SLP Service Delivery Methods: Pull Out vs. Push-In
There is not much in-depth research that has been done on what method is the most successful method of service delivery, however, push-in with collaborative teachers seems to be the best. This article summarizes an Evidence-Based Systematic Review done on service delivery methods for speech-language interventions, particularly comparing pull out and push-in delivery and group versus individual therapy.
Pull out service delivery is when the child is pulled out of their normal classroom to have speech services. Push-in delivery involves pushing into the child’s regular classroom activities to incorporate services into their routine class activities. Other examples of push-in delivery are collaboration between the SLP and teacher, or indirect services like a consultation with teacher or parent-training.
Different Service Delivery Models Compared
This systematic review looked at the effects of different service delivery models on vocabulary, functional communication, and language and literacy.
Influence on vocabulary
Out of the studies reviewed, the research compared collaborative, classroom-based teaching, individual push-in services, and individual pull out services. Out of the studies, the most effective seemed to be classroom-based team teaching, with the least successful method being individual pull out services.1
Influence on functional communication
There were a lack of studies that qualified for this review, but what the authors labeled as an exploratory study done by Howlin (1981)2 provides “some evidence that training parents to implement a specific language program at home with their children with autism shows promise of being efficacious.”3
Influence on language and literacy
There was one study that found some evidence that classroom-based collaborative service model had the most positive effects on language and literacy.4
Implications
What this systematic review found was that there is still a lot of research that needs to be done. Based on this review, it is difficult to discern that one service delivery is superior to others. The authors of this review concluded that “some evidence suggests that classroom-based direct S/L services are at least as effective as pullout intervention for some intervention goals (e.g., vocabulary and that intervention in classroom settings may facilitate generalization of new skills to other natural settings.)”5Other sources state that there is now some research that push-in services where teachers collaborate with SLPs are slightly better.6
All methods can be effective depending on the context, but it is important to understand what method the individual child needs. For example, some children may also need indirect services such as parent-training to further their understanding. Others may not respond well to push-in methods and require therapy in a separate classroom away from distractions. Due to the lack of research on the subject, it is critical for the SLP and the IEP team to be able to determine the best course of action when it comes to service delivery.
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1. Cirrin, Frank M., et al., “Evidence-Based Systematic Review: Effects of Different Service Delivery Models on Communication Outcomes for Elementary School–Age Children,” Language, Speech, and Hearing Services in Schools. 41, no. 3 (2010): 247, https://doi.org/10.1044/0161-1461(2009/08-0128).
2. Cirrin et al, Evidence-Based Systematic Review (2010), 38, references P. Howlin, "The Results of a Home-Based Language Training Programme with Autistic Children," British Journal of Disorders of Communication, 16, no. 2 (1981): 73–88.
3. Cirrin et al., “Evidence-Based Systematic Review,” 247.
4. Ibid, 248.
5. Ibid, 249.
6. Dr. Karen, “Push-in services: Are they better than a pull-out model?” Dr. Karen Speech and Language, March 25, 2018, https://drkarenspeech.com/are-push-in-services-better-than-pull-out/
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Cirrin, Frank M., et al., “Evidence-Based Systematic Review: Effects of Different Service Delivery Models on Communication Outcomes for Elementary School–Age Children,” Language, Speech, and Hearing Services in Schools. 41, no. 3 (2010): 233-264, https://doi.org/10.1044/0161-1461(2009/08-0128).
Dr. Karen, “Push-in services: Are they better than a pull-out model?” Dr. Karen Speech and Language, March 25, 2018, https://drkarenspeech.com/are-push-in-services-better-than-pull-out/