct group intervention outside of the classroom as their classroom. Furthermore, comparisons of varying program primary type of service delivery model, should we be sur- intensities and service delivery models are needed in order to prised that this is the model that continues to be perpetuated? better guide the practices of SLPs working in schools. No, we should not be. What we can be doing as training Second, it may be that the current way in which SLPs report programs is having discussions about the advantages and their intervention program intensity amounts (time × week) disadvantages of this type of service delivery model for does not accurately reflect the intensity of their intervention. one student compared to another student. It seems that the Currently, there is no method for documenting the number of latter type of dialogue may lead to recommendations for in- teaching episodes that occur during a treatment session. There- dividualizing intervention that training programs would want fore, a total duration amount as recommended by Warren et al. to encourage. (2007) is used. As the school-based efficacy research agenda University training programs may also want to address continues to evolve, methods for systematically document- issues associated with workload and caseload and how they ing teaching episodes should be recommended and tested impact recommendations for service delivery model and by scientists and clinicians working together in schools. program intensity. As one example, Schraeder (2008) iden- tified 17 workload solutions that have been pioneered by Limitations of the Study school SLPs across the country. College courses and seminars could incorporate such information and methods into their It is important to note that there were some limitations training courses and seminars. to our study. The SIDM model is a first attempt to conceptu- There were also some disability groups who received alize aspects of how SLPs make recommendations concerning individual intervention rather than group intervention when program intensity. No doubt there are more characteristics to they were in the severe category. It may be beneficial for this model that we have not considered—some that may be university programs to pursue clinical discussions as well more important than we have brought to light in this research. as studies on the advantages and disadvantages of group We also were unable to analyze all of the SIDM model versus individual intervention with respect to students’ domain characteristics in this study due to the small number disability and severity levels. of values for some of the variables. This means that there Brandel & Frome Loeb: Program Intensity and Service Delivery 475 could very well be characteristics of the SIDM model that did influence SLP recommendations, but that we were unable ACKNOWLEDGMENTS to detect. We acknowledge the valuable contribution of Debora Daniels, Holly Storkel, Betty Bunce, and Diane Nielsen. In addition, we Directions for Future Research thank Vicki Peyton for her assistance in data analysis and inter- pretation and Jennifer Knell for her assistance on the project. Finally, Overall, our results indicate a need to explore further we express our gratitude to the SLPs who completed the question- the reasons SLPs are not using more varied program inten- naire and participated in the follow-up e-mail. sities and service delivery models, especially within the classroom, to provide intervention. The SIDM model pro- vided a starting point for understanding factors that impact SLP recommendations. Some factors that were included in REFERENCES the model that may be especially important for understand- American Speech-Language Hearing Association. (2000). ing working in the classroom, such as administrative support Guidelines for the roles and responsibilities of the school-based and the SLP’s relationship with coworkers, need to be eval- speech-language pathologist. Available from www.asha.org/policy. uated more thoroughly in future research. Based on the American Speech-Language-Hearing Association. (2002). A follow-up e-mail, there is some evidence that these two workload analysis approach for establishing speech-language factors may contribute in meaningful ways to the place and caseload standards in the school: Position statement. Available time for SLP services in schools. Further, there was some from www.asha.org/policy. limited evidence in the follow-up e-mail that SLPs adjusted American Speech-Language-Hearing Association. (2005). the program intensity and service delivery model to better fit Evidence-based practice in communication disorders [Position the input of their coworkers. When questioned further, SLPs statement]. Available from www.asha.org/policy. reported the difficulty of scheduling given the demands of American Speech-Language-Hearing Association. (2006). 2006 the school schedule and the input of their coworkers. 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Program intensity and distribution in tice among speech-language pathologists: Attitudes, utilization, morphosyntax intervention: Current evidence and future needs. and barriers. American Journal of Speech-Language Pathology, Topics in Language Disorders, 29(4), 291–311. 14, 208–220. Brandel & Frome Loeb: Program Intensity and Service Delivery 477 APPENDIX A (P. 1 OF 11). SURVEY OF SPEECH-LANGUAGE SERVICES IN THE SCHOOL As a school speech-language pathologist, you have many demands upon your time and skills. In an effort to better understand these demands, we would appreciate your response to the statements and questions below. Your name will not be associated with publication or reporting of these data. Your answers will provide us with insight into your service delivery choices. During the course of this questionnaire, you will be asked questions regarding the composition of your caseload. Please have this information readily available. The questionnaire will take 10 to 15 minutes to complete. Section I: Demographic Information 1. What year did you graduate with your master’s degree in speech-language pathology? ________ 2. How many years have you worked as a speech-language pathologist within the schools? ________ 3. Please mark all of the places in which you participated in clinical training as part of your university clinic, field study site, or externship during your graduate school experience. g Delivering one-on-one intervention outside the classroom g Delivering group intervention outside the classroom g Delivering intervention in the resource room g Delivering intervention in a self-contained classroom g Delivering classroom-based intervention for preschoolers g Delivering classroom-based intervention with shared teaching in elementary classroom g Delivering intervention in elementary classroom in which did not work directly with classroom teacher. g Delivering intervention in the general education classroom, but off to the side, not part of the general education classroom activity g Delivering intervention in Middle and High School classroom in which you shared planning and teaching with the classroom teacher g Delivering intervention in Middle and High School classroom independent of the classroom teacher g Consultation with school personnel Definitions: Outside the Classroom: Providing students intervention in a place that is not in the general education classroom but is not a self-contained classroom or resource room (e.g., the SLP’s office or classroom, the hallway, or a conference room) In the Classroom: Providing students intervention within the general education classroom and in conjunction with the activities being completed by their peers as well as occurring in the same area of the room as their peers (not at a table away from the class completing differing activities as his/ her peers). 4. Please indicate the amount of instruction and feedback you received from your supervisor during your clinical fellowship year (CFY). g No suggestions or feedback for improvement g General suggestions for improvement (e.g., goal writing, intervention strategies) g Specific suggestions for improvement in your intervention on five children or less (e.g., intervention goals or place for intervention) g Specific suggestions for improvement in your intervention on six or more children (e.g., intervention goals or place for intervention) g Other __________________________________________________ 5. Please indicate any of the following types of professional development which you have completed in the last 5 years NOT including graduate training. g Read journals g Attended state conference(s) g Attended national conference(s) g Attended seminar g Completed college course g District training g On-line programs g Teleseminars 6. Which of the following best describes the area which your school district serves? g Rural g Suburban g Urban 7. Please specify the number of students on your caseload who are in the following grades: Preschool ______ Elementary ______ Middle School/Junior High ______ High School ______ TOTAL ______ 478 LANGUAGE, SPEECH, AND HEARING SERVICES IN SCHOOLS Vol. 42 461–490 October 2011 APPENDIX A (P. 2 OF 11). SURVEY OF SPEECH-LANGUAGE SERVICES IN THE SCHOOL 8. Please check the appropriate description regarding your current employment status as a school SLP. g Full-time g Part-time (anything less than 100%) 9. For any of the children that you provide intervention, do you use block scheduling? Block scheduling is defined as when the child is seen 4 to 5 times a week for 3 to 6 weeks followed by a break for the same amount of time. g Yes g No 10. Please select the teaming model that best matches the one used at your primary school. g Multidisciplinary – Team members provide services independent of one another with a single person responsible for final decisions. There is little to no collaboration or communication between service providers. Similar to the medical model. g Interdisciplinary – Team members, including the family, provide services independent of one another with shared and equal decision making ability. These teams often utilize a coordinator for each child, and team members will collaborate with one another. g Transdisciplinary – Services are provided by one or two professionals with other professionals providing consultation and training. A case coordinator is utilized, and the family is involved throughout the process. g Other 11. Which of the following statements best describes how you determine the amount of time and the place a child will participate in speech and language intervention? g I, the speech-language pathologist, determine the best place and for how long intervention is provided based upon my knowledge and the severity of the child’s disability. g The child’s team members work together to determine the best place and for how long speech and language intervention is provided. g I, the speech-language pathologist, determine the best place and for how long intervention will be provided after receiving input from other team members. 12. Please specify the number of children seen in group intervention sessions during a typical week. _________________ 13. Please specify the number of students seen in individual intervention sessions during a typical week. _________________ 14. Please specify the number of students on your caseload seen in the following places. __________ General education classroom within class setting __________ General education classroom in small group or individually __________ Outside the classroom (e.g., speech room) __________ Resource room __________ Self-contained classroom __________ Other Definitions: Outside the Classroom: Providing students intervention in a place that is not in the general education classroom but is not a self-contained classroom or resource room (e.g., the SLP’s office or classroom, the hallway, or a conference room) In the Classroom: Providing students intervention within the general education classroom and in conjunction with the activities being completed by their peers as well as occurring in the same area of the room as their peers (not at a table away from the class completing differing activities as his/ her peers). 15. Please specify the typical amount of time spent on the following activities each week at work. __________ Direct intervention for IEP students __________ Consultation __________ Meetings (pre-referral, IEP, assessment) __________ Paperwork __________ Pre-referral intervention (Tier II interventions, interventions for children not yet on caseload) __________ Supervising speech therapy assistant __________ Professional development __________ Other 16. Please select the person that is most likely to conduct on-site observations of your intervention/assessments as part of your school contract. __________ Nobody observes me __________ Special education supervisor (not Speech-Language Pathologist) __________ Building administrator (e.g., principal, assistant principal) __________ Speech-Language Pathologist (district supervisor) __________ Speech-Language Pathologist (peer) __________ Other Brandel & Frome Loeb: Program Intensity and Service Delivery 479 APPENDIX A (P. 3 OF 11). SURVEY OF SPEECH-LANGUAGE SERVICES IN THE SCHOOL 17. How many different classrooms have students on your caseload? For example, an SLP who sees five first graders who are in the same classroom would have only one. In contrast, an SLP with five first graders in two different classrooms would have two. ___________________ 18. How many teachers do you consult with regarding students on your caseload during the typical week? _________ 19. For how many classrooms do you provide intervention in the general education classroom during the typical week? ___________ 20. During a typical week, for how many students do you provide intervention that are not on your caseload (e.g., Tier II services or children who are in the evaluation process)? __________ 21. How much time during the typical week do you spend providing intervention to students in the process of being evaluated (Tier II services)? ______________ 22. Does your administration in the school allow you to provide speech and language services for the AMOUNT OF TIME necessary to improve the child’s skills? Yes No Sometimes 23. Does your administration in the school allow you to provide speech and language services in the PLACE necessary to improve the child’s skills? Yes No Sometimes 24. For the students on your caseload, for how many did you have to adjust the amount of time due to a student’s level of motivation? __________ 25. For the students on your caseload, for how many did you have to adjust the PLACE you provided intervention due to a student’s level of motivation? __________ 26. For the students on your caseload, how many were impacted in regards to the AMOUNT OF TIME intervention is provided due to a need for peer modeling? ___________ 27. For the students on your caseload, how many were impacted in regards to the PLACE intervention is provided due to a need for peer modeling? ______________ Section II: Time (Program Intensity) 28. Please select the top consideration in regards to the child’s characteristics when deciding the AMOUNT OF TIME to provide intervention for students on your caseload. _______ The child’s communication needs in relation to his/ her general education curriculum. _______ The nature and severity of the child’s disorder. _______ The child’s strengths, needs, and emerging abilities. _______ The motivation and attitude of the child. _______ The child’s age and developmental level. _______ The need for peer modeling. 29. Please select the top consideration in regards to the workplace characteristics when deciding the AMOUNT OF TIME to provide intervention for students on your caseload. _______ Caseload size _______ Administrative support _______ Workload size _______ Team Input 30. Please select the top consideration from the following when deciding the AMOUNT OF TIME to provide intervention for students on your caseload. _______ Relationship with school personnel _______ Clinical training _______ Years worked _______ Professional development 480 LANGUAGE, SPEECH, AND HEARING SERVICES IN SCHOOLS Vol. 42 461–490 October 2011 APPENDIX A (P. 4 OF 11). SURVEY OF SPEECH-LANGUAGE SERVICES IN THE SCHOOL 31. Please select the top THREE considerations from the following when deciding the AMOUNT OF TIME to provide intervention for students on your caseload. _______ Caseload size _______ Relationship with school personnel _______ The child’s communication needs in relation to his/her general education curriculum. _______ The nature and severity of the child’s disorder. _______ The child’s strengths, needs, and emerging abilities. _______ The child’s age and developmental level. _______ Team Input _______ Administrative support _______ The need for peer modeling. _______ Years worked _______ The motivation and attitude of the child _______ Professional development _______ Workload size _______ Clinical training 32. For the following grades, please select the time that you or your assistant deliver intervention for the child on your caseload with the MOST SEVERE DISABILITY in each of the grade levels. Please provide answers ONLY for those grades represented on your caseload 1 time a 2-3 times 1 time a 2 or more No child in week for a week for week for times a week *Block this grade Grade level 20–30 min. 20–30 min. 45–60 min. for 45–60 min. scheduling Consultation Other on caseload PreK K 1st 2nd 3rd 4th 5th Middle School/Junior High High School *Block scheduling is defined as when the child is seen 4 to 5 times a week for 3 to 6 weeks followed by a break for the same amount of time. Brandel & Frome Loeb: Program Intensity and Service Delivery 481 APPENDIX A (P. 5 OF 11). SURVEY OF SPEECH-LANGUAGE SERVICES IN THE SCHOOL 33. For the following grades, please