Moving Towards a Tiered Model of Speech and Language Services in Ontario Schools: Perspectives of School Board Speech-Language Pathologists

This qualitative descriptive study explored the service models utilized by school board speech-language pathologists in Ontario and the factors they perceived as influencing service provision during a period of anticipated policy change to a tiered model of service delivery in schools across the province. Semi-structured interviews were conducted with 24 speech-language pathologists recruited via the Association of Chief Speech-Language Pathologists of Ontario District School Boards. A framework analysis approach was used to analyze the interview data. Most speech-language pathologists (n =16) described using a tiered model in which services were offered at universal, targeted, and individualized levels; however, several (n = 6) described offering a range of services that were "responsive to needs" of students but did not have a formal structure for their model. A minority (n = 2) delivered services based on an assessment-focused model that included individual referral, formal assessment, and primarily individual intervention. All speech-language oathologists expressed a need to move towards a tiered approach for practice-and policy-based reasons (e.g., to increase the reach of speech and language services as well as to align with anticipated policy changes). Six factors were reported to influence service provision in this context: interprofessional collaboration and relationship building, stakeholder buy-in and support, adaptability to school culture, organization of services, resources, and policy. Implications for practice include a need for profession-specific leadership, use of consistent terminology and language, and including the clinician voice in decision making with respect to the models used to support students' success in school.