What comes to mind when you think of your "caseload"? Not all speech-language pathologists define the term the same way. For some SLPs, caseload means strictly the numbers of students seen in intervention, while others take schedules, planning time, collaboration, and meeting time with teachers and parents into account.
ASHA considers caseload (or the number of students with individualized education programs, individualized family service plans and 504 plans served by school-based SLPs) to be only one part of an SLP's total workload. To better define the scope of the school-based SLP's job, ASHA prefers the term "workload"—a more comprehensive view of what SLPs actually do to provide effective and required services to students—to indicate the total number of professional and clinical activities required of and performed by SLPs. ASHA's new portal page on caseload and workload provides information and resources to help SLPs understand and shift to a workload analysis approach.
But many ASHA members are reluctant or don't know how to use it. In the ASHA 2012 Schools Survey [PDF], members indicated that although the average number of students on the caseload has decreased over the last few years from 50 to 47, SLPs still face several barriers to implementing the workload approach: the number of students on their caseloads, inflexibility of schedules, and others' lack of understanding about job requirements beyond providing intervention to students.
What's more, the workload analysis method is favored over establishing a statewide caseload cap. Many states cap caseload size, but SLPs report that states often do not adhere to these guidelines, and the maximum caseload often becomes the minimum. Moreover, with caseloads based only on the number of students served, SLPs can't adequately describe to other members of the school's team all their required responsibilities under the Individuals With Disabilities Education Act and the indirect services they provide to students. A further reason for not adopting a caseload cap is the lack of data supporting an optimum caseload size.
Comparing the two approaches
There are distinct differences in the quality of services that may be provided using the two approaches. The workload model may increase benefits to the student and clinician.
Issue: Roles and Responsibilities
- Workload considers and provides a way to educate others about the SLP's full range of roles and responsibilities (for example, planning time with teachers and other staff, collaborating with teachers and families on IEP development, and involvement on response-to-intervention and curriculum teams).
- Caseload accounts only for the number of students receiving services.
Issue: Service Delivery
- The workload approach ensures delivery of appropriate services to students with disabilities, consistent with the intent of IDEA and best practices in school-based speech-language pathology. It allows for more flexibility in scheduling and service delivery options that meet students' individual and changing needs.
- Using caseload numbers alone may lead to greater numbers of students who receive services, but it may limit service delivery models and range of services provided (for example, traditional pull-out versus prevention, consultation and collaboration).
Issue: Recruitment and Retention
- SLPs who use the workload approach have reported greater job satisfaction and retention, an important consideration in addressing shortages of qualified providers across the country.
- Anecdotal data have indicated that high caseloads are a deterrent to recruitment of SLPs and can lead to burn-out.
The ASHA Practice Portal on Caseload and Workload provides an in-depth step-by-step process for analyzing the workload responsibilities and addresses moving to a workload model. Here are the basic steps:
- Document current roles and responsibilities
- Analyze the current workload relative to the needs of students receiving services.
- Determine if the workload is balanced.
- Collaborate with SLPs, teachers, administrators, union representatives, parents and other service providers to address workload issues.
After completing the workload analysis you can review the suggested administrative, scheduling and service delivery options outlined in the Practice Portal page.
Some limitations and successes
An administrator in a large district performed a workload analysis in a local school, and computed the student-to-SLP ratio using ASHA's workload analysis. The analysis indicated he would need more staff, but district budget constraints would not allow him to hire more SLPs. Others have experienced resistance to change from administrators, teachers and parents.
Still, many ASHA members reported that workload is interpreted differently across the country, and various approaches can be used successfully. Here are a few examples:
- A member in North Carolina used the workload model in his district and encouraged SLPs with high caseloads to re-examine their service delivery models, which led to sharing caseloads among SLPs. Moreover, he reported the workload approach is useful when quantifying workload responsibilities beyond providing direct services and can be a powerful tool when explaining the role of the SLP to administrators.
- Sharon Soliday of Oregon lists several successful outcomes when using workload, including that it streamlines dismissal criteria, allocates time for prevention activities, abandons traditional scheduling models, makes changes in treatment schedules as students gain proficiency toward IEP goals, and sets proposed dismissal dates for students with articulation issues.
- A member from Wisconsin schedules indirect service activities in blocks of time across each month (see "Time Block After Time Block"). This method gives her the opportunity to meet with parents and teachers, plan sessions and complete required paperwork without compromising services for students.
So it can be done. Complete information and resources about caseload/workload, advocacy strategies for changing to a workload approach, additional success stories, information on ASHA's documents and the "Implementation Guide: A Workload Analysis Approach for Establishing Speech-Language Caseload Standards in the Schools" are available in the new ASHA Practice Portal.