Nationwide, school-based SLPs provide services to students from at least five different groups:
- School-age students whose primary disability under IDEA is speech or language impairment
- School-age students identified under IDEA with primary disabilities other than speech-language impairment (e.g., autism; deaf-blindness; deafness; emotional disturbance; hearing impairment; intellectual disability; multiple disabilities; orthopedic impairment; other health
impairment; specific learning disability; traumatic brain injury; and visual impairment, including blindness) but who receive speech-language therapy as a related service
- Students who qualify under Section 504 of the Rehabilitation Act of 1973 who may need accommodations, supports, or other services
- Preschoolers who are eligible for speech-language services
- Students who receive pre-referral intervention, including a Multi-Tiered System of Support (MTSS; e.g., Response to Intervention [RTI]) and other services designed to help prevent future difficulties with language learning and literacy
According to the
ASHA 2016 Schools Survey [PDF], the median monthly caseload size of ASHA-certified, school-based SLPs who were clinical service providers working full time was 48, with an individual caseload range of 31–64 (ASHA, 2016).
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.
Students on smaller caseloads are more likely to make measurable progress on functional communication measures than those on large caseloads (Schooling, 2003).
These positive student outcomes may be less likely when SLPs have large caseloads and expanded responsibilities. For example, large caseloads may necessitate a shift from individual to group treatment and from smaller to larger group sizes, when such changes are not necessarily ideal for the
Student outcomes also depend on the SLP's ability to provide services that integrate the child's curriculum. Large caseloads often limit the time available to become familiar with curriculum and standards (e.g., Common Core State Standards [CCSS] or other state standards) across all grade
levels served. See
Common Core State Standards Initiative (National Governors Association Center for Best Practices, Council of Chief State School Officers, 2010) and ASHA's
Common Core State Standards: A Resource for SLPs.
Service Delivery Options
Large caseload may also constrain service delivery options. In fact, caseload size, rather than student characteristics, frequently influences recommendations about program intensity and/or model of service delivery (Brandel & Loeb, 2011; Schooling, 2003). Larger caseloads may
necessitate the use of service models that are not appropriate for some students and that may affect the SLP's ability to provide FAPE. See ASHA's resource on
IDEA's influence on student needs and expanded SLP responsibilities in schools.
Collaboration and Interprofessional Practice
Students benefit from classroom-based models in which the SLP and the classroom teacher co-teach language lessons (McGinty & Justice, 2006). Large caseloads limit the time available to the SLP for collaboration with teachers and other professionals. See ASHA's resources on
interprofessional education/interprofessional practice (IPE/IPP).
Large caseloads can also limit opportunities for SLPs to (a) work with interpreters to effectively communicate with students, parents, and caregivers about assessment procedures and results, IEP goals, and other services and (b) work with translators for written translation of
documentation as needed. See ASHA's Practice Portal page on
Collaborating With Interpreters, Transliterators, and Translators.
Other Areas of Impact
Large caseloads also have an impact on the following:
- Recruitment and retention
- Large caseloads are associated with difficulties recruiting qualified SLPs in the schools (Katz, Maag, Fallon, Blenkarn, & Smith, 2010; Woltmann & Camron, 2009) and may factor into higher SLP attrition rates in some school districts.
- Supervision and training
- Larger caseloads limit the time available to adequately train and supervise student clinicians, clinical fellows (CFs), and support personnel (e.g., speech-language pathology assistants [SLPAs]; classroom aides) to ensure the highest quality of service delivery.
- Professional development and leadership opportunities
- Larger caseloads may limit time available for participating in professional growth and leadership activities.
- Mediations and due process hearings
- Larger caseloads may result in more situations that require participation in mediation and due process hearings.
- Paperwork requirements for third-party billing (Medicaid)
- SLPs typically complete paperwork for Medicaid billing for all children on their caseloads. Large caseloads mean an increase in paperwork requirements for billing.
ASHA's Schools Surveys indicate that the average number of students on speech-language caseloads has remained relatively unchanged over the past decade, whereas the roles 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 adding value to the students' classroom experiences and improving student outcomes.
Factors that may lead to increased workload include the following:
- Changes in student populations—including an increase in students with multiple diagnosed disabilities and complex communication disorders—necessitating more intensive, long-term interventions
- Increased diversity of students' backgrounds, requiring SLPs to understand and adapt to these differences and to differentiate between difference and disorder
- 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 (LRE), focusing on state standards compliance and resulting 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 attending 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 CFs
- Increased accountability mandates involving additional documentation and paperwork
- Additional responsibilities related to supporting students in MTSS (e.g., RTI)
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
All workload activities required and performed by school-based SLPs must be taken into account when setting appropriate caseload standards. 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." This shift is consistent with the intent of IDEA and best practices in school speech-language pathology and will ensure delivery of appropriate services to students with disabilities.
Use of a workload model is foundational to
- providing high-quality services that promote positive student outcomes in the child's least restrictive environment;
- engaging in collaborative, interprofessional practices;
- delivering services with a full service delivery continuum;
- providing FAPE and maintaining compliance with state and federal regulations;
- ensuring that the student has access to—and benefits from—accommodations and modifications; and
- increasing recruitment and retention of SLPs.
A workload analysis must be conducted in order to establish an appropriate caseload. This allows education agencies to take into consideration how much time is available in the SLP's schedule when determining the number of children who can adequately and
appropriately be 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
SLPs should make a comprehensive list of all roles, responsibilities, and activities necessary for providing services in their specific school settings and then sort these activities into the four major activity clusters.
Sample roles and responsibilities, organized by activity cluster, include the following:
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
- Provide direct services to students within the confines of MTSS (e.g., RTI)
- Reevaluate students to determine whether continued services are needed
Indirect services that support students' educational programs
- Analyze demands of the curriculum and its effects on students
- Contribute to the development of IEPs, IFSPs, and 504 plans
- Monitor implementation of IEP modifications
- Design and program high-, medium-, and low-tech augmentative and alternative communication (AAC) 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
- Provide training and oversight to SLPAs and other therapy extenders
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
- Engage in interprofessional practice for education planning and communication activities (see ASHA's resources on
- Design and engage in pre-referral intervention activities (e.g., MTSS such as RTI)
- Design/recommend adaptations to curriculum and delivery of instruction
- Observe students in classrooms
- Consult with outside entities
- Become familiar with CCSS or other state standards and with the 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, and CFs
- Write student evaluation reports
- Participate in IEP/504 meetings
- Participate in professional development activities
- Maintain credentials/licenses
For examples and worksheets for the workload analysis approach, see ASHA's resource titled,
Implementation Guide: A Workload Analysis Approach for Establishing
Speech-Language Caseload Standards in Schools . See also the
Ohio Workload Calculator for SLPs [xlxs] (Carlin, 2015).
Step 2: Analyze the current workload relative to the needs of students
The Supreme Court Decision on
Endrew v. Douglas County (2017) states that "[the] child's educational program must be appropriately ambitious in light of his circumstances, just as advancement from grade to grade is appropriately ambitious for most children in the regular classroom. The goals may differ, but every child
should have the chance to meet challenging objectives" (p. 3). This standard is more demanding than the "merely more than de minimis" test requiring educational programs to demonstrate merely more than minimum progress for a child from year to year.
Keeping this in mind, the second step in conducting a workload analysis is to review current service delivery to ensure that models support adequate progress and address the changing needs of students. In this review,
- 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, or month) and the time available for these activities; and
- determine the SLP's caseload maximum—this will be reached when all available time slots are filled. This maximum number will vary across settings and will 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 and
- 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
The use of multiple advocacy strategies and partnerships is often necessary to influence workload and caseload issues within state and local education agencies. If the current service delivery is not sufficient to produce appropriate progress, suggest options to enhance services.
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] (ASHA, 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 MTSS: Trial direct services can be delivered within the context of MTSS such as RTI. Progress monitoring determines the need for continuing MTSS or considering 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, or annually). Changes in service delivery can be triggered by goal mastery. It may be helpful to clarify in the IEP document if, when, and how missed services may be made up.
- 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 to (a) extend clinical services to students who qualify for service but are unable to attend school or (b) provide services in more than one setting, thus reducing the need to
- Use of SLPAs: SLPs can work with SLPAs to deliver some of the services. See ASHA's Practice Portal page on
Speech-Language Pathology Assistants.
- 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 diagnostic team would conduct assessments and write diagnostic
- 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
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. It is helpful to write the amount of SLP services into the IEP as a quarterly, semester-based, or annual amount of time to allow for some flexibility.
- 3:1 Model: Services are provided on a typical schedule for 3 weeks, followed by 1 week with more flexible scheduling to provide a variety of direct and indirect services.
- Cyclical Schedule (e.g., block scheduling): Direct services are provided for a specified period of time followed by a similar period of time devoted to 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 on the basis of student progress toward IEP goals or changing classroom demands.
- Receding Schedule: Initial service involves intense amounts of direct services, which are then reduced over time on the basis of student progress.
- Weekly Schedule: Direct services are provided on a weekly basis (e.g., two 30-minute sessions per week).
The following are examples of various service delivery models. Using evidence-based decision making, SLPs have the responsibility to select the most appropriate service delivery model. Models should be chosen with consideration for those models 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 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 Nonacademic and Extracurricular Settings: Services are provided within the context of clubs, playground activities, lunchroom, art class, and so forth.
See ASHA's resource on
school-based service delivery in speech-language pathology.
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 resource on
eligibility and dismissal in schools for information and guidance on eligibility, dismissal, adverse effect on educational performance, and cognitive referencing as well as examples of eligibility guidelines from various states. Many states have also developed
guidelines, so check with your state department of education.
Over the years, numerous ASHA members have reported a successful transition 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 SLPs and stipends for SLPs when they supervise
SLPAs. Another district reported gaining an additional SLP position.
One state included a workload analysis approach in its statewide SLP policies and procedures and provided training in this approach to SLPs throughout the state. Another state adopted flexible and varied service delivery models (e.g., changing frequency, duration, and location of
services) that can be written into the IEP and implemented accordingly, as students achieve various benchmarks.
In 2000, the Texas Speech-Language-Hearing Association (TSHA) began the effort to develop guidelines for identifying students with speech impairments (see
TSHA Speech Impairment Eligibility Guidelines). This effort, combined with workload approach strategies, has resulted in a number of positive consequences in Texas schools, including
- better identification of students who can benefit from services;
- increased SLP coverage;
- improved quality of services; and
- significantly higher retention of SLPs.
Within a 4-year period, the city of Houston went from 38 vacancies and about 50 uncovered campuses to only seven vacancies (see
Wright & Bankston, 2009).
Workload Approach Success Stories
Student-Centered Service —
Sharon Soliday, Portland, OR
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).
For students who receive articulation services only, we have been setting anticipated remediation dates for articulation goals. We all shy away from suggesting any time frame for the most part; however, NOMS [National Outcomes Measurement System] 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 [therapy] much more quickly if a target date (if only an estimate) were in place.
2017 Update: Although the pilot is long over, SLPs in the Salem-Keizer School
District have the freedom now (and administrator encouragement) to
consistently modify their schedules based on student progress. I can't
speak to how many do so, but many individuals appreciated knowing a
framework in which to expect growth. Naturally, the SLP's professional
judgment guides any prognosis.
A Cycles Approach —
Rebecca Zutter-Brose and
Lisa Kirby-Mangas, Madison, WI
The Phonology Program (hereafter, called simply "Phonology") is a speech-language option within the Madison Metropolitan School District in Wisconsin. This program, staffed by two SLPs, 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; and
- professional development.
A 3:1 Cycles Approach —
Sharon Soliday, Portland, OR
Portland was one of the first districts to introduce the 3:1 service delivery model as a way to deal with the expanding workload of their SLPs. The implementation project began with a pilot in which SLPs used a typical schedule for 3 weeks, then set aside the 4th week for a variety of work,
including observations, assessments, consultations, meetings (with teachers, other staff, and parents), and compliance activities.
This model has allowed SLPs to spend more time in the classroom directly supporting teachers and students, and many SLPs are more involved in building literacy and reading programs and introducing new curriculum ideas to teachers. The 3:1 model has also been an effective recruitment tool when
competition for SLPs is high.
Other benefits have included
- significant reductions in districts having to provide compensation to SLPs for completing work outside the regular work day;
- fewer student service cancellations, thus improving compliance;
- improved ability of SLPs to integrate speech and language goals with classroom curriculum, as mandated by IDEA;
- increase in consultation with teachers and parents, thereby improving quality of services; and
- better morale among SLPs, thus yielding better retention.
Classroom-Based Speech Therapy —
Cheval Bryant, Houston, TX
We continue to use the workload model; however, we no longer use a 3:1 approach. Frequency, duration, and location of services are determined based on the individual needs of each student; however, in 2012, we moved to a culture of inclusive practice by making Classroom-Based Speech Therapy
our default service delivery model. As a result,
- collaboration between SLPs and teachers has increased exponentially;
- teachers and other campus personnel have a better understanding of students' speech and language needs; and
- strategies are being implemented throughout the students' instructional day versus during therapy only.
In addition, SLPs are involved in the Intervention Assistance Team (IAT) discussions regarding interventions and referral decisions for students with speech and/or language concerns. This participation leads to more appropriate referrals and avoidance of inappropriate labeling of students
who only need a few weeks of intensive interventions.
We still have specialty teams, which include a small Speech Therapy Assessment Team (STAT), Bilingual Assessment Team, Dysphagia Team, Intake Team, and Private Schools Team. We have been fully staffed since the 2012–2013 school year, all campuses are covered, and staff retention is
Taking a Workload Approach —
Mike Maykish, Brunswick County, NC
I work in the Brunswick County, North Carolina Schools, 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." Using a 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 [it has] led to a sharing of caseload responsibilities for those who have lower [caseload numbers].
Thankfully, our EC [Exceptional Children] 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 ASHA at
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, group of SLPs, or state association must consider, including
- analyzing the potential for change;
- determining of amount of support and opposition among stakeholders and decision makers;
- identifying the decision-making cycle;
- forming a group and assigning roles;
- making connections—that is, gaining support from likely and unlikely sources;
- developing an action plan; and
- creating a proposal and "leave-behind" fact and information sheets.
See ASHA's resource on
advocating for change.