From Pull-Out Therapy To Classroom Impact

I share a mindset shift for school-based SLPs when a teacher says, “I don’t know what to do with them”, and I show how that moment can point to classroom needs not just student needs. We move beyond the pull-out-only default and into a workload approach where collaboration, consultation, and Tier 1 support expand our reach and reduce the referral treadmill over time.
• reframing the hallway conversation from instant referral to classroom signal
• defining the “client” as the student plus the classroom environment and teacher support
• why pull-out therapy alone cannot carry language and literacy change
• using MTSS to think across Tier 1, Tier 2, and Tier 3 supports
• building mutual respect with teachers through agreed consultation and shared strategies
• leaning on SLP strengths in observation, task analysis, UDL, and neurodiversity-informed practice
• addressing time pressure by comparing proactive Tier 1 investment to the cost of nonstop referrals
• handling role confusion and resistance with scope clarity and small pilots
• focusing on reach and long-term impact beyond the therapy room
Just one thing. Find one classroom touch point. It might be a quick check-in with a teacher about a student you share. It might be sitting in on a classroom lesson and noticing what the communication demands actually are. It might be following a student around for a morning to truly see what they are experiencing.

https://sarahdowlingschoolslpcoaching.com

Music: Daniel Chui

Transcript

Welcome To The Aligned SLP

Sarah 0:02

Welcome back to the Aligned SLP. I'm Sarah Dowling. If you're new here, this is where school-based SLPs stop being clinical islands and start being collaborative partners. We're ditching the impossible caseload, embracing the workload approach, and reclaiming our joy as professionals aligned with the education world. Hello, welcome back. I'm glad you're

Rethinking The Hallway Referral Moment

Sarah 0:30

here. I want to share a mindset shift today. I want to start today with a scene that I think a lot of us have experienced. You're doing your thing, maybe you're walking down the hall between sessions or you're in the copy room, and the teacher catches you and they say, I don't know what to do with them. And you know what's interesting about that moment. Our instinct is to hear that as a referral, to feel pressured. There's a stress reaction, the overwhelm, to think that I need to do something. Okay, tell me about the student, let me pull some screeners, um, let me figure out if they need services. Or if it's just to feel some panic as we tell them that I'm full and cannot take on another student, the feeling of letting the teacher and the student down. But what if we're seeing this incorrectly? What if the more useful question isn't just what does this student need, but also what does this classroom need? What does this teacher need? What does this system need? That's what we're getting into today. The idea that as school based SLPs, our client isn't just the student sitting across from us in the therapy room, our client is bigger than that. It's the classroom, it's the teacher, it's the environment that the student spends hours in every single day. If you have heard me before, you will know that I have strategies for dealing with hallway conversations effectively within the Multi-Tiered Systems of Support MTSS model. Today though, we are focusing on the mindset shift when we are approached by a teacher and also for when we may not be working within an MTSS framework. So by the end of this session, I want you to have a different mental model for what school-based SLP practice can look like.

Why Pull-Out Alone Falls Short

Sarah 2:29

So at the moment and in the past, the dominant model has been for a long time has been what could be called the pull-out and send back approach. Students come to therapy, we work on our goals, they go back to class, and we repeat until we're done. And we know that there's real value in that model. One-on-one time matters, dedicated practice matters. I'm not throwing it out, but in the multi-tiered framework, that is a tier three service. So research on language and literacy development consistently tells us that students need to practice communication skills in context, in the actual environments where they're expected to use them. And for schools, that context is almost entirely the classroom. But in a traditional pullout model, we're not in that setting. We're in the therapy room. The teacher doesn't always know what we worked on. The classroom doesn't change, and the student goes back into an environment that hasn't adapted at all. We may have given a program for the class teacher to do to support our therapy goals. We may be working on goals related to the curriculum, but we may be working on our own goals, from our own assessments, with our own materials. Obviously, we do this for our students with severe speech disorders, but for those and all other needs, including speech differences, we need to consider how to share our knowledge and skills within the general classroom environment.

MTSS And Showing Up At Tier 1

Sarah 4:08

This is where the Multi-Tiered Systems of Support gives us a really useful lens to work with. If you're not familiar, MTSS is a framework for providing tiered, data-driven support to all students. It's got three tiers. Tier one is high quality instruction and support for everyone. Tier 2 is targeted intervention for students who need a bit more. Tier 3 is intensive, individualized support. And that's traditionally where we live as SLPs. Tier three, working with the highest need students. And that makes sense? But here's the question I want to ask. What if SLPs also showed up at Tier 1? What would it look like if we helped shape the universal environment, not just respond to students who struggle in spite of it? Because when you zoom out, preventing unnecessary referrals, supporting teachers proactively, designing communication rich classrooms, that's not outside our scope. That's actually one of the highest leverage things we could be doing. I want to really explore this mindset shift because I think it's the key to everything else. When a teacher comes to you and says, I don't know what to do with them, that's not just a referral. That's a teacher telling you they need support too, that the classroom needs support. Teachers are functionally communication partners. Everything they do, how they give instructions, how they explain a concept, how much wait time they offer, how they call on students, how they respond to a wrong answer. All of it shapes the communication environment in that classroom. As we have heard for years, language is the education and the means of education, and we have that knowledge that we can share through discussion, modelling and presentations. So when we think about the client, I'd argue that the teacher is part of the workload. The classroom is part of the workload, and that means our job includes building the communication capacity of the adults around our students, not just the students themselves. And we are the experts about disordered communication. That is what we bring to the school community. We shouldn't be keeping that expertise in our therapy rooms and sessions. We have a teaching profession thirsty for the ideas that we can share with

Respectful Collaboration With Teachers

Sarah 6:51

them. Obviously, this approach requires us to evaluate and develop our relationships and relationship building skills with our teacher colleagues. The type of relationships we need are based on mutual respect. We recognise the expertise each other has and what we can offer to each other that improves our own knowledge and skill sets. We are not telling someone how to do their job. We're sharing knowledge and skills within a respectful framework. We can only offer what has been requested, what has been mutually agreed. We only share websites, social media, resources and PDFs if their usefulness and the capacity to use them has been agreed. This is how the school community learns how expert you really are, through the respectful conversations around many different students and situations. They learn that we are great observers and problem solvers. We are amazing at task analysis. We are naturals for applying the neurodiversity and universal design for learning perspectives and principles. Once we know and have explored them, we understand preventative ways of

Time, Caseload Pressure, And Payoff

Sarah 8:06

working. So I know some of you are listening to this and thinking, well, this sounds great, but where am I going to get the time? That's completely fair. Caseloads are real, the paperwork is real, the scheduling puzzle is real. I'm not going to tell you that collaboration is easy or time free. But here's the reframe. The traditional caseload treadmill isn't time free either. Every referral that gets processed, every evaluation that gets completed, every student who ends up on your caseload because the classroom environment wasn't set up to support them. That's time to. A proactive investment in Tier 1 can reduce unnecessary referrals over time. Imagine a reduction in paperwork due to supporting the class teachers in their classrooms. Every year you apply and develop these practices, the more appropriate and targeted the referrals for your direct support become. It doesn't feel that way in September, but it starts to feel that way by February. You are supporting the teachers to learn about what you can offer and how they can use you appropriately and effectively.

Role Clarity And Handling Resistance

Sarah 9:22

The second thing I hear a lot is role confusion. Is this really my job? Am I overstepping? Is a teacher going to think I'm telling them how to teach? Well role clarity matters here. ASHA's scope of practice for school-based SLPs explicitly includes collaboration, consultation and professional development as core activities, not extras, not nice to haves. If you're doing teacher collaboration and co-working, you're working within your scope. The flip side is you might encounter resistance from teachers who don't want another person in their room, or administrators who think of you only as a direct service provider. Those conversations take time. Relationship building takes time, and the most effective thing you can do is to start small and prove the model.

Start Small And Build Momentum

Sarah 10:16

Work with those people who are already open to working in this way with you. You start small, one teacher, one curriculum area, one strategy. Show what's possible in a context where there's already some goodwill, and then build from there. You don't have to overhaul your entire practice immediately. So the through line of everything we've talked about today is this. Your expertise is most powerful when it reaches beyond the therapy room. The student you see individually matters, and so do the hours a day they spend in an environment you can help shape. True collaboration with teachers, real, joint, mutual, respectful collaboration with teachers gives you the reach. We start to feel part of a team. We start to feel our impact. Many of the compliments I have received have been years after the collaboration. The teacher steadily reflected and applied the ideas shared, and made a difference for students I never knew who didn't have to arrive on my caseload.

One Touch Point This Week

Sarah 11:22

So here's your call to action for this week. Just one thing. Find one classroom touch point. It might be a quick check-in with a teacher about a student you share. It might be sitting in on a classroom lesson and noticing what the communication demands actually are. It might be following a student around for a morning to truly see what they are experiencing. One thing. That's it. A new mindset. A mindset that can change your working day, your enjoyment, and your impact. Thank you for spending time with me today. Here's what I want you to take away. You're not failing. The system is asking you to do the impossible, and you're doing the best with what you have. But there is a different way. And remember, you're not alone in this. We're building something new together. One conversation, one collaboration, and one small change at a time. If this episode resonated with you, I'd love to hear about it. Share your experiments, your questions, your aha moments, because your experience matters and maybe exactly what another SLP needs to hear. Until next time, stay curious and be kind to yourself. I'm Sarah Dowling, and this has been the Aligned SLP.