Monday, June 8, 2015

The 3:1 Therapy Model: Getting Started

This is the 2nd post in a series about using a 3:1 Therapy Model. Last post, I introduced the 3:1 Therapy Model to you. My school implemented the program 6 years ago. When I started working there 2 years ago, I fell in love with the model. I know many of you are still reeling from the end of the year responsibilities. So now might be a good time to talk over changes in service delivery with your administration if you're feeling overworked. You can read here about the problems my district was facing that lead to their decision to use this model.

Whenever I start talking about this therapy model with a fellow SLP, I start to get questions about how we implemented this program. I was not with the district when they implemented it, but I will explain some of the methods out there regarding implementation of a program like this.

What about the minutes written in the IEP?

In our IEPs, the program forces us to write in a "minutes per week" style. For example, 2x15 minutes each week. On a four week cycle, this would be 120 minutes per month. Since all services are now being provided in 3 weeks, you need to adjust the length or the frequency of your sessions to meet those minutes in a shorter amount of time. For example, 120 minutes divided by 3 weeks is 40 minutes per week. You could now see this student 2x/week for 20 minutes each time to meet their minutes. On our IEPs, we would still write 2x15, but in the comments section, we note that we will be seeing the student for a total of 120 minutes per month. 

We also make a note in the "Additional Comments" section of our IEP. It reads something like this: "The speech-language pathologists in the ________ School District use a 3:1 Model of Service Delivery. This means that 4 weeks of services will be provided in the 3 week time span. The fourth week is set aside for the SLPs to complete screenings and evaluations, complete paperwork, attend meetings, perform make-up therapy sessions, consult with other professionals, bill public insurance, formulate lesson plans, etc." 

How can I start using this model while still meeting the requirements of my students' current IEPs?

A web search will show you three main ways of transitioning to this model. 

1.) Amending IEPs at beginning of school year.
- When IDEA was re-authorized in 2004, it was no longer necessary for the entire team to meet for an IEP amendment. So this is something that could be done quickly if communication with parents is strong. The proper paperwork would need to be completed and parents would need to agree to the changes & sign the paperwork (you could do this during Parent Teacher conferences, orientations, pickup & drop off times). You can find out more information about the process here.

2.) Gradually Changing the IEPs throughout the school year.
- This might work better for your students who do not have consistently involved parents. The minute wording can be changed at their annual IEP meeting. You could hold these IEPs earlier in the year to get the change done faster or gradually throughout the year.

3.) Implementation in the next school year.
-With this plan, you would notify parents of the change that would be made the following school year at each IEP meeting you hold. (So if you started notifying parents in the 2015-16 school year, you would not begin the 3:1 model until the 2016-17 school year.) In the Services Inside/Outside Gen Ed Classroom section of the IEP, you would write the minutes for the current school year as usual. The end date for these services would be the last day of school for the 2015-16 school year. Then you would write a second set of services starting on the first day of the 2016-17 school year. These services would be written in a minutes-per-month style and run through the last day of the student’s IEP. All IEPs in the 2016-17 school year would be written in a minutes per month style.
You can read more about this here.

DISCLAIMER: I am in no way trying to tell you what method you should or should not use. I am presenting methods that have been used by several districts throughout the country and thoughts presented on several different forums. It is up to YOU and YOUR TEAM to decide which method is best. Please make sure to consult all FEDERAL and STATE Special Education Laws and Policies, as well as reviewing YOUR DISTRICT'S policies on special education service administration before making any of these changes. As I stated above, I was NOT a part of the transition to this model. No matter what method you and your district chooses to use, it is IMPERATIVE that you have district & administration support.

What about make up sessions?
The Student Support Week is fantastic because it provides you with an entire week to have your meetings, but what happens when a meeting has to be held sooner than the next student support week? Go ahead and have the meeting and document the sessions that were missed. You'll make up that session during the next student support week. Many people get caught up in the idea that you can ONLY have meetings or do evaluations during that Student Support Week. And some months, that works out just fine. But we all know that there will be something that will pop up and need our attention. The 3:1 Model just provides more flexibility in scheduling. It's okay if you miss that session today, because you can make it up during the Student Support Week. The students' minutes can all be made up. It will be very, very important that you have a strong system in place to keep track of those missed sessions and the number of minutes students are seen each session. I use an attendance book. Each time I see a student, I write the number of minutes I saw them in the column for that date. At the end of the three weeks of services, I add up any sessions or minutes that were missed (ex. only saw them for 15 minutes instead of their full 20, so I need to make up 5 minutes). Then I can use that information to create my lesson plan for Student Support Week. I document any minutes they were seen during Student Support Week in the same manner. After that Student Support Week, we start the cycle over again with the three weeks of services. 

I know that was a lot of technical information thrown at you, but I hope I could explain it well. I would check around with some neighboring districts and see if any of them use at 3:1 or Cycle Model of therapy services. Have them come talk to you or help you get started. They might even be able to show you a sample of their documentation or attendance book. Then you can get some ideas. I, unfortunately, did not feel comfortable uploading any photos of my book on the internet for all to see - even with student names blacked out! :) Seriously though, take advantage of those that have done it before you. Local districts might even be able to tell you more about the legalities of making those changes for your area/state. They really are a wealth of information! 

Check back soon for the next post in this series which will talk about Medicaid Billing while using the 3:1 Therapy Model! If you missed the first post, you can go here to catch up! 

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