3:1 Model: From Research to Implementation

1
31 Model From Research to Implementation

• Friday, November 16, 2007
• ASHA Convention
• Session 0509
• Lisa M. (Keller) Herrera, MA, CCC-SLP
• Judith A. Burrows, MA, CCC-SLP
• Calhoun Intermediate School District
• Marshall, MI

2
Pre-Test

• Directions Circle True or False for the
  following
• The 31 model means 3 weeks of indirect service
  and 1 week off.
• T F
• It is recommended that approval of the 31 Model
  begin at the highest level of Administration.
• T F
• It is recommended that therapy time for the 31
  Model on the IEP be written in minutes per month.
• T F
• All therapists involved in the 31 Model must be
  on the same calendar schedule.
• T F
• Parents must be notified by letter prior to use
  of the Model.
• T F
• Good Luck!

3
Quotes About the 31 Model Prior to Its Use

• Something has to change!
• How do we see children and still do everything
  else?
• The paperwork is overwhelming!
• I would like to do classroom observations and
  consult with my teachers but who has the time!

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Responsibilities for Direct/Indirect Service Week

• Services Provided
• Therapy session-Pull-Out, Classroom, Group,
  Individual
• Classroom/Indirect Therapy
• Classroom Observation of student, Carry Over,
  Assessment of Objectives
• Classroom Curriculum Alignment
• Contacts
• Parent
• Teacher-General and/or Special Education
• ISD Personnel involved with student
• Outside Agencies
• Child Find Meetings
• Service Team Meetings
• Staffings
• IEP Meetings
• Speech-Language Pathologist Team Meetings
• Professional Collaboration with other
  Speech-Language Pathologists

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Responsibilities for Direct/Indirect Service Week
(Continued)

• Evaluations
• Screenings
• Initial Evaluations
• Re-Evaluations
• Hearing Screenings
• Scheduling
• Referral Intake
• Evaluation
• MET
• IEP
• Transition IEP
• Staffings
• Observations

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Responsibilities for Direct/Indirect Service Week
(Continued)

• Paperwork
• Preparing and completion of evaluation plans
• Preparing and sending our invitations
• Preparing MET
• Preparing IEP draft/final
• Documentation of contacts, therapy, information
• Completion of Progress Reports
• Medicaid Billing
• Email or other work-related correspondance

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Responsibilities for Direct/Indirect Service Week
(Continued)

• Planning
• Researching and Securing Materials
• Producing Therapy Materials
• Incorporation of General Curriculum into Therapy
• Producing Carry-Over Activities

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Background-How CISD got interested

• Lisa Keller and Judy Burrows read article in ASHA
  Leader about Sharon Soliday and the pilot being
  done in Portland, Oregon Public Schools.
• Lisa Keller contacted Sharon Soliday about the
  pilot to obtain info and ask questions.

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Background, Contd

• Keller and Burrows talked to the CISD SLP group
  about article.
• Soliday demonstrated that the model gave strong
  support for students in general curriculum.
• There is not a lot of additional research out
  there.
• ASHA supports the use of this model as a workload
  delivery model.

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ASHA Leader Article

• Annett, M. (2004, March 2). Service delivery
  success SLPs in Oregon schools tackle workload,
  enhance recruitment. The ASHA Leader, pp. 1,
  12-13.
• According to Soliday, results of the 2001-2002
  pilot project included
• significant reductions in speech-language
  pathology work being completed at home at the
  district's expense
• significant increase in billings for third-party
  Medicaid reimbursement, generating
• money for the district
• fewer student service cancellations, improving
  compliance
• increase in consultation to teachers and parents,
  improving quality
• better morale among SLPs
• improved ability of SLPs to integrate speech and
  language goals with classroom curriculum, as
  mandated by IDEA

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Formed a committee

• A committee of 4 people (two others besides Judy
  and Lisa) was formed to look at the issues and
  decide on next steps.
• There was not a lot of interest right away from
  the CISD SLP group.
• Many in the group worried about the change from
  current delivery methods.
• Committee had discussion with Administration
  including rationale and research for the Model.

13
Talk to Your Neighbor

• Take a minute and think about how this could be
  presented to your own SLP department.
• What factors need to be addressed?

14
Site Visits

• Committee decided to do a site visit to St.
  Joseph County ISD.
• Committee met with SLP staff at their Friday
  meeting for a panel discussion.
• We were joined by our Director of Special
  Education.

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Pros and Cons from St. Joseph County ISD
31 Model
Students to Benefit All Students What CISD
found Above items in the Pro column. Teachers
and students had no problems following schedule
once they knew model Pre-school staff followed
alternate method of 31 model More consistent
services to students Increased time for
collaboration with teachers and parents
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Site Visit, Contd

• St. Joseph County shared that they didnt know
  what they did before 31 Model.

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Group SLP Presentation with Director of Special
Education

• Discussion with the Director included Pros and
  Cons from St. Joseph County ISD.
• Committee and Director discussed concerns about
  use of the Model.
• Committee was left with 2 choices

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2 Choices

• Continue research with data collection and look
  at proposal again
• Start pilot immediately

19
Start Pilot

• Committee chose to start the pilot after some
  additional considerations.
• Committee had to look at factors involved in
  starting the pilot.

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Talk to Your Neighbor

• What factors do you need to consider when forming
  a pilot?

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Factors to be addressed

• Calendar considerations
• Who would be included in pilot?
• IEP documentation time
• Documentation for Indirect time

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Calendar Considerations

• Consistency of meeting dates
• Consistency for committee meetings
• Consideration of vacation, holiday, MEAP,
  conferences, and short months.
• Medicaid billing due dates

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Participation

• Included OT and PT groups
• OT and PT had small staff numbers and numerous
  building sites.
• OT and PT had similar frustrations regarding
  consultation and compliance issues.
• Currently, Resource teachers are looking to try a
  one day a month model similar to 31 for their
  compliance tasks.

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Talk to Your Neighbor

• What factors are needed to address time on IEPs?
• Keep in mind flexibility and maximum benefit for
  student.

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IEP Documentation

• Chose Minutes per month, i.e. 30-120 minutes
  per month.
• Our IEP only includes direct time in the service
  section. Indirect time is not specified.
• Range includes minimum service to maximum service
  time.
• Time is based on student needs.

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IEP Documentation, Contd

• Some IEPs needed to be re-written as some staff
  still documented as minutes per session, per
  week.
• IEPs done at annual meetings or thru addendums.

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Documentation for Indirect Time

• Committee looked at different ways to document
  indirect time.
• Committee shared different ways with Director of
  Special Education.
• Director chose to look only at Medicaid revenue
  to see that it remained the same or showed an
  increase.
• No other documentation needed, but could be used
  if your district chooses.

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Administrator Approval

• Committee showed materials for pilot to Director
  of Special Education for final approval.
• Model was approved easily in Spring, 2005.
• Staff was approved to start pilot officially in
  Fall, 2005.

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Talk to Your Neighbor

• What factors need to be addressed to distribute
  information or provide awareness of model?
• What should the indirect time be called and why
  is the name important?

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Indirect Time

• Committee looked at name for indirect time.
• Committee decided to provide indirect service
  time in one entire week.
• Committee chose to call it indirect week to
  encompass all of the indirect services that would
  take place.
• Committee trained themselves and the rest of SLP
  group to use the name, Indirect week, instead
  of week off.

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Procedure for Awareness

• SLPs needed to inform parents, staff, and
  administrators of use of the Model.
• Committee looked at best method for
  implementation.
• Committee needed a consistent method to ensure
  being able to pilot method in Fall, 2005.

34
Identified a start date

• Committee chose to be consistent with informing
  parents, staff, and administrators.
• SLP group started information process in Spring,
  2005 to be ready for the Fall, 2005
  implementation.

35
Method of Information

• A letter was sent out from Administration to
  Superintendents, Special Education Supervisors,
  Principals, Teachers, and Staff about 31 Model.
• The Director took the letter to meetings with
  Superintendents and Special Education
  Supervisors.
• Committee members offered to attend meetings if
  needed, but this was not the case.

36

• To School Administrators and Staff
• From
• Date August 24, 2005
• Re 31 Model for Service Delivery for the
  School Year of 2005-2006
• The CISD Speech-Language Pathologists are
  piloting a research based service delivery model
  this year. This model will enhance services to
  students, increase consultation time with
  teachers and parents, and create a better working
  environment. It is called a "31 model" for
  service delivery and has been used successfully
  in St. Joseph County along with various districts
  throughout the United States. This model is
  supported by the American Speech-LanguageHearing
  Association. Research indicates that this model
  provides
• More consistent services to students
• Increased time for collaboration with teachers
  and parents
• Three weeks out of the month are designated for
  direct intervention with students and one week is
  used for indirect services. Indirect services may
  include but are not limited to
• Conducting and attending CISD and local
  district meetings
• Performing evaluations and consultations
• Observing in classrooms
• Developing therapy materials relevant to the
  curriculum
• Completing required special education
  documentation
• Listed below are the weeks scheduled for
  indirect service. Please be advised that during
  the indirect week, Thursdays are reserved for
  Speech Departmental meetings and therapists will
  need to attend those meetings. We are excited to
  pilot this program and anticipate working closely
  with you to ensure the best service for your
  students. If you have any questions, please
  contact your building therapist or the CISD
  Special Education Supervisor for your district.
• Schedule of Indirect Service 2005-2006
• September 26-30 February 27-March 3
• October 24-28 March 27-31
• November 28-December 2 April 24-28

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• To Classroom Teacher
• From Speech Therapist
• Date
• Re 31 Model for Service Delivery
• The speech and occupational therapists are
  piloting a different service delivery model for
  this year, which will enhance services to
  students, increase consultation time with teacher
  and parents, and create a better working
  environment. It is called a 31 Model for
  service delivery.
• Three weeks out of the month are designated for
  direct intervention with students and one week is
  used for direct/indirect services. These services
  include
• Direct Intervention
• Conducting and attending meetings
• Performing evaluations and consultations
• Visiting classrooms
• Developing materias
• Completing special education procedures
• This model is supported by the American
  Speech-Language Hearing Association. Research
  indicates that this model provides
• More consistent services to students
• Increased time for collaboration between
  teachers and parents
• Below are the scheduled weeks for the
  direct/indirect week of service delivery each
  month. Please be advised that Thursdays are
  typically reserved for Speech Department meetings
  and therapists will generally be at the CISD on
  this day. We are excited to pilot this program
  and anticipate working closely with you to ensure
  the best service for your students. If you have
  any questions please contact your building
  therapist or principal.
• Schedule of Indirect Speech Service 2005-2006
• September 26-30 February 27-March 3

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Informing Parents

• The SLP group discussed the best way to inform
  parents.
• Some chose to write a personal letter.
• Most chose to inform parents at IEP meetings
  starting in the Spring, 2005.
• Mock-IEP demonstration

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Set Calendar

• The calendar needed to be consistent throughout
  the CISD.
• The committee decided to follow last week of
  month calendar option.
• There were alternate options available to those
  who decided to use them to fit their program
  needs.

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Using Alternative 31 Calendar Considerations

• Make sure meeting date is consistent.
• Communicate with staff and secretaries for IEP
  meetings, Child Study meetings, and other meeting
  dates.
• SLPs serving special populations-i.e. Preschool
  SLPs, might benefit from use.

44
Sample Schedule for Indirect Week

• Monday
• 9-930 Language group 3 4th Resource Room
• 930-1000 Observe class (2 students)
• 1000 Phone calls to 2 parents
• 1030-1100 Meeting with Mrs. Hu (re 6 students)
• 1100-1130 Observe Mrs. Ws class (2 students)
• 1215-1245 Evaluation
• 1245-200 Report Writing (2 reports)
• 200-230 Observe Mrs. Qs class (4 students)
• 245 Observe Mrs. Ts class (3 students)
• Tuesday
• 745-930 Saw students
• 1000-1030 Meeting with Mrs. Ha (2 students)
• 1030-1040 Meeting with Mr. D (2 students)
• 1045 Email supervisor, caseload
• 1130-1230 Report
• 1230-1245 Meeting with Mrs. B
• 100-115 Paperwork

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Sample Indirect Schedule (Contd)

• Wednesday
• 750-820 Saw kids
• 850-915 Observe Mrs. B (2 students)
• 930-955 Observe Mrs. K (4 students)
• 1000-1020 Individual Therapy
• 1020-1050 IEP
• 1100 Individual therapy
• Called 3 parents
• Paperwork
• 130-150 Paperwork for initial evaluation
• 200 Filled out autism scale with Psychologist
• 230-320 School Diagnostics Team meeting
• Thursday
• 745-900 Therapy
• 900-915 Meeting with Mrs. Q (4 students)
• 930-1000 Evaluation
• 1000-1130 Scoring Test, writing a report,
  corresponding with School Psychologist
• 1230-1245 Observe Mrs. Ha (2 students)

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Sample Indirect Schedule (Contd)

• Friday
• 800-930 Prepare Paperwork for IEP, edit
  reports, prepare papers to send home to parent
• 930-1000 Consult with School Psychologist
• 1000-1100 Travel to Middle school, therapy,
  travel back
• 1100 Call parent to confirm IEP
• 1100-1130 Medicaid Billing
• 1215-1240 Observe show and tell in Mr. Ts room
  (2 students)
• 1240-200 Organize office, make therapy
  materials
• 200 Individual therapy
• 230 Individual therapy
• 300 Get ready for next week

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Implement Pilot

• Pilot was ready to go once these steps were
  completed.
• Pilot was easily implemented among the various
  districts in CISD.

48
Review After Pilot Year

• Committee and SLP department reviewed data from
  pilot year survey.

49
CISD Implementation Data

• 88 (29/33)of staff used 31 model during
  implementation period.
• 12 (4/33) used traditional delivery method.
• 100 of staff felt that the use of the 31 Model
  made some difference, while 54 felt it made a
  lot of difference.
• 79 of staff felt that the use of the 31 Model
  would make them more likely to stay in their
  current job.

50
CISD Implementation Data (Contd)

• 83 felt their level of stress decreased.
• 48 felt students received increased direct
  services.
• 55 felt students received increased indirect
  services (i.e. observations, planning, etc.).
• 72 saw less cancellation of services.
• 59 saw a decrease of work at home.
• 62 felt that they were better able to meet
  time-lines for compliance activities.
• 96 wanted to use model again the following year.
• 83 liked the current calendar, however the
  calendar was tweaked to better fit needs of all.

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Review After Pilot Year (Contd)

• Calendar was revised due to lack of consideration
  for conferences, breaks, and holidays which
  meant some times were too long or too short.
• Committee looked at how many wanted to continue
  using the 31 Model.
• Committee reviewed meeting schedule for SLP
  Professional Group (OT and PT reviewed their
  own).

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Decision to Continue

• Staff overwhelmingly decided to continue with use
  of model.
• Preschool staff continued to look at ways to
  tweak schedules within the model. Some had
  continued with traditional delivery methods and
  now wanted to try alternative schedules.

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Discussion

• What will you do with this information when you
  return to your own SLP group?

54
When Is the Indirect Week?

• A new calendar is created with the Indirect week
  schedule for the year to be given out to the
  staff.

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When is the Indirect week? 2006 September
25-29th October 30-November 3 November
27-December 1 December 18-22 2007 January
29-February 2 February 26-March 2 March 26-March
30 April 30-May 4 May 28-June1
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Post-Test

• Directions Cross-Out True or False for the
  following
• The 31 model means 3 weeks of indirect service
  and 1 week off.
• T F
• It is recommended that approval of the 31 Model
  begin at the highest level of Administration.
• T F
• It is recommended that therapy time for the 31
  Model on the IEP be written in minutes per month.
• T F
• All therapists involved in the 31 Model must be
  on the same calendar schedule.
• T F
• Parents must be notified by letter prior to use
  of the Model.
• T F
• Good Luck!

57
Quotes About 3 1 Model After Pilot Year
Implementation

• "This model made my job feel do-able."
• "The 3 1 model gives me permission to do work I
  need to do."
• "The stress level reduced tremendously!"
• "I can't imagine doing my job without it."

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Resources

• American Speech-Language-Hearing Association
  (2002). A workload analysis approach for
  establishing caseload standards in the schools.
  Guidelines. ASHA Desk Reference (vol.3).
  Rockville,MD Author.
• Annett, M. (2004, March 2). Service delivery
  success SLPs in Oregon schools tackle workload,
  enhance recruitment. The ASHA Leader, pp. 1,
  12-13.

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Group Activity 1

• 1. Consider your school calendar and set up your
• indirect week (time) for the school year.
• 2. Consider your caseload and create a schedule
  for indirect time for one month.

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Time for Questions

• If you have more questions, please feel free to
  contact us at the following email addresses
• Lisa Keller kellerl_at_calhounisd.org (or
  herreral_at_calhounisd.org )
• Judy Burrows burrowsj_at_calhounisd.org