Three-Year Program Evaluation of a University–Public School Collaborative Partnership

In this clinical focus article, we describe an innovative program that addresses two challenges faced by the profession of speech-language pathology. The first is how to maximize speech-language services in school settings in a manner that can support academic outcomes in the classroom for school children. The second is the need for high-quality clinical placements for graduate students enrolled in graduate programs in speech-language pathology. These seemingly unrelated challenges were addressed through a partnership between a university speech-language pathology graduate program and a neighboring school district. This report follows a prior study that reported outcomes of the first year of the program's implementation (Koutsoftas et al., 2018). The current clinical focus article reports on program outcomes for the subsequent 3 years (Years 2, 3, and 4) of implementation.

Collaborative Classroom-Based Intervention

Speech-language pathologists (SLPs) working in school settings are challenged to address an important component of speech and language interventions, the carryover of speech and language skills into classroom settings. According to the American Speech-Language-Hearing Association (ASHA, 2010), the roles and responsibilities of SLPs in schools include the provision of direct services as well as the provision of consultation and classroom carryover. Classroom-based services have been a longstanding accepted practice in the field (e.g., Falk-Ross, 2002; McCormick et al., 2003; Merritt & Culatta, 1998; Nelson, 2010; Paul & Norbury, 2012; Wallach, 2008), and there is research that supports the use of language-based therapeutic interventions provided within the classroom (e.g., Calvert et al., 2003; Farber & Klein, 1999; Gillam et al., 2014; Roberts et al., 1995; Smith-Lock et al., 2013; Swanson et al., 2005; Throneburg et al., 2000; Valdez & Montgomery, 1997; Wilcox et al., 1991). Yet, SLPs working in school settings reported that the majority of their time, an average of 19 hr per week, is spent providing therapy in a separate location, whereas classroom-based services are provided an average of 5 hr per week (ASHA, 2020).

Two systematic reviews on speech-language pathology service delivery in school settings provide support for the implementation of classroom-based speech-language therapy (Archibald, 2017; Cirrin et al., 2010). Cirrin et al. conducted an evidence-based systematic review of peer-reviewed studies from the prior 30 years and found five studies comparing the effectiveness of different service delivery models (separate location, classroom-based, consultative). Their findings suggested that classroom-based services are as effective as therapy provided in a separate location from the classroom. Archibald reviewed 49 peer-reviewed studies that examined SLP–educator classroom collaboration to further understand the variety of ways SLPs can support students with speech and language needs in the classroom. Of the studies reviewed, 24 were intervention studies that included classroom instruction, small-group instruction, or consultative approaches to service delivery supporting language outcomes related to vocabulary, expressive language, narration, phonological awareness, and curriculum-based language. Combined, these reviews account for the majority of current best evidence in support of collaborative classroom-based intervention (CCBI) by SLPs in school settings.

An overarching goal of the program was to support graduate student interns and speech-language pathology supervisors in their implementation of CCBI. We use the term CCBI to describe service delivery that includes consultation with educational personnel and the provision of services within classroom settings (e.g., Mitchell et al., 2020). Similar terms have been used such as push-in services, inclusive practice, or inclusion; however, we propose that the term CCBI allows for a more proactive and positivistic approach to classroom-based services and collaboration. CCBI encourages SLPs in school settings to engage in interprofessional practice with educational personnel including classroom teachers (general and special educators), teacher assistants, paraprofessionals, and related service providers (e.g., occupational therapy [OT], physical therapy [PT], and applied behavior analysis services). CCBI encourages the provision of speech and language services in general or special education classroom settings in a variety of ways including consultation, classroom-based instruction in collaboration with teachers, small-group interventions within the classroom, and providing individualized supports to children with speech and language goals. There are two important reasons for using CCBI for students receiving speech and language services: first, to support the carryover of speech and language skills into the classroom and, second, to decrease the amount of missed classroom instruction for students receiving speech and language services (e.g., Archibald, 2017; Brandel & Loeb, 2011; Cirrin et al., 2010; Pfeiffer et al., 2019).

Two surveys of SLPs working in school settings provide insights as to the reasons why classroom-based interventions are not more widely utilized (Brandel & Loeb, 2011; Pfeiffer et al., 2019). Brandel and Loeb (2011) surveyed 1,897 SLPs working in school settings regarding factors considered when making decisions about service delivery. Their findings indicated that student-based factors were the primary driver for service delivery decisions and that speech-language pathology factors that influenced decision making included their own graduate clinical experience. Specifically, SLPs who had graduate experience that involved collaboration, referred to as shared teaching, were more likely to make those recommendations for service delivery for students on their caseload. Pfeiffer et al. (2019) surveyed 474 SLPs about their engagement with interprofessional practice in school settings with the goal of identifying predictors and barriers to implementation. Findings indicated relatively low percentages of SLPs engaged in interprofessional collaboration during intervention (about 14%) and barriers for collaboration included scheduling (48%), resistance by other professionals (23%), and a lack of support from administration (11%). The researchers found that one factor that predicted engagement with interprofessional practice was prior collaborative experience. Combined, these survey findings suggest that providing graduate students opportunities to engage in CCBI as part of their graduate experience will likely support implementation in professional practice.

Program Description

Koutsoftas et al. (2018) reported on outcomes for the first year of implementation for the university–school district partnership, the results of which indicated a successful first year. The program was evaluated by triangulating three sources of data including semistructured interviews with key program stakeholders, survey data from teachers at the participating school, and child-level descriptive data including the frequency of speech/language services provided in the classroom and therapy room. A program evaluator (D.M.), who was not part of program development or implementation, conducted and analyzed the semistructured interviews. The same approach to program evaluation was used for each of the 3 years of program implementation evaluated in this clinical focus article. The same logic model was used throughout the duration of the program, albeit with refinements made as part of ongoing progress monitoring. The logic model presented in the current study (see the Appendix) may differ from the logic model presented in the prior study (Koutsoftas et al., 2018) due to these refinements.

While the first-year program evaluation (Koutsoftas et al., 2018) indicated a successful implementation, there was one primary change made to how graduate student interns were assigned caseloads in subsequent years. Starting in Year 2, a caseload approach was used whereby each graduate student intern was assigned to a set number of students they worked with for the duration of the internship. Using a caseload approach resolved several issues that arose during the first-year program implementation, the primary of which were concerns about consistency of care for the school children, which was raised by classroom teachers and other key stakeholders including graduate student interns and supervising clinicians.

For each year of this 3-year program evaluation, each supervising SLP was assigned two to three graduate students, each of whom was assigned a portion of the caseload for the 3 days per week they attended the practicum. This is consistent with approaches to supervision used in traditional on-campus clinics whereby one supervisor oversees several student clinicians. Student interns were required to observe and participate in speech therapy sessions provided to the children in the SLP's office and to spend the remainder of their time observing and engaging in activities with the same children in their classroom, during recess, at specials (i.e., music, gym, art), and even at lunch. In this way, graduate student interns received traditional clinical supervision during speech therapy sessions provided in the therapy room (i.e., separate location from the classroom) and were also able to consider speech and language skills in a variety of contexts including the classroom. This also decreased the amount of people in the speech-language pathology office allowing for the supervisor to provide individualized feedback to student interns contextualized to the school children with whom they worked. The speech-language pathology supervisor and interns met in the morning, at lunch, and at the end of each day to plan and discuss interventions as well as other responsibilities (assessment, progress monitoring, etc.), allowing for additional learning opportunities and points of collaboration. To further support the success of the program, a clinical adjunct instructor provided onsite supervision 1 day per week to support the classroom-based intervention provided by graduate student interns. Graduate student interns developed classroom-based intervention plans in consult with the supervising SLP, and these plans were supported by the clinical adjunct instructor provided by the university.

The augmented speech and language services provided in the classroom by speech-language pathology graduate students included the following: (a) reinforcing speech and language goals that are listed on the student's Individualized Education Program (IEP) within the classroom; (b) daily checks and support for students who use augmentative and alternative communication, hearing assistive technology, and other communicative supports in the classroom; (c) language and literacy support within the classroom commensurate with IEP goals; (d) parent and teacher training focused on speech and language development and carryover of skills to home and classroom environments, including creating materials for home and classroom carryover; (e) articulation blasts provided in addition to regular treatment; (f) preteaching vocabulary that students will encounter within the classroom; and (g) consultations in collaboration with IEP team members including teachers, classroom aides, and related service providers.

Approach and Purpose

This program evaluation reports on a university–school district partnership that is an innovative clinical education model that allowed for two to three graduate student interns to participate in a clinical practicum together with one supervisor. The purpose of the program was twofold: first, to augment speech/language services provided to students that aligned with the district's mandate to support students with special needs in the classroom setting and, second, to ensure high-quality clinical placements for graduate students in speech-language pathology in school settings that emphasized CCBIs. A goal of the collaboration was to increase graduate students' interest in working in school settings, an important consideration given local and nationwide shortages of SLPs in school settings (Cross, 2017).

The purpose of this clinical focus article is to report outcomes across 3 years of the project's implementation. In order to conduct an objective evaluation of the project, we developed a program evaluation protocol that aligned with the project's logic model. The program evaluation was conducted by the second author (D.M.) who has expertise in program evaluation but was not involved in the development or implementation of the program. The project's logic model and program evaluation followed qualitative educational research guidelines (Bogdan & Biklen, 2007) and is available in the Appendix. The logic model for program implementation and evaluation purposes was designed to consider project resources, core project components, evidence of project implementation and participation, and evidence of change alongside environmental resources and project assumptions.

Aligned with the project's logic model (see the Appendix), the core project components and evidence of implementation and participation differed by stakeholder group. The stakeholder groups included school-based speech-language pathology supervisors, graduate student interns, and elementary school children. For speech-language pathology supervisors, the primary activity was to provide training and ongoing support to manage three graduate student interns and support CCBI. For graduate student interns, the primary activity was to provide high-quality speech-language therapy using a caseload model, data collection, and delivering CCBI. For elementary school children, the primary activity was to provide high-quality and augmented speech and language services. Evidence of change as a result of the intervention was accounted for through short-, medium-, and long-term outcomes included in the logic model. The program evaluation was designed to assess achievement of these outcomes across 3 years of project implementation by stakeholder group. The Method and Results sections provide information about program implementation and program evaluation. The outcomes and how these were achieved are detailed in the Discussion section.

Method

This program evaluation reported as a clinical focus article was reviewed and approved by the institutional review board at the Seton Hall University. The program was implemented in two elementary schools within the partnering district, each with one full-time SLP responsible for the caseload. There were three key stakeholder groups for which the logic model was designed (speech-language pathology supervisors, graduate student interns, and elementary school children). Additional stakeholders included faculty from the university and the partnering school district. From the university, there were two faculty members from the speech-language pathology program who developed and implemented the program and a clinical adjunct instructor. The clinical adjunct instructor was a different person for each of the 3 years of this program evaluation. From the school district, there was the director of special services for the district and the educators working in classrooms where the speech-language pathology interns provided CCBI. Data sources for this program evaluation aligned with the logic model and included data collection binders completed by graduate student interns, a survey of educator satisfaction with the program, and semistructured interviews with stakeholders. Additional sources of data included records of onsite debrief meetings, professional trainings for speech-language pathology supervisors and interns, and e-mail or other communication among stakeholders.

Participants

Schools and Speech-Language Pathology Supervisors

The same schools and SLPs participated in all 3 years of the program. One of the schools included a majority of students with a qualifying category of autism because that particular school contained most of the autism classrooms for the district. The other school was a general education elementary school. Both schools included preschool children receiving special education services. According to the district's website, there were approximately 7,800 total students enrolled in the district, of which 63%–70% come from economically disadvantaged backgrounds, 9% are students identified as having a disability, and 20% are English language learners. An ongoing goal for the district was to increase classroom-based services by SLPs, and this partnership supported that goal. Speech-language pathology supervisors participated in an onboarding meeting about the program at the onset of the first and second years, after which support was provided via ongoing debrief meetings or e-mail.

Graduate Student Interns

Graduate student interns were assigned to the clinical site following departmental procedures used by the director of clinical education for assigning clinical placements. The graduate students were made aware of the program only after being assigned by the director of clinical education. There were three graduate students assigned to each of the two sites for each year of the program, except in Year 4 when only two students were assigned to one of the sites. There were a total of 17 graduate student interns over 3 years who participated in the program.

Elementary School Children

Elementary school students who participated in this program were part of the speech-language pathology caseload at each of the elementary schools and were receiving speech-language services through an IEP. Table 1 provides descriptive information by year collapsed across schools. School children were in grades preschool through fifth and qualified for special education services through one of the following qualifying categories: autism, communication impaired, intellectual disability, multiple disabilities, other health impaired, preschool child with a disability, or specific learning disability.

Procedure

The procedures described below are twofold and include program implementation and program evaluation activities, all of which were included in the project logic model (see the Appendix).

Program Implementation

Program implementation for graduate student interns was supported in three ways: a training protocol in advance of the internship, regular debrief meetings on site at schools with all stakeholders, and caseload management activities using a data collection binder. These were in addition to regular supervisory practices by cooperating speech-language pathology supervisors in the school and from the adjunct clinical supervisor who visited each school every other week.

Initial Training Protocol

Graduate student interns participated in a 2-hr training with university faculty in advance of the internship. The initial training protocol included an overview of the project including a description of key stakeholder groups, caseload management including data collection binders, and procedures and activities related to CCBI. This was in addition to training provided through clinical education courses designed to prepare students for internships. The training protocol included content related to data collection procedures and approaches to classroom collaboration including how to establish rapport with classroom personnel and students and conduct observations that can inform interventions.

Debrief Meetings

Debrief meetings were held at each school throughout the internship with varying frequency by year. The purpose of these meetings was to gather stakeholders by school to discuss progress of the program, identify strengths and weaknesses, and troubleshoot specific challenges. Included in these meetings were the school-based SLP, graduate student interns, university faculty, and the director of special services. A standing agenda included the following items: challenges and triumphs, scheduling, data collection checks, and opportunities for additional activities. Additional activities included observing interdisciplinary team meetings and assessments and conducting in-service trainings that could address challenges identified at the school. The frequency of meetings did vary whereby, in Year 2, meetings were monthly and, in Years 3 and 4, meetings occurred twice throughout the internship. In Year 4, meetings were held using video conferencing, due to COVID-19 restrictions, with additional meetings as needed. Across all years of the program, stakeholders communicated via e-mail to address any concerns and to check on progress.

Data Collection Binders

Data collection binders were designed for the study and included five forms designed by the first author to support clinical internships in school settings. These forms were assembled in binders that the graduate student intern could bring to each therapy session and classroom to document progress toward meeting IEP goals and drive CCBI activities. The first form was a school organization form that included a script for introducing oneself to faculty and staff in the school community. The form included a table where the intern could list key faculty and staff, room number, role, and document when they introduced themselves. The second form was a student intern activity log that listed a variety of activities the intern might engage while in a school setting including: classroom observations, assessments, annual review and educational team meetings, traditional therapy, and classroom-based therapy. Interns recorded the frequency of occurrence of these activities by including dates on which these occurred. The third form was an IEP “quick look” that included the most relevant information needed from IEPs including demographic, linguistic, and medically relevant information, as well as speech and language goals. The fourth form was a child observation log, and interns were required to observe each child in at least two settings that were not the speech therapy room (e.g., classroom, lunch, recess, specials such as music or art). The fifth form was a classroom-based therapy log for each child on the caseload that included the date, time, goal, and classroom-based activity that supported the goal.

Program Evaluation

Data sources for program evaluation included quantitative and qualitative data from three different sources including data collection binders, teacher surveys, and qualitative interviews.

Data Collection Binder

Data collected from the binders were deidentified for this report and included descriptive information about school children on the caseload including age, grade, gender, special education qualifying category, classroom mandate, and related services (e.g., OT and PT). Also included were speech and language goals and the number of minutes spent in the classroom targeting each goal. Data about the graduate student intern experience were also obtained from these binders and included frequency count in days for the number of opportunities graduate student engaged in expected activities (e.g., traditional speech-language therapy, observations) and additional activities one might not experience in a school internship (e.g., observation of an IEP team meeting or assessment).

Teacher Survey

The classroom teachers who had a graduate student intern work with a child on CCBI in their classroom were surveyed following Years 2 and 3 using an electronic survey. The survey was not distributed following Year 4 as it was a COVID-altered year. The response rate was 18 out of 29 educators (62%) for Year 2 and 13 out of 29 educators (45%) for Year 3; however, there was no way to know if the same educators were surveyed across years because the surveys were anonymous. The survey was designed by the program evaluator who asked the SLP at each elementary school to e-mail the survey link to educators who worked with a graduate student intern in the classroom. The survey consisted of demographic data including the number of years the teachers had taught (M = 17.4; SD = 10.8; range: 5–40) as well as the number of years the teacher had been at their current school (M = 9.4; SD = 8.9; range: 1–35). The next nine questions consisted of Likert-type rating scale statement regarding communication about the program, the teacher's perception regarding the benefit of the program, and whether the speech-language pathology intern was beneficial or disruptive to the classroom. Table 2 includes the survey statements and responses.

Semistructured Interviews

At the end of each year of the internship, each stakeholder was interviewed by the program evaluator using a semistructured interview approach. These included interviews with the director of special services for the participating school district, the SLPs at each elementary school, the adjunct clinical instructor who observed the graduate students in the classroom, and the speech-language pathology graduate students. The graduate students for each school were interviewed as a group. Interviews were conducted in person, over the phone, or through video-conferencing software. Semistructured interview questions are available in Table 3. The program evaluator (D.M.) has experience with program evaluation and conducting semistructured qualitative interviews; however, she had no contact with stakeholders prior to interviews, except in the case of interviewing repeat stakeholders each year. The interviews were recorded and then transcribed for analysis. The authors of this clinical focus article reviewed transcripts together to identify common themes and identify areas for changes to the program. Of the three faculty, two were SLPs and one was not (D.M.); however, only one of the faculty had prior experience with school-based speech-language pathology practice (A.D.K.). The diversity in coders coming from related and unrelated backgrounds was a strength in the analysis of the interviews because it allowed for a broad perspective for analyzing qualitative data. Findings from these interviews were used to either support current program procedures or make suggestions for future program implementation. Interviews were analyzed using an inductive approach (Azungah, 2018) whereby all three researchers worked together to review transcripts of the interviews and identify themes from each interview. An inductive approach allowed for thematic analysis of responses to the semistructured interviews, which were consistent across all stakeholder interviews. The themes identified by the researchers were then compared across interviews, and the researchers identified common themes across each stakeholder group and then across all stakeholders. The overarching themes were determined in collaboration across all three researchers from the final set of themes extracted. These overarching themes were compared to the original program goals and anticipated outcomes to determine the success of the program.

Results

In line with the purpose of this program evaluation, the Results section reports data collected for program evaluation purposes and aligned with the logic model in the Appendix. In general, results indicated a favorable response to the program implementation across Years 2, 3, and 4. Annual interviews consistently indicated that all stakeholders agreed that the program was positive for the individuals involved. This was despite a unique challenge each year that required real-time adaptations. These adaptations were made in consultation among the university faculty and the director of special services. In Year 2, there was a delayed start due to administrative leave by the director of special services. In Year 3, each of the two supervising SLPs took a leave of absence at different times of the academic year. In Year 4, the program was interrupted by COVID. Of note, while graduate students were still able to complete their internship, the data collected for Year 4 were not parallel to the prior 2 years and were evaluated differently or excluded from analyses. Specifically, as a result of COVID pandemic, the school district moved to remote instruction for the remainder of the school year, so instruction was provided through Google Classroom, including speech-language therapy sessions. Speech-language pathology graduate students were given access to remote sessions; however, this approach was not parallel to the prior 2 years of implementation.

Quantitative Data About Graduate Student Interns

Here, we summarize quantitative data collected by graduate student interns about their own experience and the provision of CCBI in the classroom. Data about school children are available in Table 1 and include descriptive characteristics as well as time spent receiving speech-language therapy in the classroom and in the therapy room. Data about graduate student interns are available in Table 4 and include the frequency that graduate students engaged in clinical activities related to school practice. For Years 2 and 3, graduate student interns provided an average of 31 days of traditional speech-language therapy compared to an average of 36 days of CCBI. This suggests that they were able to engage with students on the caseload just as frequently in the classroom as in the therapy room. Across Years 2 and 3, graduate student interns were able to engage in school practice activities including classroom observations; child study team assessment observations; annual review meetings; and child study team meetings including initial, triennial, or reevaluations. In Year 4, graduate student interns appeared to have been able to engage in similar school-based practice activities but to a lesser degree than in the prior years. As part of the program, graduate student interns were asked to address a problem faced by school-based practitioners by implementing a professional development or schoolwide solution. For example, student interns provided a professional development that highlighted how paraprofessionals and SLPs could collaborate to support children with autism. Another example was the development of parent training videos that were designed to support completion of speech/language homework and included topics of phonemic awareness, dialogic reading, and articulation drills (https://blogs.shu.edu/row-lab/speech-and-language-hw-videos/).

In Year 2, school children received classroom-based intervention an average of 316 min across the 12-week internship, whereas in Year 3, they received an average of 309 min. In Year 4, to our surprise, school children received 434 min; however, this was highly variable given the range and standard deviation (see Table 1, bottom row). In Year 4, there was a great deal of variability in access to online classrooms, which impacted this metric and is attributed to access to equipment by school children and whether the classroom teacher allowed interns to participate in the online classroom. Recall that one school had a high incidence of students with autism, many of whom were reported to have challenges tolerating remote instruction. Finally, CCBI was in addition to regularly mandated speech-language sessions, which on average are 60 min per week or 720 min per 12-week internship.

To understand how the ratio of three graduate students to one clinician impacted clinical contact hours, we compared the average number of hours obtained by graduate students in this program to the average number of hours obtained by graduate students in the university program. For Year 2, the average number of clinical contact hours completed by the students in this program was 154 (SD = 30.96) compared to the university cohort, which was 131 (SD = 35.40). For Year 3, the average number of clinical contact hours completed by the students in this program was 159 (SD = 21.48) compared to the university cohort, which was 138 (SD = 33.31). For Year 4, the COVID impact year, the average number of clinical contact hours completed by the students in this program was 102 (SD = 16.60) compared to the university cohort, which was 57.89 (SD = 22.34).

Classroom Teacher Survey

Teacher survey data collected from classroom teachers who had a graduate student intern providing CCBI within their classroom are available in Table 2. These data have been collapsed across all teachers across both schools who responded to the survey. As shown in the table, the majority of responses for Year 2 were somewhat or strongly agree, and in Year 3, most responses were somewhat or strongly agree. We attribute this to increased familiarity by stakeholders as to how the program was implemented in the schools.

Qualitative Findings From Semistructured Interviews

Findings from qualitative interviews conducted as part of program evaluation for Years 2, 3, and 4 were overwhelmingly positive and consistent across stakeholders by year of the program. There were five overarching themes, which were supported using inductive reasoning and thematic analysis of semistructured interview data and are presented in Table 5. These themes were identified if all three researchers came to consensus that these themes were consistent across all stakeholders and across all years of the project.

Discussion

This clinical focus article reports on the outcomes of a program to provide graduate students in speech-language pathology an opportunity to engage in a variety of roles and responsibilities in a school setting while increasing engagement with school children receiving speech-language services. The logic model for the program included short-term (annual), medium-term (2–3 years), and long-term (4+ years) outcomes, which serve as evidence of change resulting from the program implementation. The discussion that follows centers on achievement of these outcomes by the following topics: program implementation, alignment with clinical education needs, and CCBI in school settings. The short- and medium-term goals that were met through this program's implementation over 3 years are discussed within each of the subheadings below. The long-term goals of the program were related to improving speech/language outcomes of students in the district and more broadly for the profession and are discussed as part of the clinical implications and future directions.

Program Implementation

Outcomes related to the program implementation were included in the logic model to ensure successful implementation of the program as planned while allowing for real-time changes to the program as needed within and across years of implementation. The short-term outcomes related to this were to improve the knowledge of the program and its implementation for both the school-based SLPs and the graduate student interns. This was achieved by providing a preservice professional development training for the graduate student interns and revising this protocol annually based on feedback from supervisors. This was also supported by regularly scheduled onsite debrief meetings with key stakeholders and students on site at schools. There was an increase in the frequency of meetings from the first (Koutsoftas et al., 2018) to second year of the program's implementation and then a decrease in the third year; however, this refinement did not appear to impede outcomes from being achieved. These meetings allowed for seamless program implementation by allowing real-time changes to be made as all stakeholders were present to acknowledge triumphs and confront challenges. Future implementation will continue to include two debrief meetings with additional meetings as needed via video-conferencing software. The medium-term goal related to program implementation was to expand the program throughout the district, which was achieved by the end of this 3-year program evaluation whereby the program expanded to an additional (third) school. Success of the program's implementation was also observed as part of the semistructured interviews, specifically Themes 1, 2, and 4.

Alignment With Clinical Education

Outcomes related to clinical education needs were included in the logic model because one of the driving factors for the program was to increase the quantity and quality of clinical placements in school settings. These outcomes are related to the graduate student interns and represent an overlap between department clinical standards and the innovations associated with this program. The short-term outcome was to increase knowledge of speech/language services in the public school system, which aligns with the department's clinical expectations and standards. That is to say, graduate students had to meet the department's clinical standards in a school placement whether as part of this program or in a regularly assigned placement. As part of this program, graduate student interns were able to gain additional experiences they might not receive in a traditional school placement. These included opportunities to engage with child study team activities including assessments, professional development activities, solution-oriented schoolwide projects, and CCBI. These additional experiences supported the medium-term outcome to increase the graduate student interns' interest in pursuing employment in a public school setting that is considered high needs. These outcomes were achieved as indicated by 17 graduate students successfully completing the program over the 3 years included in this program evaluation. These students would have met this goal through traditional placements; however, this program allowed for up to six student interns to participate within one district for the semester. As can be seen by the average number of clinical contact hours reported earlier, the students who participated in this program achieved the same or more clinical hours than peers in traditional placements. Findings from qualitative interviews across all five themes also support that this program resulted in a positive clinical education experience. It is worth noting that at the time of publishing this clinical focus article, a graduate of this program currently worked as an SLP in the partner district and has been doing so for about 4 years. This aligns with prior survey research that suggests that those who engage in collaboration or interprofessional practice as part of their graduate experience will engage in these practices as professionals (Brandel & Loeb, 2011; Pfeiffer et al., 2019).

CCBI

Outcomes related to CCBI were included for all stakeholders including school-based SLPs, graduate student interns, and the elementary school students who receive these services. CCBI was a driving factor in the development of this program because the district had adopted a classroom-based services approach that the district SLPs were keen on implementing; however, none had received any formal training or support. Until this time, the approach was referred to as “push-in” therapy, a term we have tried to rebrand as CCBI to more clearly indicate how “push-in” therapy should be approached (e.g., Mitchell et al., 2020), as a collaborative classroom-based intervention. For the school-based SLPs, the short-term outcome was to increase opportunities for CCBI, which was achieved through onsite debrief meetings and regular communication with university faculty as part of this 3-year program evaluation. This was demonstrated by findings from semistructured interviews. For the graduate student interns, the short-term outcome was to increase knowledge of CCBI by asking them to spend more time in the classroom and observe the speech/language needs of students in the classroom. The graduate student interns spent at minimum 5 hr per week in the classroom, which is equivalent or more than what was reported in the ASHA (2020) Schools Survey. Findings from qualitative interviews indicated that the graduate students were able to provide classroom-based speech/language supports that aligned with students' IEP goals. This was further supported by daily discussion with the speech-language pathology supervisor and the support of a clinical adjunct. For the elementary school children receiving speech and language services, there was an increase in the time they received classroom-based services, which was in addition to their regularly mandated services (see Table 1). Through this program, there was also an opportunity to improve classroom teachers' attitudes toward CCBI and we were able to report generally positive feedback via a survey (see Table 2). Combined, achievement of these short-term outcomes supported the medium-term outcome of improved acceptance and receptiveness of teachers and school personnel for CCBI. This was further supported by the director of special services, school principals, and the school-based SLP writing letters of introduction to school personnel introducing the program and interns, annually. As part of the data collection binders, graduate student interns were provided a structure for introducing themselves to school personnel with whom they interacted, which further supported achievement of these outcomes. Findings from qualitative interviews conducted each year of the program's implementation supported that CCBI was well received by all stakeholders and as a demonstration of short- and medium-term outcomes being achieved.

Clinical Implications

This university–school collaborative allowed for two community institutions, a university and a school district, to combine efforts to better support their constituents, students. For the university partner, their students received high-quality placements with partner districts. By partnering with the district, and pooling resources, one district was able to support nine graduate students, of which six participated in the program and three more who were in traditional one-to-one placements. If the university were to replicate the program across five districts, then they could accommodate school placements for an entire cohort. While this may sound like an increase in workload for the directors or coordinators of clinical education, the time spent searching for placements and onboarding new districts would decrease. The time spent making and finding placements could be replaced with increased time collaborating with district partners and supporting clinical education in the field.

For the school district partner, speech/language goals are being supported in the classroom in addition to the therapy room, which can have radiating effects in two key ways. First, for the teachers, aides, and paraprofessionals in the classroom who may not easily be able to communicate with students who have speech/language needs, the presence of the graduate student intern in the classroom can provide a model for communication and speech/language related strategies. Second, for the students in the classroom who may not be receiving speech/language services but could benefit from language supports in the classroom, the graduate student intern in the classroom can work with small groups of students providing language and literacy enrichment and support.

This clinical focus article demonstrates proof of concept for an innovative way to approach clinical education in school settings. The long-term goals of the project's logic model were related to improving speech/language outcomes of students in the district and more broadly for the profession. Therefore, the clinical implications discussed below are related to what we learned about this approach during the program's implementation or as part of the program evaluation.

The feasibility, quality, and adaptability of the program were supported by having a logic model for the project, which required ongoing program evaluation. One goal of program evaluation is to find opportunities for improvement (Durlak & DuPre, 2008). Based on regular debrief meetings and annual qualitative interviews, key stakeholder concerns were compiled and discussed. Programmatic changes that have been made as a result of this layered feedback include moving to a caseload approach, increasing communication between school faculty and individuals involved in the program, increasing onsite support, increasing student training in CCBI, and including behavioral management techniques that can be utilized in the classroom. This demonstrates the feasibility, adaptability, and quality control elements for implementing a program as such and shows the opportunities for innovation that can be achieved by preprofessionals as part their clinical education.

The adaptability of the program was demonstrated because of an unforeseen challenge each of the 3 years of program implementation evaluated in this report. In the second year, the program was delayed due to an administrator on medical leave; in the third year, each of the district SLPs had a medical leave; and the fourth year of the program was interrupted by COVID-19. Because of the adaptability of the program and the collaborative spirit among program stakeholders, adaptations to support the program were easily implemented. This is supported by evidence from clinical contact hours completed by students and findings from semistructured interviews.

A strength of this program was the opportunity for contextual learning for graduate students in speech-language pathology. For example, while we teach students the importance of tracking data, this program gave the university faculty an opportunity teach and support data collection in a real-world context. The data collection binders allowed us to collect information about this program while also supporting acquisition of this complex skill in graduate students. Moreover, we were able to use the data collected to model how to make evidence-based decisions about modifications to speech and language services for school children.

While an increase in the student-to-supervisor ratio may appear to require more work for the SLP, our finding was that the workload for the supervisor did not change and the opportunities for the graduate student interns and elementary school children did increase. This was the case because of additional resources and ongoing supports, which would be necessary for future replication and expansion of the program. It is worth noting that ASHA requires students to be supervised for a minimum of 25% of service delivery time, and there are no regulations barring the supervision of more than one student at a time. Traditional on-campus clinical models have utilized the supervision of more than one student by a supervisor. At the onset of this program, supervisors were hesitant about the supervision of more than one student; however, initial onboarding meetings, ongoing debrief meetings, and support from the university and clinical adjunct alleviated concerns and supported successful implementation.

Future Directions and Implementation Considerations

This program came about as an opportunity to support a district in implementing classroom-based services as the district was concerned about students with special needs being removed from the classroom too frequently. Classroom-based services have been an understudied intervention approach and are being mandated by state and local education agencies with increased frequency. Future research directions should center around implementation strategies and approaches to collaboration (e.g., Brandel & Loeb, 2011; Mitchell et al., 2020; Pfeiffer et al., 2019), as well as dosage and measurement concerns. Regarding dosage, there is an empirical need to study how to better implement speech and language supports that can carry over or be targeted directly to the classroom with a particular focus on how to modify IEP mandates. For example, in the partner district, speech/language therapy is mandated in minutes per week in the classroom or in the therapy room. An adaptation as such allows for the SLP to distribute time throughout the week instead of two individual or group sessions. The impact of this must be studied to support practices and funding policies. Regarding measurement, it was a challenge to measure progress in the context of IEP-related services as progress on goals are measured quarterly using an ordinal rating scale with the anchors of progressing, mastered, not mastered, and abandoned. While there are district guidelines that operationally define these terms, our attempt to use these data failed due to the lack of reliability and to some extent the validity of these progress monitoring practices. In light of this and aligned with current best practices in education, curriculum-based measures of oral language are needed to align with the nature of speech/language therapy in schools (e.g., Brandel & Peterson, 2018; Nelson, 1989). Measures as such would allow for valid and reliable documentation of progress toward oral language outcomes and could potentially inform goal modifications including dosage, location, and termination of services. Most importantly, these can be used within a school year to make programmatic decisions, rather than waiting for annual or triennial testing results. Finally, future programs or studies that aim to implement CCBI and replicate this approach should consider an implementation science framework to inform the logic model.

Conclusions

This project and 3-year program evaluation was informed by the needs of a university graduate program in speech-language pathology as well as a partnering school district. The solution was an innovative program that addresses multiple field-related concerns including preprofessional training, school-based services, classroom-based services, and outcomes for students with speech and language disabilities. The call for classroom-based services has been on hold for far too long. Students who miss the most classroom time are those most in need of uninterrupted learning. Our efforts to support these children can shift to classroom-based approaches, which have the potential to support speech and language needs of those with and without communication disabilities in the classroom.

Data Availability Statement

The data generated and used for this clinical focus article are not publicly available as these data were collected for program evaluation purposes.

Author Notes