Thursday, April 11, 2013

I'm a Clinician, not a Magician---Caseloads and what's within reason

After a few of my articles have been published about therapy data documentation, one of which you can see here, I've received a few polite inquiring emails.  Every one of these email authors have asked about  caseload size, basically other SLPs wanting to know how many children I work with.

 One reader wrote that her caseload was 71, while another said 80.  That same reader said that they had difficulty finding certified SLPs to work in their setting.  My response is this:  I couldn't and wouldn't work in that setting either.  How could an SLP possibly treat 80 students? Taking adequate data on IEP goals would be impossible.  Just taking attendance would be a challenge. My ramblings on using Google forms and spreadsheets   wouldn't exist because I would have no time to create spreadsheets or take much data.  My work life would be more of mere survival.

When I first thought about being an SLP, I was determined that I would NEVER work in a school setting.  My life changed, and with my family, I discovered the school schedule worked.  Through luck and picking and choosing my settings, I've worked full time first in a residential school for children with autism (caseload 7), then full time in a rural public school in Virginia (caseload 30), and now full time in a public school in North Carolina (caseload under 30).   I'll never work in a setting where I can't do my job adequately due to huge caseload size.

A look at ASHA's 2010 Schools Survey showed the average caseloads around the country in a school setting.  Take a look at Indiana.  I'm no magician, so if I did have that setting of 80 kids, I know that job is not for me!  Maybe I know my own limits, while other SLPs may have more clinical and organizational skills to pull it off.  When I read others' blogs, though, I see a lot of frustration with caseloads and paperwork, so I'm guessing there is a lot of stress out there.
I don't have magic answers, but.....
there are a few things we do as a group in our school system to keep our caseloads down.

1. Advocate, advocate, advocate.  We have a lead SLP, and she and the one before her have been instrumental in attending higher level meetings, and advocating for reasonable work loads.

2. Become known to the important people.  I've gone to school board meetings and given speeches.  We SLPs use email to educate, and we encourage parents at times to do the same about important issues. We make our faces known---at the PTA meetings, leading a school improvement team, doing presentations, writing grants, going to the local autism society meetings, sitting on the RtI team, writing letters to the editor.  I've done all of that and so have my fellow SLPs.

3.  Make sure kids on your caseload are in need of speech therapy to access their education. We, as an SLP group, strive to make sure that the children on our caseloads meet the criteria for needing speech/language therapy according to North Carolina guidelines.  To do this, our lead SLP pushed us to begin a peer review process.  For example, after I evaluate a student, I record scores and pertinent information on a Peer Review Form.  I present this case, usually in person, to a team of three other district SLPs who help determine whether the child actually meets North Carolina criteria, and if the child then needs speech to access his education.  I'll write more about this process in a subsequent post.  I really like peer review, though.  Caseloads are consistent through the district, and the children are truly in need.



 4.  Use RtI as a preventative measure.  We see children with mild articulation problems in RtI rather than as a full-blown speech impaired IEP kid.  A child with a single sound error (such as R) is not eligible for a speech IEP under NC guidelines.  Short term intervention under RtI is an option, and an easier process for everyone involved.  Of course, there still needs to be negative impact of his speech sound error in the classroom.

I could write more on this topic, but then it would be more than a simple blog entry!  The bottom line is that we all want children to make progress.  A manageable caseload is one factor to ensure this.

5. VOTE for your ASHA Board and President.  Vote for a change in the status quo.
          Go here to read more about that.  Only 3 percent voted in the last election.
.





.



16 comments:

  1. Ruth, great post! I'm in Indiana, and not only do we have the highest caseloads, our salary is also below average. Just got the ASHA leader, and though I know I'm going to be lower as a first year, I am about $20K lower than the national average for elementary school. And yes, my caseload is over 100. Just got back from the state conference, and nearly every SLP I talked to had over 80.

    It is true that our caseloads are in part so high because there is a shortage. Take a shortage plus no caseload cap and low salary--many SLPs don't want to work in that kind of set-up! Like you, the school schedule works for my family life, and there are other perks (like 2 of my kids attend the same school where I work, which is 2 blocks from my house!). Still, yes, sometimes I know I'm not being effective because of the high caseload. Those moments of effectiveness make me long for being able to do so consistently.

    So, we're working on #1. #2 depends on the individual SLP, but I try! #3--I have had only 2 initial evaluations on my own this year (2 more still to go). I've had other initial evals initiated through the psychologist, but otherwise I'm working to provide teachers strategies for the classroom that might help, before referral. I also wrote a grant for instructional material that I think would benefit all students in our low-socioeconomic school, to help develop oral language. I will work with teachers to implement next year. And we're also working to develop an RTI program for articulation, because, yes, this will help.

    I'm also very creative in service delivery, trying a variety of ways to be effective. Next year I'll be spending 1 day per week in each grade level (K-4th) for 4 hours, working in the classroom and with the teacher (and doing pull out into the hallway when needed).

    anyway, I appreciate your post, because it's a good reminder that sometimes the job feels overwhelming because it IS overwhelming. As we work to change the culture of SLPs in the schools in Indiana, it will take time. And a reminder that it IS a lot to take on is a very helpful reminder. :)

    ReplyDelete
    Replies
    1. Thank you for your thoughtful comments. It sounds like you work hard, like what you're doing, and are being creative in service delivery to make it work best for the children. Good luck with both your job and with advocacy on behalf your kids and speech services.

      Delete
  2. I am doing my CF in an urban elementary school. Going into it, I knew the caseload was high but I was eager to learn a lot during my CF. My caseload is teetering around 75 right now and it is impossible to see everyone according to their IEPs. I definitely look forward to the day where I can actually service my kids and not attend meetings half of the week! Great article :)

    ReplyDelete
    Replies
    1. Thank you! Good luck with your CFY year! There are lots of great opportunities out there once you get your Cs.

      Delete
  3. I'm in my second year as an SLP (Texas) and I have a caseload of approximately 60. It's manageable because I see most of my students once per week. I can't imagine having 80-100 (all would almost have to be on consult!) If my boss had her way, we'd all have caseloads of 40, but we're hurting for school SLPs down here and unfortunately the districts don't have the budgets to hire as many as we need. (Thank you, State of Texas, for taking away a good chunk of our funding!)

    I am incredibly thankful to be in a supportive district with an amazing boss who advocates for us. She'd give us the clothes off of her back if we asked. I think it definitely makes having a high caseload easier.

    ReplyDelete
  4. Sigh. I'm another Indiana SLP. While my caseload is fairly 'low', I am only .6 FTE. My numbers: 40 students -- ALL of whom have complex communication needs. It is truly frustrating to me that I have such limited time, that I have to parse out my minutes on IEPs based on what I know I can achieve (I always emphasize 'at least') on a regular basis. All my prep and paperwork is done on my time.

    I'm not really complaining. I love my job, love my students, love the challenge of working with AAC and challenging behaviors. And all of your suggestions are valid. But the core of the problem, at least in my area, is deeper.

    Our school systems are broke. Broken, too, but broke. I have asked for more hours -- I don't need to be fulltime (don't need the benefits), but I was hoping to up my hours so I could do more, have a better impact, have the opportunity to work more with teachers and staff on strategies for integrating what I do into their lesson plans. I was told abruptly that there is no money. NO money. I can't even purchase materials, as there is a spending freeze. Until there is more money, I don't see our school system considering hiring more SLPs or providing more hours for part-time employees. They are actually looking for ways to REDUCE staffing costs.

    I'm not going to quit out of frustration. I'm working with what I have. But I advocate for better support of our public schools at every turn. Quality input (staff) creates quality output (student success).

    This problem is a big one. I am happy to see that there are several states who are addressing caseload size. I advocate for us all to keep working, keep advocating, keep emphasizing that what we do matters.

    ReplyDelete
  5. This is an excellent article. This is my 30th year as an SLP (state of California). The highest caseload I had was 76...but that was long before the paperwork spiraled out of control--although I thought my situation was pretty overwhelming at the time. I work in a district where there is intense scrutiny of our paperwork due to past lawsuits. Entire IEPs are returned to us for correction if there is a single error or typo. So much energy and time goes into this now that finding the time to plan lessons is a thing of the past. We too, have a dismal budget situation, as do many districts here. I would also point out that SLPs are asked to bill MediCal (Medicaid in your states) using our private practice licenses without compensation. We have no idea how much we bring in nor any idea what it is spent on (it goes into the general fund). This is a huge ethics issue for me.

    Now, I would like to say, on a more positive note, that I have learned how to make materials and sell them on teacherspayteachers which has become a huge motivator for me. There is nothing better than having the knowledge and skills to produce materials for your students! I also have wonderful colleagues and have had the privilege of mentoring a "homegrown" SLP student who was just admitted to grad school. Her situation is another positive influence on my career. She may return to our district to work when she finishes school. :) :)

    ReplyDelete
  6. Ruth, this is a great post! It is SO up to us to change the climate in our districts if we are not happy. I think you give great points to what must be done. The SLPs in my district are currently trying to find our way through this fight through our union and are determined to serve kids better...which you just can't do with a high caseload. It is certainly not an easy task, with budget cuts and broken schools, but no one is going to change it for us.

    Jenn
    Crazy Speech World

    ReplyDelete
  7. Ruth, I love your materials and your posts. I've been an SLP in the schools for 23 years. The most students I had at one time was 50 (between 3 schools) while working full time and 35 when working 70%. The 70% caseload was manageable, however, the sheer SEVERITY of the disorders made it feel like 50+ students (the numbers aren't always a true reflection of the amount of work a caseload my require). With that being said, I felt like I was burning out because of working with students demonstrating behavioral disorders. I found myself doing less and less therapy and more behavior management and paperwork. I decided to quit working within a school (on-site) and began working for a company providing tele-therapy. It is sooooo wonderful being able to do mostly THERAPY with only some paperwork! I feel rejuvenated! I adapt most of your materials to use with my tele-therapy students and they love it! I mention tele-therapy because some of the people that have posted reported such large caseloads while districts are tightening their budget belts. Tele-therapy could be a more cost-effective approach to help fill vacant SLP positions until someone can be found to work on-site or permanently fulfill those vacancies. SLPs - It would be worth discussing it with your district. The philosophy of the company I work for is NOT to take over existing clinician positions but to fill in for those under-served or un-served students.
    Keep up the excellent job, Ruth! Thank you for all that you do!

    ReplyDelete
  8. I noticed that there are no numbers reported for South Dakota. I think there is a reason for that.. The last 2 years I have started with over 100 on my caseload.

    ReplyDelete
    Replies
    1. Maybe the form couldn't handle triple digits!

      Delete
  9. Great post Ruth! When I started in my district, my caseload was between 45-50. It's grown (as have the caseloads of the other SLPs in the district) to about 70. My caseload is average for my district, but others have up to 90! We're being asked to really look at eligibility because, I believe, many students are over-identified. However, we're also being warned of potential budget cuts...meaning that the retiring SLPs (2 during the next school year and another at the end of that school year) may not be replaced! I'm hoping this is just "talk" and the days of lower caseloads are on the way! I'm glad you and your colleagues have been able to keep your numbers reasonable!

    ReplyDelete
  10. Wonderful post as always. My caseload seems to start around 48-50 and declines to about 37-38 by the end of the year (granted, it's only my second year). I am so thankful for NC's caseload cap. I don't think I could handle more than 50 without going crazy.

    I love the peer review idea!

    ReplyDelete
  11. Thanks for sharing the great info in your post. My highest caseload was 120(no exaggeration)---I was traveling to 3 different schools in a large school district and one of my therapy rooms was an extremely hot room off the school kitchen that emitted the heat from the ovens---during lunch time it was almost impossible to function between the heat and noise of the cafeteria. Oh-and I was 7 months pregnant at the time! I decided to stay at home a few years and when I returned to work, I was much pickier (I resigned from the previous position of 9 years) Now I am in a private school setting (ages 10-18 with average/above avg IQ's who have language-based learning disabilities) and have a caseload of under 20!!! It's as close to a dream job as I'm going to get---I love working there and I feel like I am finally, truly MAKING A DIFFERENCE! As for the other school district, there is no beating the system---they refuse to hire enough SLP's to make caseloads more manageable (budget reasons!) Not sure how they can get away with it but I'm glad I no longer work there! Rose (www.speechsnacks.com)

    ReplyDelete
    Replies
    1. Thanks for commenting. I feel that if you have confidence in your own abilities, you can hold out for the better jobs, just like you did! I enjoy your blog, by the way!

      Delete
  12. Awesome post!!! I have a higher case load than you, but much smaller than many. AND I have an AMAZING SLP-A 3 days per week that makes everything soooo much easier!

    I love the idea of peer review for eligibility!! Please email me with more info!! speechforme at gmail dot com

    ReplyDelete