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by Marat Moore
Call it IEP Fever-those last weeks of school when speech-language pathologists and audiologists rush to complete Individualized Education Programs, respond to parents' demands for meetings, collaborate with school personnel, plow through stacks of paperwork and, finally, think about what's coming up in the fall.
It's never been easy. But recent years have brought dramatic changes to the education environment, resulting in growing pressure on clinicians. Inflated caseloads are only the tip of the iceberg. Federal and state mandates under the Individuals with Disabilities Education Act (IDEA) '97, Medicaid, and the No Child Left Behind Act bring with them heavy paperwork burdens. State budget cuts have impeded the hiring of needed personnel in some areas. Many districts are placing more children with more severe disabilities on the caseloads of school-based SLPs. Demographic shifts, medical advances, and current knowledge of best practice have expanded and complicated the roles of SLPs in the schools.
To recognize the broad responsibilities of school-based SLPs-including compliance with state and federal laws and regulations-in 2002 ASHA developed and adopted a new policy to quantify the largely invisible workload responsibilities that extend far beyond caseload numbers. To implement "A Workload Analysis Approach for Establishing Speech-Language Caseload Standards in the Schools," ASHA has produced an implementation guide to help clinicians apply this approach, and customize it to meet their needs in their local districts. (See the ASHA Resources sidebar for a list of documents and other ASHA resources).
In a growing number of states, SLPs have found success using the workload documents in improving student outcomes, and in some cases, convincing administrators of the need to hire additional qualified SLPs. This article, the first in a series, focuses on efforts in one district in Wisconsin. The next article will explore successful strategies based on workload analysis being implemented in Minnesota and in other states.
The Middleton/Cross Plains Story
Heidi Notbohm, a Wisconsin SLP with 23 years of experience in the public schools, has seen the impact on her workload of changes in populations and federal mandates.
"In the past we had students with articulation disorders and milder language problems," she said. "Now we're getting children with much more severe disorders. We have lots of children with autism, and many who need augmentative and alternative communication (AAC) devices, both low-and high-tech.
"These children need more supports to be successful. Some need social stories to get through their day, or other materials. In some cases the curriculum needs to be modified so they can grasp the concepts. We need much more collaboration time with these students," said Notbohm, who provides services in an elementary school in the Middleton/Cross Plains School District located about 10 miles from Madison.
The extra demands for this school population, Notbohm said, "were pushing us beyond our ability to serve them. For years we've talked about this problem and said, 'How do we make administrators understand that the workload for 20 children with mild disorders is not the same as 20 children with more severe problems?"
With the support of ASHA's workload analysis tools, Notbohm has helped turn this situation around in her district in just six months. She spearheaded a local effort to implement a workload approach, and administrators are using the workload formula in their assignment of full-time employees (FTEs) in the fall.
By customizing the workload analysis model to align with the weighting system already in use in the district, students with communication disorders all begin as a "1" and severity points are added or subtracted depending on their needs. Children with autism who need intensive intervention or students who need the support of AAC devices, for example, would receive a higher weighting than children who only receive consultation (see sample of the weighting system).
Trici Schraeder, an associate faculty member in the department of communicative disorders at the University of Wisconsin-Madison who helped develop ASHA's workload documents, assisted Notbohm in her efforts.
"What helped make this successful is that SLPs in the Middleton/Cross Plains School District looked for a workload solution that fit in with a weighting system the district already was using with children with cognitive, behavioral, and learning disabilities-but not with speech-language disorders."
With Schraeder's support, Notbohm took a step-by-step approach to build support for the workload approach for speech-language pathology services. After attending a session on workload analysis at the 2003 ASHA Convention last fall, she:
- Matched the philosophy and needs of the school district. Knowing that the district already used a weighted formula for other special education students, Notbohm decided to try the same approach for students with communication disorders.
- Networked with other SLPs. At a district-wide speech-language meeting, she proposed developing a weighting system for speech-language programs. Her colleagues agreed and formed an ad hoc committee that included two SLPs who were leaders in the local teachers' union.
- Used ASHA policy documents and workload implementation guide. The committee spent long hours analyzing ASHA's workload documents and implementation guide to determine how it could be applied most effectively in their district.
- Gained support of the local teachers' union. A long and close relationship between SLPs and the local teachers' union-with some SLPs serving in union leadership positions-paid dividends when this new approach was proposed. Since trust and understanding already existed, the union immediately moved to support the effort.
- Sought feedback from all district SLPs. The committee worked hard during the 2003-2004 school year and produced monthly progress reports that were distributed to all district SLPs. As a result of the feedback, two separate weighting systems were developed, one for elementary schools and one for middle and high school students.
- Collaborated with a principal who supported the workload approach. Notbohm's principal had recently moved from another school in the district, and immediately noticed the difference in speech-language workload. Because her current school serves many children with severe problems, the workload is much heavier. The principal was so supportive of the workload analysis model that she agreed to provide information to other principals in the Middleton/Cross Plains District.
- Ensured inter-judge reliability. The district's SLPs tested the system at a district-wide speech-language meeting by comparing their ratings from eight case studies. When the clinicians came up with similar ratings, they knew they had inter-judge reliability-everyone was in accord on how to use the formula.
- Began a trial year to test their system and reassess. After the committee studied the ASHA materials and customized their approach to use their district's weighted formula system, the SLPs in several schools piloted the system in early 2004 by rating elementary and middle/high school students.
- Discovered an unexpected bonus in student outcomes. SLPs' use of severity ratings also helped students make a smoother transition from elementary to middle school. Says Notbohm, "Since we did the ratings in March, the data was shared with the teachers and clinicians who would be delivering services to that child. So they knew what that child needed long before the transition was made."
Notbohm wholeheartedly supports the shift in approach from caseload to workload. "Workload analysis in general, and the particular weighting system that we're using here, is much more appropriate and quantitative when SLPs are allocated in buildings. ASHA's workload analysis model is the best tool I've seen in 23 years in the schools. It gives us the data we need."
Adds Schraeder, "By using a workload analysis approach, school districts facing budget cuts can document accountability for what SLPs are doing and why they're doing it. "
As school drew to a close, the director of student services informed Notbohm and her colleagues that the district reviewed the weighted workload numbers-and plans to add 1.1 FTE positions next fall.
"We're very pleased that staff are being assigned based on the workload activities required to meet the individual needs of students," Notbohm said. "Now we'll be able to meet the communication needs of our students in the public schools."
Contact Heidi Notbohm at heidin@mcpasd.k12.wi.us.
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