August 1, 2013 Departments

Overheard: Paperwork in the Trenches

Seven school-based clinicians gathered for a focus group on the burden of paperwork at the 2012 Schools Conference in Milwaukee. The Leader listened in ...

Overheard: Paperwork in the Trenches

MODERATOR: Jeanette Janota, ASHA senior research associate

Janota: Can I see a show of hands of how many people do paperwork at home?

Participant #1: It's against my rule. [Laughter.]

Janota: Six out of seven, okay.

Participant #2: But that's great, because like our union people, our union heads are constantly telling us [to] stop doing it at home. We have to take a stand and show the powers that be that we can't complete this amount of paperwork in the time given. Yes, there's a certain amount we should do at home-just like teachers do at home-but not everything.

Participant #3: But when I worked in New York City, Board of Ed. ... and I did all my paperwork at school because they paid me money to stay after school and write. It was great! $35 an hour ...

Participant #2: Not anymore. [Laughter.]

Participant #3: I know, but that was so great, you know, and I did that. It was, it was wonderful.

Participant #3: You know, because I never took anything home ... and I got it all done, I could hand it in ... it was disbursed and ... and then I just did [evaluations]. And it was really in all five boroughs, because if we shipped the kids out, then I'd have to go follow them. Because I could do speech and eds, I was dually certified. But you know ... they don't do that anymore.

Participant #2: Yeah, they do that for the after school evaluations that they do and the weekend evaluation. But if you're doing an evaluation in school on some of your kids ...

Participant #3: Oh no, all I did was evals. I did no therapy, I just did evals.

Participant #2: Mm-hmm, yeah. CSE still gets paid for.

Participant #3: OK.

Participant #4: I actually think it's kind of interesting ... to hear you guys talk about taking a stand and following up with your union representatives. In the school district that I work in, both of them I've worked in, in the state of Wisconsin, we've adopted a workload approach. So we spend approximately 80 percent of our time doing direct service delivery, and then 20 percent taking care of indirect service provision, so basically that is paperwork. And I think it's interesting to hear you guys say all this, because even with my workload approach, I still do a lot of work at home. A lot of paperwork comes home with me.

Janota: Can I see another show of hands? Speaking of caseload/workloads. Which ones of you are on a caseload approach at work? One.

Participant #4: What do you mean?

Janota: Caseload is just the kids that you have, workload is ... caseload, plus all the other stuff that goes with it.

Participant #3: Well, mine changes from year to year. I've been with this district for six years. I've had seven directors of special ed. So it really depends on who's [in charge]-and right now we have nobody.

Participant #5: We moved more toward the workload, but ... we're all given our caseload in the beginning of the year, and it's printout and so forth. But we, they went to ... every other week we get a day to do all the paperwork, informal ... observations in the classroom and so forth.

Participant #4: It's probably worth mentioning that on my Indirect Services Day-which is what we call it in my district-I still have to document what I'm doing during that time for our special ed director.

Janota: By show of hands, how many of you write reports at home?

[Six of seven participants write reports at home.]

Janota: OK, [we're] going to move on to reducing paperwork. [One person laughs.] No laughing. [One person laughs.] Describe the computer strategies your district or state has implemented to simplify or reduce paperwork. What's happening in your district or state?

Participant #6: My district, last year, [purchased a] brand-new ... computerized system, based on Medicare. So it's through the county, and you can do your Medicare or Medicaid, whatever it is-I always get confused-as well as your, IEPs and your ... not daily progress report, but your progress reports that are reported, you know, four or six times a year, whatever it is ... And really, that has helped tremendously. I mean, there are bugs that need to be worked out-like if you're on it, I can't be on it, and even when you're off of it, it still thinks you're on it. But, huge. That has really, really made a difference.

Janota: Good.

Participant #6: So, being able to do more online.

Janota: Any other improvements?

Participant #5: Um, [a] few years ago they went to an online IEP-type profile. And Oasis. It's gone. There's ... other companies and so forth. Medicaid billing is also online, and progress reports, and they're kind of linked with the IEP.

Participant #6: Daily? Daily progress reports, or the report card?

Participant #5: We have to do monthly.

Participant #6: Month[ly], okay.

Participant #5: We can input daily, you can input for Medicaid billing daily, but ...

Janota: Anyone else have any experience with improvements?

Participant #1: My district has been computerized probably since 2001, but this past year we just got a brand-new computer program because they aligned the special ed with the rest of the district. The district just went all-database, so that the parents can access their kids' state and federal testing online. But, the program we had before this-we have a program called ASPEN which is a district-wide program. It has all the children's reading scores and all their standardized tests. We had a program called E-Sped, which was created for the special ed department in my district. And we had all the bells and whistles, so it was very easy. I could pull out an IEP probably in 15 minutes for a speech-only kid. But [with] this, we lost all our bells and whistles. So even though it's computerized, it takes a lot longer now to do an IEP. And I was the trainer of the [special ed] staff. So we're still working out all those bugs. But we can do our IEPs, it has all the goals in the program so you don't have to input them yourself. And we do our progress reports on there now, too, so hopefully it will improve this year. [Laughs.]

Janota: Potential.

Participant #1: It does have potential.

Participant #4: Yeah, in my district, the paperwork has gone computerized as well. I'll be honest, I have never done paperwork by hand at my young age. [One person laughs.] But what I do like about our current system is that it kind of streamlines the process for us. So where we write our IEPs is where we also do our [evaluation] reports, where we can find our disability checklists for eligibility criteria, and also in put our progress reports that we do six times a year. So it's ... one-stop shop, and you don't have to go searching. Everything is listed under that student. You can access previous years' files and things like that, too.

Participant #5: In our district, they're going to Google Docs for a number of things. They just started that, so I can't really say how it's going ... And then Blackboard, they use that. Number of other things.

Participant #3: We've been online ever since I've been there. The nursing home was, but this is, I've been there now. They're all online. The only thing that's not online, we have to do a fellow thing called Penn Data, and that kind of feeds into the medical access. But that goes to the state, Penn Data's. And then Harrisburg counts it and we get the money. But everything's online except for MA billing. And that has to be written out each month. But everything from IEPs, the evals, even the observation, there's a form to, you know, just type in everything. The re-evals, the progress, everything is right there, which is nice. So when I go home, I can just go to IEP Write, or you know, dot P, boom, and it's all there. And I can go through it, which does make it easy to write at home. It's just the ... you're still just ...

Janota: You're still home. [Laughs.]

Participant #3: Yeah, at home, exactly. [Laughter.]

Participant #5: 2:00 in the morning. [Laughter.]

Participant #2: You know, one of the problems we've been having is ... every three years the kids come up for full re-evaluation-triennial. And myself and the other two speech pathologists I work with, every three years we'd like to do a full assessment on the kids to see, well, let's see what happened in the last three years. Any improvement, where are the weaknesses. And the way the system is set up-the computerized system-it's almost discouraging you from doing a full assessment. Now the rules that are coming down form the city and state is they say well you really don't have to reevaluate the children, you can just do an observation report, jut an informal, um... evaluation. But that's not always enough. And what happens is, if we do full evaluations, which, you know, does take time, it takes time to write it up, when we try to input it, unless the psychologist from the team puts in a request for a full speech and language evaluation, we can't input our information. We can only go on a shorter progress report. [And we can't access it.] So, usually our psychologist is in sync with us. But ... she's learning the system also, and [sometimes] she can't figure out how to access it, so we end up somehow fitting all that information into the progress report. You know, because we're still doing the evaluation, we want the information there, we want it to be seen by others. So, the way this-I don't know, maybe it's just New York City, we're always behind the times with, you know, anything to do with speech and language. But the system is really not conducive to, I think, good clinical practice.

Janota: Anything from your state or district that's been an improvement?

Participant #7: Probably not. [She and a few others laugh.] But our IEPs, in my area of southern California, are also online. I just have a short form for the MediCal billing. We're lucky because we have a clerk who does that, so we just send that billing and she-that's her job. And so she's paid ... part of that MediCal billing money somehow. So it was easy. She's the one who gets ... all of the write-ups from the doctors, and she sends out requests, and so we don't have to do that. Thank goodness. I thought my life was hard, but I guess ... [Laughter.] But that's it. You know, I think just having the IEPs online makes a huge difference. But I think I'm like everyone else, when I write my reports, when I do my IEPs and progress reports, it's 1:00 or 2:00 in the morning. [One person laughs.]

Janota: What ideas or suggestions do you have for improving paperwork?

Participant #3: Oh, I would love to go back to when I started in 1976 and have one page. And that was it, and you just wrote [it] down. You didn't need a request for this. If the kid needed to be evaluated, you eval-it was great. And you did it-it was so nice, and you didn't have to go through all this rigmarole. And if they-well my kids were never, when I started out, never got dismissed because they were profoundly, severely retarded, which you can't say anymore. But they had just come out of the institutions, so it was like the parents were grateful whatever you would do for them because they had been, you know, tied to beds and in cages and everything, and, and ... so. And then then I, I... because everybody knows that I love evaluations, they wait, and when I get these 4th graders there's a boatload of reports, and they say OK, we know you like to eval. They're really ready for dismissal. [But] you have to go through this whole rigmarole to get them dismissed even, and go-it's incredible. Instead of just ... calling the parent, saying ... they're done, you agree, oh, OK, boom, you know. But not now.

Janota: So, can we go back to the good old days?

[Several people say no.]

Participant #3: Uh, no, because there's too much money. Unfortunately. There's too much money involved. The bottom line is the dollar. No matter what, how you look at it, the bottom line is the dollar. I've worked all over the country-Oregon, California, Arizona, Michigan, New Jersey, Pennsylvania, New York-and the bottom line is the dollar. And I swear, they would be happy if I did my paperwork and I didn't see a kid for speech.

Janota: All right ...

Participant #3: That's it, and unfortunately, it's sad but true.

Participant #6: Well, I think it is the dollar, but I also think that it's bureaucracy. There's so many hands ...

Participant #3: But that's the dollar though ...

Participant #6: ... in the pot. And it's all for legal [reasons] ... There's been so many lawsuits. From those lawsuits have stemmed, you know ...  

Participant #3: Liability.

Participant #6: Yes. OK, well now we have to do this because we have to ... cover.

Janota: So is there any hope? Can paperwork be reduced?

Participant #4: I don't know if it can be reduced, but I think there are ways to streamline it more effectively. I used to work in ... Wisconsin, and I didn't realize how good I had it at the time with their paperwork system. [Laughter.] We were able to run reports for progress notes, so I could go in and print progress notes for [my] entire caseload; it would print every single one in alphabetical order. I didn't have to go through, I didn't have to individually, student by student, print all of my progress notes out to hand out to parents and things like that. Now that I do not have that anymore ... [Laughter.] ... I recognize how valuable that was. Just literally not having to go through student by student. How much time it takes to do that is a little ridiculous.

Participant #3: Mm-hmm.

Janota: So that's a possibility. That's something that can be done?

Participant #3: Yes.

Participant #5: Yeah, I would agree with Lauren. The computer-we-there's still more to do with the computer.

Participant #4: Absolutely.

Participant #5: [Another] aspect of the paperwork [and] streamlining it: I think we can't get away from a lot of the paperwork because it's mandated.

Participant #4: Yeah.

Participant #5: [After all] my reports over the years, now I do a one-page [evaluation] report, if possible. I don't do a lot of initials. Because I'm at the high school, so I have re-evals. I'm on the other end of it. And a lot of the evals, thorough evals have been done already. So there's a lot of information for me already there, and I'm not going to repeat all of that. And the parent, by that time, has already been through several IEPs, and so forth. So ... I do a background, my findings and a summary. And the findings might be pretty big, maybe. But I try to reduce that. The district has wanted us not to be too wordy in the PLOP [Present Level of Performance] ... Some people write, you know, pages and pages for the PLOP and other people don't. So they wanted us to summarize more. So that's one thing.

Janota: Anything else you can think of that would be helpful?

Participant #1: I think for me, because I deal with such a young level ... most of my evals are initials, and IEPs are all initials. But there are those children who've been with us for three years that we're ready to discharge. And to test them again when they've ... achieved their goals. And I know it's a, it's either a state or federal law, but for me, the parent agrees with us that the child is ready to be discharged, but yet, you've got to get them to sign the permission to test, [and] have them come in again for an eval. And I'm talking straight [articulation] kids. There's not one sound that the child's mispronouncing anymore, but yet you have to give them an articulation test in order to discharge them. So that's-permission to test, do the testing, write a report, have them sign the paperwork [so] you know they're not eligible for services anymore. When, if we could just go right to that they're not eligible for services anymore, it would save me quite a lot of hours of work. And the parent. I mean, we're both in agreement. I could see if the parent's not in agreement, and you need data to substantiate that the child's ready to be discharged. But especially for artic kids, to have to do a test and do the whole process, to me it's just a waste of time for all of us.


  

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