One of the greatest challenges of school-based practice is to how to deliver speech-language services in a way that effects the most change in students within the confines of the daily schedule and logistics of the school environment.

Education law (the Individuals with Disabilities Education Act, IDEA 2004) supports serving students in the least restrictive environment (LRE), which can be interpreted not only as a place but also as inclusion with typical peers. For most students, inclusion means that speech-language services should take place with typical peers in the classroom environment, which can include the classroom as well as the lunchroom, playground, art room, gym, and field trips.

Speech-language pathologists should consider first serving students in classroom settings and then moving into more restrictive environments, such as a separate room, as dictated by the needs of the individual students. Although some students will require direct, individual instruction that can be best accomplish in the "speech room," many students can be moved quickly along the continuum of service delivery back to less restrictive settings in which typical peers can be used as appropriate speech and language models.

New Service Delivery Models 

Little evidence suggests that two half-hour sessions weekly promote students' ability to acquire and generalize speech or language skills, yet this option is typically chosen by teams that develop the Individualized Education Program (IEP). In a systematic review of research on school service delivery models, Cirrin et al. (2010) found that in many instances classroom-based services were at least as effective—if not more effective—in helping students to meet speech-language objectives.

To reconcile the requirement to serve every student in the LRE within the constraints of the daily school schedule, SLPs should look beyond twice-weekly sessions and consider a wide range of service delivery options to meet students' individual needs. For example, clincians are finding that "blast" treatment—providing short bursts of daily intervention—is proving to be very effective for many students. Clustering or grouping several students who receive speech services in selected classrooms is a helpful management tool, but it requires support from school administrators.

Administrators and other school personnel should be prepared for SLPs to take a role in implementing new service delivery models. The culture of the school must be amenable to SLPs working collaboratively in classrooms and planning with teachers weekly. The SLP may want to begin to effect change by providing an in-service to the entire school staff on the changing role of the SLP and new models of service delivery. SLPs may want to use the following strategies to effect change in the school culture:

• Garner administrative support to cluster students.
• Enlist teacher support to accept clustered students.
• Include time in the SLP's schedule to plan, pull students out, conduct evaluations, and provide consultation.
• Write functional goals for students in collaboration with teachers.
• Plan with teachers to embed intervention in classroom routines.
• Actively co-teach with teachers.
• Provide teachers with documentation of IEP goals.
• Devise a useful data collection system.

Clustering Students 

Clustering a group of four or five students who are eligible for speech-language services in a single classroom makes efficient use of the SLP's time in providing classroom-based services. Planning is essential to the success of this model, and may occur by meeting with teachers individually, at grade-level meetings, or within learning communities. Some clinicians choose to plan weekly or to spend one week each month planning, writing IEPs, or providing services on behalf of students, as suggested by the 3:1 model (Annett, 2004).

Classroom-Based Services 

Within the classroom, the intervention model will be different for every collaborative SLP-teacher team. Friend (2010) suggests several types of classroom-based service delivery approaches:

• One teach, one observe—one observes while the other teaches.
• One teach, one "drift"—one assumes primary teaching responsibilities while the other assists individual students.
• Station teaching—each teaches at a separate center.
• Parallel teaching—each instructs half the class using the same material.
• Remedial teaching—one presents material while the other re-teaches previously taught material.
• Supplemental teaching—one presents the lesson in a standard format while the other adapts the lesson.
• Team teaching—both share lecturing.

Classroom-based services using curriculum materials ensure relevance with the curriculum; fulfill IDEA mandates, which require that all services be educationally or functionally relevant; and support students in meeting the adequate yearly progress requirements of No Child Left Behind. However, some students will still need individual or small-group services in another room. Intervention for these students should be built around curriculum-relevant activities and materials, which may be a new concept for both SLPs and teachers.

Consultation 

Consultative/collaborative service delivery is another option for many students. The SLP provides these services—such as programming augmentative and alternative communication devices or engineering communication-rich environments—on behalf of the student. Consultative/collaborative services may be combined with direct services, and many states and local education agencies (LEAs) have a mechanism for documenting these services on the IEP. These services, which support teachers in carrying out speech-language goals, can be used at any point on the service delivery continuum.

Documentation 

A perceived stumbling block to new service delivery models is IEP documentation. States and LEAs have different rules about the documentation of services, but most allow some flexibility. The number of sessions that can reasonably be provided during a reporting period should be estimated; student absences, SLP absences, meetings, and field trips should be taken into consideration. For example, an IEP can reflect seven one-hour classroom-based sessions and seven half-hour individual sessions in the speech room per nine-week reporting period. SLPs who bill Medicaid can bill only for the number of sessions stated in the IEP, regardless of the length of the reporting period; when writing IEPs, SLPs should keep students' needs, not the potential for cost recovery, in mind.

When SLPs build better connections to teachers and the curriculum, they can strengthen the services they provide by focusing on curriculum-relevant skills that help students meet adequate yearly progress. When SLPs model their specialized instruction techniques in classrooms, teachers develop the ability to embed speech-language supports into daily routines, benefitting not only the students who receive services, but also other students in the classroom.