Elizabeth, the speech-language pathologist at Shady Grove Elementary, must schedule treatment for 51 students with individualized education programs. The classroom teachers all plead that their students can't miss instructional time—and, oh yes, they all have a few more new students to refer for evaluation. To make sure the referrals will be appropriate, Elizabeth suggests scheduling speech and language response-to-intervention sessions to gather data about the new students.
Together, they schedule a four-times-weekly RTI articulation group for the first 30 minutes of the school day, and a three-times-weekly RTI language group the last 30 minutes of the school day. The teachers agree this schedule is least intrusive on instructional time and understand that the RTI groups will run for a specified number of weeks.
Scheduling: It's the bane of just about every school-based speech-language pathologist's existence. We are responsible for assessing students, providing intervention, writing goals for individualized education programs, participating in IEP meetings and conferences with teachers, working with general education students who are not performing at grade level, and completing mountains of paperwork.
Prevention, assessment, intervention, dismissal—meeting all of these responsibilities often seems like trying to assemble an intricate, complex puzzle. And just when we think all the pieces are interlocking perfectly, we realize there are a dozen pieces we've forgotten to put in.
The demands on school-based SLPs' time and expertise—the pieces of the puzzle—are not limited to the needs of students with individualized education programs that include speech-language intervention. Current educational models call for robust response-to-intervention programs in which teachers and other school personnel help struggling students meet grade-level expectations and avoid unnecessary special education placement.
Some SLPs may not understand that under federal law—the Individuals With Disabilities Education Act—speech-language pathology services encompass the expectation that SLPs provide prevention (RTI) services (see "Where's the Money?"). If that provision is new to a school or district, the SLP's first step may be to meet with the special education director or administrator to gain administrative support. Using federally funded SLPs to provide RTI that is part of general education services, then, is allowed under IDEA.
So how do you fit those services—as well as assessments and dismissals, paperwork, conferences with parents and teachers, and prep time—into a manageable schedule?
We believe the key to caseload management is a workload approach (see "School Matters"). A successful workload approach can:
- Provide the capacity and flexibility to meet students' needs.
- Broker both general and special education systems.
- Offer a full continuum of RTI and IEP services.
A workload approach starts with the total work activities of the school-based SLP, rather than the total number of students who need services. As we described in our Aug. 30, 2011, Leader article ("How to Fit Response to Intervention Into a Heavy Workload"), the workload approach allows the SLP to make student-centered decisions about who to serve, how to serve, how long to serve, where to serve and what context to use for services. It includes direct and indirect response-to-intervention and educationally relevant IEP services and activities. It differs from traditional scheduling, which usually prioritizes direct IEP services first and uses any remaining time for indirect services and activities and for paperwork and compliance obligations.
This approach incorporates the features of more traditional scheduling to use time and meet students' needs most effectively.
To understand the theory behind flexible scheduling, it helps to look at the features of some traditional approaches:
- In a traditional weekly schedule—the norm in most schools-the SLP schedules students for services on the same time/day(s) every week. You can, however, vary the amount of time, location and service delivery approach: for example, provide one session of individual pull-out treatment per week and alternate small-group pull-out sessions with classroom-based service delivery every other week. Combining service delivery models allows you to focus on educational relevance and treatment effectiveness.
- In a receding schedule, the SLP provides direct services in an intense schedule of increased frequency for a period of time, and then reduces direct services while increasing indirect services. For example, in the first semester you work with a student 90 minutes per week on IEP articulation goals; in the second semester, you reduce the amount of individual direct services to 15 and provide 30 minutes of indirect services per week (independent practice of target sound production and monitoring generalization).
- In a cyclical schedule, the SLP provides direct services to students for a period of time followed by no services or only indirect services for a period of time. You foster growth and learning of new skills in the first phase and monitor stabilization of skills in the second phase. The 3:1 model is an example of a cyclical schedule—direct services for three weeks in a row are followed by indirect services and activities in the fourth week. Another type of cyclical schedule can be described as pulse scheduling with, for example, direct intensive services for weeks followed by one week of no direct service and indirect service provided. The pulse on-off direct services allow students to stabilize skills learned during the "on" cycle.
- In a block schedule, sessions are longer but less frequent, and often reflect the school's master block schedule (fewer, longer classes every day or every semester). SLPs should clearly define direct and indirect services on the IEP schedule of services so the student and parents understand which types of services will be delivered at what times.
A flexible schedule uses features of these schedules to maximize services and best meet students' needs.
Get started with activity blocks
If you decide to try a flexible approach, you will need to look at your time in a different way. Resist the urge to schedule intervention for your IEP students first, and then squeeze everything else around them. Instead, a good first step when using a workload approach to scheduling is to designate blocks of time for key activities. Schedule blocks of time for:
- Direct IEP-mandated interventions that use a variety of service delivery models, including individual or group pull-out sessions and classroom-based sessions.
- Direct prevention services, such as Tier II or Tier III intervention through response to intervention.
- Indirect services to support implementation of students' IEPs.
- Indirect services and activities related to RTI.
- Indirect activities to support students in the least restrictive environment and help them progress in the curriculum.
- Evaluation activities, including direct testing, classroom observation at different times of day and on different days, and conversations with teachers and parents.
Remember, in this workload approach, the schedule for each week may not be the same. This chart [PDF] illustrates a sample week in which activities—not students—are scheduled.
Find time for RTI
Prevention services in a response-to-intervention model often work well in several discrete time slots:
- "Backpack" times of the day. It's important to minimize interruption to the core instructional times of the day, and the first and last 30 minutes of the school day—"backpack" times—are typically not intensive instructional times. Students are either emptying or loading their backpacks to prepare for class or to go home.
- Before or after school. Many school-based SLPs are included in faculty duty assignment rotations (for example, breakfast duty or dismissal duty). The SLP's time is better spent offering Tier II or Tier III intervention with a group of students during duty times. When extended day programs are available at the school through grant funding, the SLP may provide Tier II or Tier III intervention as part of the grant-funded program.
- A hybrid of backpack and before- and after-school slots, if state rules and regulations allow for work outside of the school day hours. A student could, for example, come to RTI for 15 minutes before dismissal during "backpack" time and stay after school for 15 minutes to participate in a 30-minute intervention session. Because RTI is a general education initiative, there may be flexibility to keep students after school with parent permission.
- During the school day, if the school has intervention times built into the master school schedule. For example, a campus might designate 2–2:30 p.m. on Tuesday, Wednesday and Thursday as school-wide intervention times for identified students. A student might participate in a Tier II reading intervention in that slot on Tuesday and Thursday and a language intervention session on Wednesday.
A sample schedule [PDF] provides a more detailed description of how the SLP schedules the various workload activities: It includes hybrid scheduling for RTI articulation lab at 7:45–8:15 four days/week; backpack scheduling for RTI language lab at 2:15–2:45 three days/week; and indirect RTI activities at 9:30–10 one day/week. Although IEP speech-language services may vary from week to week with an established rotation pattern, RTI sessions should be scheduled on the same day and time each week in a similar manner to the scheduling of Tier II and Tier III reading interventions at the school. For example, an SLP may establish three different schedules and rotate through the three schedules throughout the school year.
Prevention, assessment, treatment and dismissal are the cornerstones of SLPs' responsibilities in schools. With a limited number of hours in a week and increasing numbers of students with a wide range of needs, SLPs may find that stepping outside of the traditional IEP-centered schedule gives them the flexibility to combine service delivery models and times to meet student needs across the continuum.