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Starting Push-In Speech Therapy in Schools

Discover effective strategies for implementing push-in speech therapy services in secondary settings. Learn how to foster inclusion and utilize collaborative teaching formats for successful speech-language therapy in schools.

MIDDLE SCHOOL SPEECH THERAPY

K. Abendroth

3/14/20266 min read

How to Do Push-In Speech Therapy for Middle School

It goes by a lot of names: push-in therapy, collaborative services, inclusion, integrated therapy, or co-teaching.

For consistency I will use the term “Push-In Therapy” throughout this article to describe providing speech-language services in the classroom, rather than “pulling out” students in pairs to your speech room.

Whatever the term, I am here to tell you that going into classes is your secret weapon in secondary grades. It took me a LONG time to lean into collaborative teaching models, or push-in therapy formats, but now I will never go back. Here’s why:

Efficiency. See more students per group and they don’t waste time transitioning between rooms.
Face Saving. Secondary students often do not want to be pulled out of class. Going into the classroom eliminates this issue.
Effective. Model language strategies and AAC for teachers.
Therapy focused. When I am in a classroom, I can focus on the lesson because the teachers help with behavior management. I don't stop my lesson for one student, although engaging activities also reduce behaviors.
Authenticity. I can see how my students interact with peers. There is ample opportunity for in the moment learning.

Types of Push-In Therapy

Push-in therapy can take many different forms. You may also take a different role in different classes. Here are the most common:

✅One Teach One Float Model

This is my favorite mode, with the teacher getting a break while I take the lead. However, some students (e.g., AAC) may benefit from your direct support while the teacher presents a lesson.

✅ Stations Model

This model works in special education classes during literacy blocks or even in library blocks. Set up depends on small groups within the class, with the SLP taking the students who have IEP goals and targeting those.

✅ Co-Teaching Model

These are fully collaborative lessons where the SLP and another professional teach together. I have used this approach with school counselors for pragmatic and social skills lessons, in particular.

What Do Push-In Sessions Look Like?

For me, going into classrooms means working with larger groups than I could pull out in smaller sessions. Typically, I do a whole class lesson at the front of the room. For students who get speech-language services on their IEP, they participate in the activity.

If students are in the room who don’t have Speech-language services, my activity is optional. Most teachers I work with will give the “non-speech” students an alternate writing activity they can complete.

While this format, where I take the lead, does require planning an activity that fills the time, it is much less than planning multiple sessions throughout the day. I use the same broad activity throughout the week with all groups, modifying the types of questions and interactions for ability level.

In most push-in sessions, I start with an engaging topic or visual prompts that the whole class can see. For example, using pragmatic cards like these or using vintage ads are a great way to get students talking. Another example was using live zoo feeds to target multiple goals and get everyone talking about habitats.

The second portion of the session involves writing or drawing, for consistency. It may include opinion questions, perspective taking prompts, asking students to write a question for the group, or a graphic organizer.

What does data collection look like?

The biggest question I get from other SLPs is how do you collect data during push-in lessons? Honestly, I don’t collect numeric data on every student every session. I do observe everyone, and actively consult with teachers.

I pick 2-3 students per session to collect data for them on a clipboard. Pick students who have similar goals (e.g., perspective taking or naming emotions), and direct questions towards those goals.

I complete quick session notes documenting the activity, and then add the percentage accuracy for the 2-3 students who were the focus that session. If you take nothing else away from this article, hear me when I say: you don’t have to collect data on every student every session.

Barriers to Push-In Therapy

Common challenges to push-in formats, plus solutions that work for me, are listed below:

Teacher Buy-In

In my experience, teachers are not wary about push-in services. They are wary of more work being put on their already overcrowded plate, managing challenging behaviors, and constant interruptions. To sell reluctant teachers on push-in, I take the lead.

Tell teachers you are offering a 30-minute window where you can see how their students authentically interact, and they have a window to check email and pee. They will appreciate that! Take the pressure off, and then as you build a relationship during the year, ask them what skills their students are struggling to retain and ask for their suggestions for challenging students.

Stage Fright

Admittedly, there is a bit of “being on” when you are presenting in front of a whole class. Most SLPs are taught how to do individual sessions in grad school, and not whole class lessons. Especially if you are a newer SLP, it is an adjustment to feel performative at the front of a class.

Fortunately, this gets easier each week and students tend to respond well to enthusiasm and respect. Maintain consistent boundaries for group discussions, but let para-professionals and teachers handle behaviors. You just do your lesson!

Planning Sessions

Some SLPs appreciate being able to improvise, just grabbing a game or worksheet, pulling students, and using drill formats to collect data. Although planning group activities takes a few minutes at the beginning of the week, you will free up 25-30% of your weekly schedule by doing more push-in sessions.

Again, use the same activity throughout the week and use topics that promote engagement but can be scaled for ability level.

If your district has a subscription to News-2-You, weekly content is available with AAC support for current events. Or, grab this free secondary speech cheat sheet with 10 goal areas and free links to activities.

Final Thoughts

If you are struggling with managing a heavy caseload, limited time, and burnout, give push-in services a try. You will free up 25-30% of your weekly schedule if you reduce small group sessions, and do more push-in. Start with teachers you already have a lot of interaction with, like the special education team, and branch out from there.

Think of push-in therapy as a flexible model. When I was a newer SLP, I was easily discouraged if teachers had any criticism. If one format doesn’t work well, check with teachers to modify things for a better fit. Once you are there, teachers can benefit from your expertise while you help with instruction.

Another way to develop persuasive skills is to watch ad for zoos, or ads against zoos, to see how they are trying to convince people to visit or not visit.

Like going to the gym, the hardest part is just showing up. If you need help with getting started, be sure to grab my free cheat sheet with 10 goal areas and free activity links for secondary students.

Have more questions? DM me on Instagram @DDVSpeech. I love to mentor and support newer SLPs!