The age old question: how do I determine service levels?
The answer is simple: it depends.
One of the most vague yet honest answers I heard throughout graduate school and still rings true to this day. Throughout my years of schooling there used to (almost) always be in answer. You take a test and there was a right or wrong answer. None of this wishy-washy “it depends” answer that left you with more questions than answers.
I have come to learn and love the “it depends” answer. It applies not only to so many things at work, but it also applies to life as well. Before I diverge too much, let’s address what you came here for and discuss things to consider when determining services.
Before we get started, let’s review how NOT to determine services levels in a school setting:
Do I have time in my schedule to see this student?
As much as I know this is a reality for some, the focus for service is what the student needs to make meaningful progress on his or her goals.
My student has had 30 minutes/week for the past 10 years, I should just continue.
Past service levels do not automatically determine future services levels. Goals drive services.
Of course my skills and training as an (insert profession here) would help this child but it’s not related to his or her educational program.
This is probably one of the toughest ones I struggled with. I am sure you are an awesome and amazing therapist (that’s why you’re reading this) and your skills set is far more advanced in certain areas that may not be applied in the school setting. My training as a physical therapist allowed me to assess with a clinical mindset where we focused on global development, treating impairments, and participation across one’s life. In the school setting, we focus on educational participation and what impairments may be contributing to decreased access and participation. For example, if a child has the skills to navigate the school campus and playground but is unable to run a mile in less than 10 minutes, my intervention focuses on what he or she needs in school, even if I have the knowledge and skills to intervene for improved running speed. This may apply to specialists who are trained in swallowing and feeding depending on the guidelines in your district
I sometimes share the analogy of going to therapy for occupational health (workman’s compensation) vs therapy after a sports injury/surgery. An occupational heath therapist will focus on getting you back to a level where you can perform your job duties, not to get you back onto the ski lift to carve some fresh powder.
Now let’s get to questions to ask ourselves and the team to determine services levels once goals are established
What is this students’ prognosis? Are we looking to progress or maintain skills?
Are there changes to the environment that could help this student achieve this goal?
Who else can contribute to the success of this goal?
Does this goal require the expertise of a specialist to achieve this goal? If so, what is the specialist providing that no other staff member or specialist is able to provide?
How long can the student tolerate (medically or attention-wise) a session?
Is the student making progress or changes between sessions?
What happens during extended breaks (extended school year, holiday breaks, etc)? Do they regress so significantly that it impedes their progress?
During this time is other classroom staff with you and the student learning what you are doing for carry over or is it just 1:1?
When considering setting, what are the advantages and disadvantages of push-in vs pull-out and what is the amount of time necessary for each option?
As you gain experience you will start getting a sense of how your role and expertise can impact and influence change through intervention. It is good to get perspective from others, but too many opinions can muddy the waters and will leave you with more confusion than clarity.
If you’d like to continue the conversation, collaborate with more like-minded individuals, and keep up to date with different approaches to school based practice, we would love to have you join our online community!