Nationwide, school SLPs provide services to students from at least four different groups:
- school-age students whose primary disability under IDEA is speech or language impairment;
- students identified under IDEA with primary disabilities other than speech-language impairment (e.g., autism, deaf-blindness, deafness, emotional disturbance, HI, intellectual disabilities, multiple disabilities, orthopedic impairment, other health impairment, specific learning disability, TBI, and visual impairment including blindness), but who receive speech-language therapy as a related service;
- preschoolers who are eligible for speech-language services;
- students who receive pre-referral intervention, such as Response to Intervention (RTI) and other services designed to help prevent future difficulties with language learning and literacy.
According to the ASHA 2014 Schools Survey [PDF], the median monthly caseload size of ASHA-certified, school-based SLPs who were clinical service providers working full-time was 47, with an individual caseload range of 1 to 240.
Some states have established maximum caseload guidelines for school SLPs, but others leave these determinations to local districts. Contact individual state departments of education for current information regarding caseload guidelines.
Large caseloads are those that are difficult to manage, because of the number of students and/or the complexity of their needs. Large caseloads may impact
- student outcomes, because larger caseloads appear to minimize opportunities for individualized intervention. Caseload size may lead to a shift from individual to group treatment, as well as an increase in group size (Schooling, 2000). Communication skills, in particular, appear to be positively influenced by small treatment group size; students tend to verbalize and/or use gestures to communicate more in small-group settings. In addition, students on smaller caseloads are more likely to make measurable progress on functional communication measures than those on large caseloads (Schooling, 2000, 2003).
- service delivery options, because large caseloads appear to be a factor constraining the service delivery options for school SLPs. Large caseloads limit the ability to provide the full continuum of services addressing individual needs and may no longer support individualized services that are required for the student's IEP. Caseload size, rather than student characteristics, appears to be a frequent factor influencing recommendations regarding program intensity and/or model of service delivery (Brandel & Loeb, 2011; Schooling, 2003).
- recruitment and retention, because current trends toward increased school SLP caseloads and expanded responsibilities appear to be important factors contributing to high rates of attrition. Large caseloads are also associated with the difficulties experienced by educational agencies in recruiting qualified SLPs (Woltmann & Camron, 2009; Katz, Maag, Fallon, Blenkarn, & Smith, 2010).
In addition, a higher caseload impacts
- provision of a Free and Appropriate Public Education (FAPE) as mandated by IDEA because larger caseloads may necessitate the use of service models that are not appropriate for some students (see IDEA's influence on student needs and expanded SLP responsibilities in schools)
- integration of curriculum, because the SLP's first responsibility is to provide educational services to the students on his or her caseload, which requires sufficient time to become familiar with curriculum and standards (i.e., Common Core State Standards or CCSS) across all of the grade levels served. High caseloads reduce the availability of time for planning. (For more information about CCSS, see Common Core State Standards Initiative and ASHA's Common Core State Standards: A Resource for SLPs.)
- opportunity to collaborate with teachers, because high caseloads mean less time for the collaboration necessary for transfer and generalization of strategies and skills
- the implementation of a successful educational model depends on quality collaboration with the students' teachers.
- consultation with parents and other professionals, because high caseloads make it very difficult for SLPs to schedule these opportunities. Coordinating services with other professionals and involving parents in planning and implementation are keys to effective intervention.
- supervision/training of SLPAs, classroom aides, student clinicians, and interpreters, because larger caseloads limit the time available to adequately train and supervise student clinicians and support personnel to ensure the highest quality of service delivery
- professional development and leadership opportunities, because larger caseloads may limit time available for participating in professional growth and leadership activities
- mediations and due process hearings, because larger caseloads may result in more situations requiring participation in mediation and due process hearings
- paperwork requirements for third-party billing (Medicaid), because SLPs typically complete paperwork for Medicaid billing for all children on their caseloads.
ASHA's 2014 Schools Survey (ASHA, 2014) indicates that the average number of students on speech-language caseloads has remained relatively unchanged over the past decade, while the role and related responsibilities of the school-based SLP have increased dramatically. These increases in responsibilities necessitate the shift to a workload approach if SLPs are to continue to add value to the students' classroom experiences.
Factors impacting increased workload include:
- changes in student populations including an increase in students with multiple diagnosed disabilities and complex communication disorders, necessitating more intensive, long-term interventions, and increased diversity of students' backgrounds, requiring SLPs to understand and adapt to these differences;
- increased need for collaboration in planning and providing services as students frequently receive services from a variety of providers;
- new mandates, requiring SLPs to provide services in the least restrictive environment using Common Core State Standards-compliance with which results in additional planning and collaboration as well as service delivery time;
- added responsibilities in facilitating literacy for children and adolescents;
- reporting requirements (including progress reporting) and student-centered meetings (both IEP and non-IEP) with general education teachers and parents;
- increased mandated staff development, "other assigned duties" in the building (bus duty), mentoring new SLP staff, and supervising clinical fellows;
- increased accountability mandates involving additional documentation and paperwork.
Thus, caseload can be viewed as only one of many factors that affect the overall workload of the school SLP.
Factors Impacting Workload
Advocating for a Workload Approach to Assigning SLPs
Given the expanding roles and responsibilities of school-based SLPs (ASHA, 2002) and the impact of larger caseloads on service delivery options and student outcomes, it is imperative that there be a conceptual shift from "caseload" to "workload" in order to ensure delivery of appropriate services to students with disabilities, consistent with the intent of IDEA and best practices in school speech-language pathology. That is, the total workload activities required and performed by school-based SLPs must be taken into account to set appropriate caseload standards.
In order to establish an appropriate caseload, a workload analysis must be conducted. This allows education agencies to take into consideration how much time is available in the SLP's school day, week, or month to determine the number of children who can be adequately and appropriately served.
Steps in Conducting a Workload Analysis
Step 1: Document current roles and responsibilities.
The first step in conducting a workload analysis is to document current workload activities. The roles and responsibilities of school-based SLPs can be organized into four major activity clusters:
- direct services to students,
- indirect services that support students' educational programs,
- indirect activities that support students in the least restrictive environment and in the general education curriculum,
- activities that support compliance with federal, state, and local mandates.
Prior to documenting and analyzing their workloads, SLPs should identify a comprehensive list of all roles, responsibilities, and activities necessary for the provision of services in their specific school settings and then sort these activities into the four major activity clusters described above. See below for sample roles and responsibilities documentation.
Direct services to students
- evaluate students for eligibility for special education
- identify students with speech and language impairment
- provide direct intervention to students using a continuum of service-delivery options
- re-evaluate students to determine whether continued services are needed
Indirect services that support students' educational programs
- analyze demands of the curriculum and effects on students
- contribute to the development of IEPs, 504 Plans, and IFSPs
- monitor implementation of IEP modifications
- design and program high-, medium-, and low-tech augmentative communication systems
- update and train staff in the use of AAC materials and devices
- design curriculum modifications
- provide staff development to school staff, parents, and others
- provide training to interpreters and SLPAs
Indirect activities that support students in the least restrictive environment and in the general education curriculum
- consult with teachers to match student's learning style and teaching style
- design and engage in pre-referral intervention activities (e.g., RTI)
- design/recommend adaptations to curriculum and delivery of instruction
- observe students in classrooms
- consult with outside entities
- become familiar with Common Core State Standards and implementation of these standards
Activities that support compliance with federal, state, and local mandates
- collect and report student performance data
- complete compliance paperwork
- document third-party (Medicaid) billing activities
- supervise paraprofessionals, teacher aides, interns, Clinical Fellows (CFs)
- write student evaluation reports
- participate in IEP/504 meetings
- participate in professional development activities
- maintain credentials/licenses
See also Examples and Worksheets for the Workload Analysis Approach.
Step 2: Analyze the current workload relative to the needs of students receiving services.
- Identify services, settings, group size, and tasks necessary to meet each student's individual needs and IEP goals.
- Determine the time it takes for each student-related service and activity (per school day, week, month) and the time available for these activities.
- When all available time slots are filled, the caseload maximum has been reached for any individual SLP. This maximum number will vary across settings and be a function of the needs of the specific students on the caseload.
Step 3: Determine if the workload is balanced.
When all time slots are filled but required activities or student services remain unscheduled, an imbalance exists between the SLP's assigned workload and the amount of time available to fulfill those responsibilities. To address this imbalance
- make a list of services and activities required for full implementation of IDEA and best practices that cannot be completed given current workload conditions,
- objectively assess how the local education agency might address these unmet needs.
Step 4: Collaborate with SLPs, teachers, administrators, union representatives, parents, and other service providers to address workload issues.
The use of multiple advocacy strategies and partnerships is often necessary to influence workload and caseload issues within state and local education agencies.
ASHA has developed a variety of resource materials that can strengthen local SLP advocacy efforts. Working for Change: A Guide for Speech-Language Pathologists and Audiologists in Schools [PDF] (2010) outlines a number of strategies for collaborating with teachers' unions and local and state education agencies to improve working conditions. These strategies can also be used to establish a joint workload review committee between union and district representatives.
School districts have implemented a variety of administrative solutions to assist SLPs in managing their existing workloads.
Contract Language: Teacher contracts may be written to prescribe maximum caseloads and/or the use of workload when establishing a caseload. Contracts may also prescribe other activities in which an SLP may and may not engage.
Expansion of Response to Intervention (RTI): Trial direct services can be delivered within the context of RTI. Progress monitoring determines the need for continuation in RTI or for consideration for special education services. The workload model provides for this kind of service.
IEP Factors: IEP documents can be written to reflect a variety of service delivery options, including frequency, location, and amount of service. Amount of service can be specified in various clusters (e.g., weekly, monthly, biannually, annually). Changes in service delivery can be triggered by goal mastery.
Staffing: Additional SLPs can be hired if the workload analysis indicates that additional staffing is required to deliver all specified services, or existing staff can be redistributed to ensure equity of workload within a district.
Telepractice: Telepractice offers the potential (a) to extend clinical services to students who qualify for service but are unable to attend school or (b) to provide services in more than one setting, thus reducing the need to travel.
Use of SLPAs: Support personnel can be used to work with SLPs to deliver some of the services.
Use of Technology: Efficiency can be increased by using computerized IEP systems, report-writing formats, and programs/technologies to schedule sessions and collect/analyze data.
Use of Staff Specialists: SLPs can be hired for specific jobs. For example, in this staffing model, most SLPs would provide direct and indirect services, but a smaller team (e.g., a diagnostic team) would conduct assessments and write diagnostic reports.
Weighted Caseloads: "Weights" are assigned to reflect the intensity of services [specified on the IEP] needed to meet the severity and complexity of the students' needs. The district determines a total weight that represents a reasonable caseload.
Scheduling should be clearly noted on the IEP; SLPs should ensure that scheduling decisions are individualized and that parents, caregivers, and educators understand the strategy or strategies selected. Although federal regulations allow for significant flexibility in designating frequency of service on the IEP, local and state jurisdictions may operate differently.
3:1 Model: Direct services are provided for 3 weeks, followed by indirect services provided for 1 week.
Cyclical Schedule (e.g., Block scheduling): Direct services are provided for a specified period of time followed by a similar time of indirect services (e.g., 9 weeks of direct intervention, followed by 9 weeks of indirect services).
Flex Schedule: The frequency, amount, and type of services vary based on student progress toward IEP goals or changing classroom demands.
Receding Schedule: Initial service involves intense amounts of direct services, which is then reduced over time based on student progress.
Weekly Schedule: Direct services are provided on a weekly basis-for example, two 30-minute sessions per week.
The following are examples of various service delivery models. SLPs have the responsibility to select the most appropriate service delivery model, using evidence-based decision making. Models should be chosen with consideration for those that afford the most flexible and efficient delivery of services, while ensuring FAPE, according to IDEA.
Pull-Out (small group or one-on-one): Direct services are provided in a location outside of the general education classroom, typically in the speech-language pathology treatment room.
Classroom Based: Direct services are provided within the general education setting, using one-on-one, small-group or large-group models, as well as co-teaching and/or co-treatment.
Community Based: Direct or indirect services are provided within a community setting (e.g., in the context of transition activities, job coaching, or home-based services).
Combined Service Delivery Models: These models use more than one of the options listed above.
Service Delivery in Non-Academic and Extracurricular Settings: Services are provided within the context of clubs, playground activities, lunchroom, art class, etc.
Focus on Eligibility Criteria
Appropriate and consistent identification of children who qualify for speech and language services will help prevent over-identification that unnecessarily expands caseload and workload. See ASHA's Eligibility and Dismissal in Schools page for information and guidance on eligibility, dismissal, adverse affect on educational performance, cognitive referencing as well as examples of eligibility guidelines from various states.
Over the years, ASHA's School Services team has received reports from numerous members who have successfully transitioned to a workload-analysis approach for establishing caseload numbers. In one district, a successful transition to workload resulted in a separate and higher salary scale for speech-language pathologists and stipends for supervising speech-language pathology assistants. Another district reported gaining an additional SLP position. One state included a workload analysis approach in its state-wide policy and procedures for SLPs and provided training to SLPs throughout the state. Still another state adopted flexible and varied service delivery models, such as making changes in the frequency, duration, and location of services that can be written into the IEP and implemented accordingly, as various benchmarks are achieved by the student. At one university, graduate students' practicum placements required workload and alternative models of service delivery.
In 1999, the Texas Speech-Language-Hearing Association (TSHA) began an effort to develop guidelines for identifying students with speech impairments. This effort, combined with workload approach strategies, has resulted in a number of positive consequences, including
- better identification of students who can benefit from services,
- increased SLP coverage,
- improved quality of services,
- significantly higher retention of SLPs.
For example, within a 4-year period, the city of Houston went from 38 vacancies and about 50 uncovered campuses to only 7 vacancies.
Examples of Workload Approaches
Service Delivery Models: Designated, Scheduled Prep Block: Heidi Becker ([email protected])
The Designated, Scheduled Prep Block works the same way as the 3:1 Model. The difference is that the indirect service activities are scheduled in blocks of time across the entire month instead of being all done in one week. All of the SLPs in the Verona Area School District switched from the 3:1 Model to the Designated, Scheduled Prep Block, because of jealousy on the part of other special educators, who also said they wanted a "week off" from teaching students. The SLPs achieved better collaborative relationships by breaking up the 3:1 Model and distributing the same amount of indirect service time across the entire month instead of having it all in one week.
Scheduling Strategies: Student-Centered Service: Sharon Soliday ([email protected])
I'm working with the Salem-Keizer School District on a pilot project this year that I've labeled, "Student-Centered Service." In a nutshell, I'm working with administration to specify time allocations for SLPs to do Prevention, and I've been mentoring and encouraging SLPs in the pilot program to abandon traditional scheduling (i.e., getting out of the therapy room or sticking to a schedule that was set in September but should be changed by November, based on student needs). And in the arena of students who receive services for articulation only, we have been, we have been setting some anticipated remediation dates for parents, children, therapists, and others to work toward achieving articulation goals. We are always asked "how long will therapy take," and we all shy away from suggesting any timeframe for the most part. NOMS data tells us that students remediate or make significant growth following 20-30 hours of service in the schools. It's not unreasonable that we should project growth. And I believe students could and should be out of speech much more quickly if a target date (if only an estimate) were in place.
We're having great success with pilot SLPs really engaged in some good work. Students are making the growth they should, and if not, SLPs are changing their efforts.
Scheduling Strategies: A Cycles Approach: Rebecca Zutter-Brose [email protected]
Lisa Kirby-Mangas [email protected]
The Phonology program is a speech-language option within the Madison Metropolitan School District. This program, staffed by two speech-language pathologists, focuses on facilitating preschool children's speech intelligibility. The program emphasis is on building the accuracy of sound patterns to promote rapid change in speech clarity.
Children attend Phonology Tuesday through Friday for half day sessions, on a 6-week cycle schedule.
- Cycle "A" receives remediation within Phonology for 6 weeks, while Cycle "B" is off-cycle completing a calendar of activities designed to promote generalization of speech sound patterns.
- After the 6-week period, Cycle "B" receives remediation within Phonology for 6 weeks while Cycle "A" has a generalization period.
One day per week (Monday) is provided for
- planning and preparation of remediation activities
- conferencing and communication with families and educational staff at the end of each cycle
- developing daily practice opportunities, weekend games, and calendar activities for families to promote generalization of speech sound patterns
- paperwork completion
- visits to educational sites that Phonology students attend
- professional development.
Weighted Caseloads: A Working Model: Gail Rothwell ([email protected])
The Tacoma School District has devised and utilized a weighted caseload system for 9 years. Revisions have been made as necessary. This information is utilized when individual SLP assignments are made in the spring for the upcoming school year. This system uses factors (e.g., troubleshooting a student's hearing aids, behavior problems that necessitate individual therapy or academic supports), rather than severity per student, which appears to be a more equitable means of analyzing caseload. The use of an Assignment Committee, caseload guidelines, and the role of the SLPA also helps with workload issues.
Taking a Workload Approach: Mike Maykish ([email protected])
I have been in the Brunswick County, North Carolina Schools for the past 2 years, and we use the workload approach. I feel as though most school-based SLPs, both in and out of our district, would consider themselves "very busy." The workload calculator helps individual SLPs to quantify their "busy-ness" in a meaningful way. This has led to several positive changes. It has encouraged SLPs with high caseload numbers with comparatively low workload numbers to reexamine service delivery models, and led to a sharing of caseload responsibilities for those who have lower. Thankfully, our EC director has been responsive to our needs. This has improved morale among the staff as well as our service to our students.
If you have a workload success story that you would like to share, please e-mail us at [email protected].
SLPs wishing to advocate for the adoption of a workload model in their district or state need to do "their homework" before launching any effort. As with any advocacy effort, there are many factors that an SLP or group of SLPs or state association must consider including
- analyzing the potential for change
- determining of support and opposition among stakeholders and decision makers
- identifying the decision making cycle
- forming a group and assigning roles
- making connections-gaining support from likely and unlikely sources
- developing an action plan
- creating a proposal and leave behind fact and information sheets.
See Advocating for Change.