While traditionally many SLPs practiced only the pull-out service delivery model, this has been changing in recent years and the expectation that school SLPs provide services using the push-in model is increasingly common. In New York City, Chancellor of the Depart of Education, Dennis Walcott called for a push-in model to be used with students receiving related services. When I started working at a middle school in Brooklyn, I did not have any previous experiences providing services by pushing in. At the school placement I had done in graduate school, the SLP I worked with used the pull-out model. When I asked around for advice, I was hearing that a lot of SLPs wanted to provide push-in therapy and wanted to go into the classrooms but most did not know how to do it effectively.

I read as much as I could online, incorporated tips from colleagues and went into the classroom with an open mind and looking out for how I could address IEP goals and common core standards while there. I mostly work in ITT classrooms and 12:1:1 classrooms where as many as half the students in the class get speech services. So far, I have decided to do 1 pull out session and 1 push in session for each of the kids that get services twice a week. My push-in therapy includes collaboration with teachers by getting their lesson plans ahead of time and picking out the vocabulary and language that I think will be most difficult for the kids on my caseload. I collaborate with teachers by letting them know the children’s speech goals so that they can incorporate that into the class as well. I can design my pull out sessions around what is being done in class. I also try to scaffold for the speech kids by providing graphic organizers and sentence starters during class activities. I help them to remember strategies we had practiced in the pull-out sessions.

I have noticed a lot of benefits of using the push-in model of service delivery. The most obvious advantage is the ability to collect data on and support carryover of skills practiced in pull out therapy sessions. Sometimes a student looks very different when comparing his performance in a small group setting versus the classroom. The disability can become much more apparent when the student is in the most important setting! The opportunity to work more closely with classroom teachers, who are able to spend a lot more time with those students on my caseload, has been very helpful as well. The teacher’s point of view gives me insight as to their progress on goals and in writing new goals. I am also able to share my knowledge with teachers and paraprofessionals and give them tips on how to support those kids with language impairment. The push-in model is also a great way to develop good clinical judgment. I am around typically developing kids from the same speech community as the kids on my caseload all the time. This has been especially useful when attempting to tease out what difficulties I’m seeing that are the result of dialect and socioeconomic differences and what is caused by the language disability.

But, there can be challenges to providing push-in therapy too. The SLP must develop a good working relationship with the classroom teachers and make time in their schedule to collaborate effectively with them. It can also be hard to find your role in the classroom and not fall into being another paraprofessional. With my age of students (middle school), sometimes the kids resent having the SLP in the room because it’s embarrassing in front of their peers. Additionally, data collection can be more difficult within a chaotic classroom (compared to the speech room).

What about you? What benefits and challenges have you seen while providing push-in therapy? How do you do it?