If you’re a school SLP or other related service provider who can’t seem to address all the skills your students need in your therapy sessions…guess what?
You’ll never be able to do it.
You aren’t losing your mind…this is really impossible.
And if your brain is tempted to say, “The SYSTEM is too broken to solve the problem,” stick with me for just a minute, because I’m going to walk through a step you can take despite systemic limitations.
It’s impossible to effectively address language, executive functioning, and any important cognitive skills kids need when you’re trying to do it in 30-minute weekly sessions.
I know your administrators might be asking you to use this model because that’s what we all know.
I ALSO know there are other systemic issues impacting your ability to provide quality services.
But the system only FEELS broken because we’re expecting pieces of it to do things they were never intended to do.
For you, as a clinician, one of those things is direct therapy.
It’s true that there are MANY useful ways we can use a direct service model to support language and executive functioning.
For language therapy, many foundational skills need an element of intensive, direct therapy to form the foundation for skills that could be applied outside of sessions.
For executive functioning, the same applies, but also direct interactions with students can serve as an opportunity to preteach, frontload, and prepare students for things coming up in their lives.
But those direct sessions are only one layer of what needs to be happening. A powerful layer, yes.
But not the only one.
Without other support and scaffolding outside sessions, we often see poor skill-transfer because controlled small-group or 1:1 sessions often don’t provide the same experience as being out in the world and applying language and executive functioning skills.
Expecting direct service to be the “complete package” would be like booking a one-way ticket and being upset that you didn’t end up back home. You haven’t completed all the necessary steps to get you to your final destination.
When clinicians feel overwhelmed when addressing language and cognition (even clinicians with a lot of experience and knowledge), I recommend they use a concept called “stacking”.
Ideally, clinicians should have a robust set of protocols that they could use to address both language and executive functioning in some way in direct intervention.
But they should also have a set of tools they use for other service delivery models to facilitate generalization, such as consultation, coaching, training, classroom-based intervention, community-based services, among others.
Direct therapy is just ONE of many service model options.
When you think of the complexity of language and executive functioning in direct intervention alone, it’s quite overwhelming for clinicians. Add on other service models, and it feels impossible.
It IS nearly impossible, if you try to implement all those pieces at once.
That’s why instead, I have clinicians come up with a vision for a long-term solution, and slowly “stack” pieces of that solution one at a time.
Here’s how the stacking concept could look:
The framework I teach for language therapy centers around vocabulary, and addresses five linguistic components that support language comprehension, expression, and literacy:
- Phonology
- Orthography
- Morphology
- Semantics
- Syntax
First clinicians could start by “stacking” protocols in their language therapy system, which could be one layer.
Then, they could do the same thing with executive functioning.
The framework I teach for executive functioning centers around these five components that inform what protocols you’d build:
- Time Perception
- Self-Talk
- Future Pacing
- Episodic Memory
- Encoding
If you’ve already “stacked” language protocols, now you can continue addressing language in your direct intervention, but spend your planning time building executive functioning assets.
All of this can be happening within the “direct intervention” layer. But once you have a solid set of protocols for BOTH language and executive functioning, you can move on to the next phase, which is “stacking” service models.
Once your direct intervention feels solid and streamlined, you’ve created space for focusing on USING those tools you’ve designed for direct therapy to build additional tools to support operating procedures around consultation, training, and coaching.
You could also use your assets to develop tools you could apply to a classroom-model or community-based model.
You could think of your specific treatment protocols (e.g., time perception, semantics, syntax) as “micro” stacks, and your service models (direct therapy, consultation, training) as “macro” stacks that have mini stacks within them.
Should you also focus on advocating for MORE direct service time and smaller caseloads so you can target more within a direct model? Also yes. That could be another layer.
But the important thing is that you have a lot you can do NOW, in the system as it currently functions, with all its benefits and many flaws.
The system isn’t broken. We don’t need to throw it all out and start over.
We just need to use the pieces of the system as they were intended.
We wouldn’t be upset if we used a screwdriver like a hammer and it didn’t work. We’d be asking the screwdriver to do something it wasn’t designed to do.
Why not use a hammer AND a screwdriver so we have multiple tools at our disposal, so we can leverage each of them for their benefits?
I teach the concept of “stacking” in Language Therapy Advance Foundations (for language therapy) and the School of Clinical Leadership (for executive functioning).
Learn more about Language Therapy Advance Foundations at: drkarenspeech.com/languagetherapy
Learn more about the School of Clinical Leadership at: drkarendudekbrannan.com/clinicalleadership
