Types of Services

The way in which professional therapeutic intervention is provided to individuals is service delivery. Types of services provided are impacted by treatment setting and therapeutic goals. The environment in which the individual is served (early intervention, public school, private practice, group home, short term care or long term care) will have different regulatory guidelines and procedures. Legislative and regulatory agencies that define policy for service delivery in various settings should be referenced by clinicians to ensure compliance. Whenever possible, interprofessional collaborative practice should be implemented to maximize the communication outcomes for an individual.

Direct and Consultative Services

The term direct services usually describes services provided by a specialist while in direct contact with a child or adult learner. These services may be provided in a one-to-one context, where the specialist is working with only one learner at a time, or in a group context, where the specialist is working directly with more than one learner at a time. For example, a speech-language pathologist (SLP) might facilitate a learner's use of natural gestures by providing communication opportunities while playing with a child on a structured learning task or teaching a learner how to select pictures to request foods at mealtime in the cafeteria.

A specialist may use separate pull-out time specifically to introduce and target certain communication skills. Pull-out treatment also may be used for role-playing conversations or to create structured opportunities. In the pull-out setting, there are fewer distractions. The special educator or classroom teacher also may be teaching the student how to communicate during natural interactions and within larger groups. The goals of the two service providers are complementary—and success with both is essential for the student, but they are not identical. Push-in services, rather than pull-out, may result in more time for students with severe disabilities to spend with friends, fewer disruptions to class routines, and increased communication among specific team members.

Whenever a specialist works with a teacher, parent, or other individual who will be responsible for promoting communication, the services are described as indirect or consultative. Sometimes a specialist will consult with a learner’s communication partners about strategies that will improve communication. For example, a specialist might teach a parent how to position a child in a way that promotes good breathing for speech or instruct a classroom teacher in the use of a picture schedule to comprehend transitions between activities. These would be examples of indirect or consultative services.

If the goal is to increase someone's ability to demonstrate a particular skill or behavior, then direct services are often appropriate. If the goal is to increase spontaneous use of a communication skill or behavior across many settings and with many different communication partners, then indirect or collaborative services may be more appropriate. This may include increasing the individual's interactions with friends, responses to questions in class, increasing communication skills related to job setting or within the community. A combination of service delivery approaches may be used to suit individual needs.

If the goal is to increase the individual's interactions with friends or responses to questions in class, then it may be more beneficial to provide direct or indirect services in the context of the classroom. For example, the individual's teachers may need to learn to use gestures or visual cues to enhance the child's comprehension of class routines or lesson content. Friends may need to learn to interpret a child's behavior in order to interact with him or her in meaningful ways. In this case, the SLP may act as a communication and language coach for the learner, teachers, and friends.

Bottom Line:

Both direct and indirect or consultative services are effective methods used to teach communication skills to individuals with severe disabilities. Services can be offered either in set-aside or pull-out treatment rooms or within the individual's natural environment. Each setting offers unique advantages for reaching the individual's specific goals and should be utilized to best increase functional communication outcomes. The decision regarding which service delivery approach or combination of approaches to use should be based on the targeted intervention goals for each individual.