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Push-In vs. Pull-Out Services in School-Based OT: Which One is Better?


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As occupational therapy practitioners working in schools, we are always searching for the best methods of intervention to provide our students with the highest quality care. One of the most debated topics in school-based OT is the question of whether to implement push-in or pull-out services. However, this question oversimplifies the complex needs of each student and assumes that one approach is superior to the other.


In reality, the best approach depends on a variety of factors, such as the student's individual needs, the IEP goals, and the resources available. Today, we will explore the pros and cons of both push-in and pull-out services, discuss the importance of collaboration and flexibility, and highlight the benefits of combining these two methods to create a comprehensive intervention plan.



The Fallacy of All-or-Nothing Thinking


Before we dive into the pros and cons of push-in and pull-out services, let's take a moment to discuss the all-or-nothing fallacy here. This type of thinking assumes that there is only one right answer and overlooks the potential benefits of multiple solutions. In the case of push-in vs. pull-out services, this fallacy assumes that one method is inherently better than the other. However, the reality is that each method has its own benefits and limitations, and the decision of which one to use should be based on our evaluation, student progress, and the priorities of the IEP team.


The Problem with Research


When it comes to research in school-based occupational therapy, it's important to be aware of the potential for misleading guides. Studies often use particular inclusion criteria, such as focusing only on general education students or exclusively on autistic children. While these studies can provide valuable insights into the effectiveness of particular interventions within specific populations, it's crucial to consider how their findings apply to our own caseload and decision-making processes.

For example, if a study only looked at the effectiveness of push-in therapy sessions for students with autism, it may not be applicable to students with other disabilities or those in different educational settings. Similarly, if a study only included general education students, it may not provide insight into the needs and challenges of students in special education programs. Therefore, it's important to carefully read and evaluate research in the context of our own caseload and consider how it may or may not be relevant to our specific situation.


There is no question that research can provide useful insights for our practice. However, to be evidence-based, we must also critically evaluate its relevance to our specific caseload and decision-making procedures. By doing so, you can ensure that you are providing the most effective and appropriate interventions for your students.


Benefits and Limitations of Push-In Services


Push-in services refer to interventions that occur within the student's classroom or natural environment. The primary benefit of push-in services is that they promote developing and generalizing skills in the context where they will be used. Additionally, push-in services can improve collaboration with teachers by providing opportunities for modeling and coaching.


However, there are also limitations to push-in services. One of the main limitations is the limited privacy that students have when working in a classroom setting. This is especially important to note as students get older and become more self-aware. Additionally, push-in services can potentially disrupt classroom routines and make it difficult for the student to focus on classroom tasks when there are other distractions in the environment.


When it comes to implementing a push-in therapy model, there are a few key considerations to keep in mind. First and foremost, it's important to establish clear goals, expectations, and times for the therapy sessions. This can help ensure that everyone involved is on the same page and working towards the same outcomes. It also ensures that the teacher knows when to expect us, and we know what to expect when we go into the classroom. Additionally, it's important to be flexible and adaptable. Unlike in a pull-out session, during push-in sessions, you have limited resources and control over the environment.

Finally, it's crucial to communicate regularly and openly with teachers, parents, and other members of the student's support team to ensure that everyone is informed and involved in the therapy process. With these tips in mind, a push-in therapy model can be a highly effective tool for supporting students in reaching their full potential.


Benefits and Limitations of Pull-Out Services


Pull-out services refer to interventions that occur outside of the student's classroom or natural environment, such as in a therapy room, stage, closet, or hallway (just to name a few). The primary benefit of pull-out services is that they provide a more focused and controlled approach to intervention, allowing the therapist to target specific areas of need that may not be possible while in a classroom. Pull-out sessions may be offered individually or in small groups with students with similar needs.


However, there are also limitations to pull-out services. One of the main limitations is that students may feel stigmatized or embarrassed by being pulled out of the classroom. Additionally, pull-out services may provide limited opportunities for generalization, as the student may struggle to transfer skills learned in the therapy room to the classroom setting.


We must remember that every moment a student spends in a pull-out therapy session, they miss crucial educational content in their classroom. You and the IEP team must weigh if the pull-out therapy session is worth the missed educational content.



 
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Using a Combined Push-In/Pull-Out Model


While push-in and pull-out services both have benefits and limitations, it is important to remember that we are not limited to using one method exclusively. In fact, using a combined push-in/pull-out model can provide the best of both worlds. By using a combined model, you can provide individualized and focused therapy sessions in a quiet and private environment while also promoting generalization by working on skills within the student's natural environment.


After years of working in the schools, I found myself recommending and using this type of service model more frequently. For example, I would write on the IEP that the student would be seen twice a month in a pull-out model and twice a month in a push-in model. I then collaborated with the teacher to determine the best time for me to come into the classroom. From there, every week, I switched off where I saw the student - from in the OT room to in the student's classroom.

One potential challenge of using a combined push-in/pull-out model like this is that it requires a great deal of flexibility and collaboration with teachers and the IEP team. You must be willing to adjust your approach based on student progress and evolving needs and work closely with teachers to ensure that therapy goals are aligned with the student's academic goals.


The Importance of Collaboration and Flexibility


Regardless of which service delivery method is used, it is important to prioritize collaboration and flexibility. As school-based occupational therapy practitioners, we are part of a team that includes teachers, administrators, parents, and other service providers. It is important to communicate and collaborate with all members of the team to ensure that therapy goals are aligned with academic goals.


We must also be willing to adjust our approach as things change. This may mean shifting from pull-out to push-in services, or vice versa, as well as adjusting therapy goals and interventions based on changing classroom routines or priorities. Remember, an IEP is a living document that can be amended at any time. More than once, I have called a parent to share with them that my plan was not working. We discussed why I thought that was, potential solutions, and how we would move forward with the changes we felt would best support the student.


The Wrapup


Push-in and pull-out services are both valuable tools for us as school-based OT practitioners. The decision of which method to use should be based on our evaluation, research, experiences, student progress, and the priorities of the IEP team. It is important to remember that neither method is inherently better than the other and that using a combined push-in/pull-out model may provide the best of both worlds.


Collaboration and flexibility are key to effective intervention, regardless of which service delivery method is used. By working closely with teachers and the IEP team, we can ensure that therapy goals are aligned with academic goals and that interventions are consistent across school environments. As we strive to provide the best possible support for our students, we must be willing to adapt and adjust our approach based on student progress and evolving needs.


See ya next time,


👋 Jayson

 
Learn more about when to choose push-in and pull-out services.

Sign up for the A-Z School-Based OT Course to help you better understand school-based OT and to create systems to ensure you are giving each student your absolute best.


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