Monday, June 1, 2015

3:1 Therapy Model - What is it?

This is the first post in a series that will discuss implementation and benefits of using the 3:1 Therapy Model for Speech and Language Services. If you are feeling burnt out, taking a ton of work home each night, and falling behind in your professional responsibilities due to lack of time during the work day, this series is something you'll want to read! It's a huge undertaking to get the process started, but so worth it in the end. I have spent the last 2 years working in a district that has been using this model for 6 years. It is definitely something you'll want to present to your administration if you're feeling overworked!

We all know that providing therapy, completing evaluations, writing evaluation reports, completing screenings, providing RtI services, writing IEPs, attending meetings, completing continuing education work, billing Medicaid, and writing lesson plans can take a TON of time. Throwing in a Clinical Fellow or Intern to supervise, trying to get some prep done, or having to travel between building can kill huge chunks of time as well. Yet we are all expected to complete all these tasks with flying colors. It's a recipe for disaster. And a few years ago, my school experienced the disaster.

This happened before I started working at this particular school, so I don't know the WHOLE story. But I can fill you in on the factors that lead to the disaster. My district has an incredibly high poverty rate, with the majority of students qualifying for free or reduced lunch - so that means most of them have Medicaid services I need to bill for. This year, of the 52 kids on my caseload - 48 of them required me to bill Medicaid. That's a high percentage of medicaid billing. Furthermore, my district has a high turn over rate for SLPs. We're talking at least one new SLP each year. Which requires training - and usually those new SLPs are CFs, which require supervision. Every SLP in our district travels to at least 2 buildings, most to 3 - another HUGE time sucker. They were all taking home hours of work each night just to get the basic needs met. Therapy was not nearly as effective because prep time was nonexistent. The result? Three very burnt out SLPs that were falling behind on their work and providing only basic therapy.

Thankfully, they went to the administration with their concerns. As a team, they started looking for alternative approaches to therapy implementation that would provide for more time for indirect services while still meeting the needs of the children. They decided to pilot the 3:1 Therapy Model, which is supported by ASHA, for a year. Six years later, the district is still using the model. Dismissal rates have actually improved over the last 6 years. Medicaid is getting billed regularly and timely. IEPs and evaluations are being completed within the timelines WITHOUT DIFFICULTY. Missed sessions are consistently made up and students minute per month totals are being met. And the amount of work that SLPs take home has been greatly reduced. So, if this sounds like something your district needs, keep reading!

What is the 3:1 model?

It always surprises me that when I tell people that we use a 3:1 therapy model, their first question is "What is that?"  So, let me begin with the basics. The 3:1 Therapy Model is a method of service delivery where students are seen for services for 3 weeks in a row. The fourth week is set aside for the SLP to complete evaluations, administer screenings, provide make up sessions, attend meetings, and complete indirect service tasks (Medicaid billing, writing IEPs, etc). We call this week, "Student Support Week." But I have also seen it referred to as, "Indirect Services Week," "Coaches Week," "Collaboration Week," and "Meeting Week." This model allows for time to be spent during the work day on those extra tasks, thus reducing the amount of work taken home. Similar models include a "Cycles Model," where you may set a different amount of time for each. For example, you might spend 9 weeks providing services and then have 2 weeks for indirect services. We like the 3:1 model because we know we have one week each month to make sure we are getting those evaluations done within the 60 day timelines.

Is there evidence to support this model?

Yep! In fact, ASHA supports this model. It may seem counter-intuitive since the students are only receiving services for 3 weeks instead of 4 each month. But, evidence has shown that consistency matters more than amount. Since this model allows time to make up missed sessions, consistency of services provided increases dramatically. You can find more information about addressing "caseload" vs. "workload" and the different approaches to service delivery here. ASHA addresses several different service delivery models under the "Service delivery" heading. There are also several studies that have determined that job satisfaction in much higher with this model. You can read some information about that here. You can also find more information about the implementation and evidence supporting the 3:1 model here.

Check back later to read the rest of the posts in this series. Follow my blog to make sure you don't miss any of the new information. Up Next: Getting Started! 

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