The Confession
Dear School-Based SLP,
I need to apologize to each of you. I often find myself standing in front of you and telling you all that it is going to be okay. You will be okay, SLP, and your efforts are always worth it. You come up to me after presentations, your eyes wet, and tell me that I convinced you not to quit. We hug, and I’m grateful we kept another great SLP in the profession. You email me about your caseload of almost 100 students, and I help you problem-solve how to talk to your special education director. You thank me, and I’m hopeful that you will have a reprieve from your daily profession efforts, soon. You write to me and ask if it is worthwhile to switch to the profession of speech-language pathology. I write back and tell you about the meaningful outcomes of my profession, and you tell me that you will work hard to join the SLP ranks. In the last few months, the quiet whisperings of “this is not right,” “how am I suppose to do this” and “is it really worth it?” has been getting resoundingly louder. So, we need to talk.
The Arithmetic Does Not Add Up, SLPs
In junior high and high school, I used to compete in math. Let’s remove some of my mathematical cobwebs and apply my skills to school-based speech-language pathology. Let’s say, we are given a 40 hour work week. School-based SLP, I know that you are all laughing at a mere 40 hour work week; however, humor me. As an SLP who has served in many districts, I am going to ballpark that most SLPs have a caseload of 65 students. I am currently providing support on a campus that has 71 students receiving speech/language services. Those services are usually provided by one full-time SLP. Last year, I worked in a district alongside an SLP-Intern who was serving almost 90 students across 6 campuses, and I just spoke to an SLP who supports one SLP-Assistant with an anticipated caseload of 100+ for the 2019-2020 school year.
Time Given Per Student
Okay, let’s recap. We have a full-time SLP at one campus with 65 students. Let’s see how much time it would take to provide our students speech-language therapy in one week. Let’s say each student is seen twice a week for 30 minutes per session. In other words, it would take one hour of speech-language therapy per student. I fully acknowledge that this is a pattern of service delivery, and that is illegal. For the sake of my point, let’s allow this. Now, in a clinical setting, I must acknowledge that it would take me 65 hours to get this done, and the kid would get 60 minutes of my undivided attention. In a school setting, I use my creative grouping powers to get this done because this is how the structure of speech-language pathology has been set up. Let’s say I put the students in groups of 3. So, now I have 22 groups, and this means 22 of my 40 work hours are dedicated to direct therapy. Not bad, right? I still have so much time left over during my work week.
Let’s dig a little deeper. This also means that each student’s time, in theory, is now divided by three. A group of one student in a 30 minute session means that the student gets 30 minutes of intervention. A group of three means that my school-based SLP attention will be divided, and my work is not as rich as one-one-one therapy.* (Hmmmm, I wonder if this will have an impact on how long the student will be in speech-language therapy? I digress, and the answer is YES, YES, YES! ) Then, I realize that three of my students need to be seen individually. So, I am going to add three more hours of therapy into my week. We have now used up 25 hours.
*I whole-heartedly acknowledge that there are MANY benefits to group therapy: students serve as models for one another, mutual understanding that we all have individualized needs, tackling social skills with peers and much more. Here is a post I wrote about group therapy. Please know that I use this example to convey that it’s not okay to keep adding students to groups because we do not have the available time in our schedule.
I.E.Puh-lease!
No worries because I still have 15 hours of the work week left. However, I have 3 IEP meetings this week. On average, it takes me 30 minutes to prep each student (I’m really good at prepping), 60 minutes to run the meeting and about 45 minutes following the meeting to wrap up, make copies, get accommodation/modification info out to teachers and send the paperwork home. Now, I am down to an entire 9.75 hours left in my week! I am surely sitting in the SLP-lap-of-luxury.
I forgot! Since I had 3 IEP meetings, I missed therapy for 18 students. According to our laws, I must make this up. What does this look like? Well, I already have a schedule in place. So, this typically looks like doubling up on my groups. Remember my group of 3 students? Just like that, I now have a group of 6 students. My 30 minute session looks differently. (I also want to acknowledge that other educational professionals have substitutes when they are sick or go to training. This does not happen for SLPs, and we are expected to make-up the therapy on top of our current schedule. I’ll say it–this sole fact compromises our professional integrity.)
But, wait. I have an evaluation due in a week. So, I test my student. It’s a test that I use frequently. So, I don’t need to take a few hours to read through it. SLP-smart, I am. She is a student with concerns in the area of receptive language, expressive language and articulation. The testing takes me 2.75 hours. I will acknowledge that in the clinic, my evaluation usually take 45 minutes for articulation concerns, 60 minutes for fluency concerns and 1.5 hours for a language assessment (in two languages). In the schools, it always takes longer. Factors include finding time to pull the student in truncated episodes and gathering the paperwork from the family and the teachers.
We are now at 7 hours left in my week. This is awesome because it takes me 7.5 hours to gather the paperwork, score the tests, analyze the results, and write up the report, and I am only 30 minutes in the red. Again, I must acknowledge that report writing takes longer in the schools. Integrating the information from the parent forms, the teacher forms, the observations across settings and, at times, the content from outside evaluations takes time. Sitting down for 20-30 minute chunks to write the report requires added time to rethink, remember and rework the content that you completed a few days prior makes the process longer. This is our truth.
Spending an additional half an hour one evening a week doesn’t sound too bad, right? Except I have not completed my Medicaid billing. This takes me another 1.5 hours on a different evening. Whew! It’s been a great week! Let’s remember: lunch is overrated, I only had to stay up late to work 2 evenings, planning and collaborating are a luxury and I only had one evaluation due. As an SLP, I look at the glass-half-full. Since we are friends, though, I’d like to tell you what a not-so-good week looks like.
Here’s 99 Problems
Here’s 99 problems and compliance is surely one, school-based SLP. I acknowledge that there are many holes in my example above; however, I need for us to acknowledge that there is a problem right now for school-based speech-language therapy. This was a fabricated example, and the outcomes are insignificant. The real life scenarios of caseloads I’ve covered and the whispered confessions of my SLP peers are atrocious and sad. And, dearest SLPs, this is not a “people problem.” This is not YOU. This is a “systems problem.” Our school systems are not set up in a manner that 1) yields optimal progress for students (a.k.a. service delivery problem), 2) compliancy for school districts and 3) emotional health and safety for my speech-language pathologists. Brené Brown, a research professor, talks about how “being kind” is “being clear.” Right now, I want to be VERY clear. We need to make changes to the system. Now. If you don’t believe me, here are true examples of what is happening:
- SLPs recommend 30 minutes of speech-language therapy weekly because they cannot physically see the students for more time
- SLPs are compliant on IEP and evaluation deadlines. Therapy minutes are secondary because it’s not tracked by school district personnel
- SLPs dismiss students once they get to the secondary level because there are not enough SLPs
- SLPs do not have time to conduct an evaluation and write up a report to dismiss students. So, they keep and keep and keep staying on the caseload
- SLPs tell their teachers, “I don’t have time. Just pick the worse student in your class.”
- SLPs are told they CANNOT recommend more than one 30-minute session
- SLPs do not qualify students
- SLPs are quitting
Again, I need my SLPs to whole-heartedly know that I do not blame them for these errors. This is the direct result of what has been placed on our very full speechy plates. It is not a “people problem.” It is an “exhaustion” problem. You are all tired, and you are barely staying afloat. This is not okay. This is not okay. You got it, SLP? This is not okay.
What’s Next?
So, what’s an SLP to do? I have already acknowledged that you do not have any more time. So, SLPs, I need for you to sit out on this paragraph. I am now going to address school district leaders, state organizations, state legislators and, finally, the American Speech-Language-Hearing Association. SLPs, you need to understand that your school district hires you. This means that hiring is mandated by your state’s School Board Association. School districts, here is information you need to know about your SLPs: Staffing Considerations for SLPs.
And, I cannot go without acknowledging that SLPs serve the largest numbers in special education, and we also support the efforts that provide Medicaid reimbursements for school districts. We surely do not support our students and families for the money; however, it goes without saying that our efforts are considerable and vast. Then, state organizations needs to acknowledge this problem. I have heard from SLPs across the country, and this is an epidemic. You are the link to the work that needs to be done. For example, in my state of Texas, the joint Texas Speech-Language-Hearing Association (TSHA)/Texas Council of Administrators of Special Education (TCASE) Joint Committee is talking about ways to address this big problem.
Third, our legislators need to know that school-based speech-language pathologists are a part of instructional personnel. I fully acknowledge that our public school system needs are great, and SLPs need to be a part of the discussion that takes place at the state level. Last, let’s talk about ASHA. I’ll be honest. I am not sure ASHA can give direct guidance on caseload numbers. From my perspective, the needs are too diverse across the nation based on what I see when I visit school districts and when I speak to you all. ASHA, however, has given input on workload versus caseload, and this is a worthwhile consideration.
The Reality
As I conclude my heated rant, I need to bring it back home–this is you, SLP. I have spent the last few months thinking often and deeply of your daily woes. You tell me that you got into this profession to support the communication journeys of your students and their families. Know that you are. It’s amazing. As you talk to me about your caseloads, inundations of evaluations and reports and Medicaid billing, you start sharing success stories of your students. You talk about how he started putting together a sentence. You talk about the creative ways you use science experiments in speech-language therapy. You talk about the scholar that started using her communication board to request for her favorite breakfast. Here’s the thing. Despite EVERYTHING that is happening against you, you show up. You show up, and you work hard.
Now, it’s time for others to show up for you. It’s TIME.
Excellent article! I wonder how the situation differs in states that have unions!
Monica,
You bring up an important point. We have presented in states with unions, and the needs are different. I would love to hear input from SLPs from states with unions. Thank you.
The district I currently work in has implemented the 3:1 model. I honestly can’t imagine working as a school-based SLP without the 3:1 model. I hope that this model is implemented around the nation, as it allows us time to complete paperwork, evaluations, make-up sessions, and collaborate with teachers and other IEP members during our workday.
Hi Elyssa,
You bring up a valuable point with service delivery models. I supported a larger district the year we implemented the 3:1 model, and I appreciate 3:1 for its ability to 1) align our SLP content to the general education curriculum, 2) tracked time in our schedule of service to meet with teachers, reach out to parents, program devices, make materials and 3) provide a true representation of our prime duties (therapy AND testing AND report writing AND Medicaid billing AND AAC/AT AND aligning to curriculum, etc.) I agree with you–I whole-heartedly believe that considerations to service delivery is part of the answer for our workload. I will also say that the purpose of 3:1 is to 1) generalize the skills to home and classrooms and 2) alignment of the curriculum. It is also one service delivery model, and this should also be individualized to the student needs, as well. Thank you for bringing up this important consideration, Elyssa.
I implemented the 3:1 model a few years for the majority of my students a few years ago and I will never go back! It legitimately provides time for all the “extras”. In addition, as a district, we are filling in the Workload/Caseload spreadsheet on ASHA to get a better idea how to distribute caseloads more evenly. With the new response regarding Dr. Zirkel’s letter (Jan 29, 2019) from the US Dept of Ed, our responsibilities can no longer include RTI or MTSS which should help…however this may mean more evaluations and collaboration time with regular educators.
Heather,
The intent of the 3:1 model was to support the comprehensive efforts of SLPs and to provide opportunities to align to the curriculum and generalize skills. It’s also one of many service delivery options that needs to be individualized. Sadly, you are right. The intent of the model has shifted due to the initial reasons why I wrote this post—-the workload is too much.
I’m so glad you brought up ASHA’s caseload/workload model. In the district I used to support, we used a workload model. It helped us determine assignments. The following was accounted for: Meidicaid billing, student needs, bilingual responsibilities, caseload, specialized units, etc. I do believe in the workload model. In saying that, I acknowledge that districts using the workload model have seen significant increases in workload in the last decade. For us in Texas, there was a significant change when our state budge was cut in 2011. Oh, I could go on.
Thank you, Heather, for your input. You bring up valuable points to consider.
Please tell me what your collaboration (in regular classroom) week looks like….what do you do that week?
Hi Kristi,
During indirect weeks, my direct interaction in the classroom includes: attending grade level team meetings to align to the curriculum, training teachers on use of AAC device and/or getting feedback from teachers to add to communication devices, leading whole-class lessons using speech/language strategies embedded within literacy lessons, leading whole-class lessons on story grammar, organizational writing, describing (visualizing/verbalizing), working alongside students who stutter to create educational presentation for classmates, teaching fine art teachers (music, PE, art) vocabulary for social skills to implement to entire school, whole class lesson on production of specific sound, whole class lesson on sharing personal cultural narratives. At the secondary level, I spend time doing whole-class functional activities for the Life Skills programs (this is actually not limited to just indirect weeks). Activities have included communication strategies embedded within the following activities: selling snacks/drinks to campus, gardening activity, bowling activities, shopping at grocery store. Indirect weeks are busy and fun and functional! It’s a way to support the students’ efforts in the classroom.
Phenomenal article! Thank you for your advocacy and speaking our truth!!!
All I can say is thank you, thank you, thank you, thank you for “doing the math.” As an SLP I have to say most of the time I feel inadequate. I feel like I’m spinning my wheels and I’m never enough, therapy is never enough, I don’t have time to make cute “Spring themed activities” my reports should be done faster, my IEP’s should be more dynamic. Why? This is why. Thank you for asking the RIGHT question. The question has always be, “Why can’t the SLP do this?” “What does he/she need to do differently?” What we should be asking is, “What is wrong with this system?” “How can we change the role of the school based SLP?” Mind blown!
Christina,
This is it. We need to stop reprimanding SLPs for what “X, Y or Z” that is not happening. Instead, we need to ask, “Why is the system not set up to support our speech-language pathologists?” I get to meet many SLPs, and, at times, I feel like I just see a sea of crying professionals. For me, tears mean that something is important, and I KNOW that we all value our students, clients and our families. When things don’t happen, we need to think about the breakdown in the system. Perhaps she missed therapy because her caseload has increased by 10% this year?
And, finally, the part that makes me the saddest is that SLPs feel like they are not doing a good job. This is unfair. Last week, I had a group of 8 kindergarteners in one group. I had two ARD/IEP meetings that day, and it was one way to not miss my minutes. The group went well, and I was proud of myself for getting the job done. Then, when a fellow SLP said, “Ugh, I need to be better at that,” I realized what I was doing. My dear SLP friend does not need to berate herself for not yet putting 8 kids into one group. This is not normal and expected. However, it’s what we are doing to make it work. So, instead of feeding the system, I am going to speak our truths.
Thanks for reaching out, Christina. Here’s to a productive end-of-year and love to Region 4.
I’m fortunate to have approximately 50 students on my caseload at the moment and am on a 3:1 model as well. Even this, sadly, is too much, especially considering additional responsibilities–i.e., lunch break, recess duty, cafeteria duty, prep time, team meetings during prep time, etc. Because of my smaller caseload, it’s possible for me to see more students individually. Each of these students receives much more intensive intervention and I feel receives adequate “group” time with their typical peers the remainder of their day. My concern with the 3:1 model is that the 1 part is not held sacred, and is seen as an opportunity to schedule mandatory SLP meetings, trainings, etc.
Trevor,
You are right. I see this, as well. The intent of this model is to 1) support alignment of curriculum and 2) generalize skills. I strongly caution SLPs to 1) NOT use this model for all students (this goes back to pattern of service delivery) and 2) as an avenue for completing our work outside of direct service. Again, this goes back to my initial sentiments—-we need more help, and this system is not working. I also agree with your efforts in seeing students individually and in a group. We need to give them the time they need, and I’m glad you have the opportunity to do that. What’s not okay is that this luxury should be a “status quo.” Thank you for your thoughtful input and SLP-efforts.
Personally, I believe in order to be effective, ethical service providers, we must know our limits and prioritize the students we serve. I cannot help but feel that ASHA is about “job security” by proclaiming our need to be involved in every type of possible communication disorder. There are other service providers who can and should be the first contact when dealing with students with selective mutism (an ANXIETY disorder) or severe/profound disorders in which daily language stimulation is needed.
I am not saying that SLPs cannot provide a supporting role in these cases, but in my experience, there is NOT a team approach. The SLP IS the team, and ASHA adds to the pressure and watering down of our services with the idea that every single child can communicate, and all can benefit for our services. I know I’m likely overgeneralizing, but I am beat down by the system and feeling a bit pissy. I started the year with a caseload of 65, later to find out that THIRTY of the students were in the Severe and Profound classes, and ALL had AT/AAC needs that were not in place. And the students who I truly feel would benefit most get pushed to the side while I spend the majority of my time attending staffings and ARDs and attempting to developing assistive technology for students who either aren’t benefiting from my service and/or whose parents/teachers refuse to let go or to assist in the process.
Hi Brandi,
Your bring up some really good points. The specialized skills of a speech-language pathologist are unique, and I agree that, at times, our educational peers do not understand the scope of our practice. For me, it’s helpful to do a brief staff training once the campus knows and trusts my efforts. I also agree that a team approach is best. I have been at campuses where interdisciplinary work reigned. Collectively, we were able to use each of our skills to address the students’ comprehensive needs! It was awesome. I have also been on campuses where this did not happen, and our efforts were reduplicated and less effective. From my experience, I feel like part of this is attributed to available time. The ASHA Schools Survey always asks for challenges in the field, and SLPs talk about lack of time for collaboration.
Wow, having almost half of your caseload of 65 with severe and profound needs is significant. I can surely testify to the amount of time and work it takes to set up our students on with their AAC/AT supports. This sounds hard, Brandi. As for feeling frustrated, it makes sense to me. I’m hopeful the post will serve as an opportunity for conversation. We can’t change things unless we acknowledge the truth. And, the truth is that we are having a hard time. Thank you for sharing your truths.
Take care,
Phuong
I think it is very important to enlist the help of the teacher’s union. I’ve been paying teacher union dues for years, but with my new district I feel like I’m finally being heard. I tried my best to help them understand my situation, by using teacher situations. For example, how would they feel if they 30-50% more students in their classrooms fully knowing that their cap is 25-35 students. So just imagine having 40-50 kindergartners in a class!
Thank you for this perspective, Olga. I am glad there are proactive ways for you to convey your needs in the school. It sounds like there is still a gap in understanding between general education and special education (US!) needs. I really like how you communicated what our needs “look like” if we were classroom teachers. Thank you for advocating, and thank you for being a part of our field.
Thank you for discussing this. While the financial decisions do lie with the legislature etc.. I think we as SLPs need to make some decisions about how we choose to work in our field. I left the schools when I first entered the profession (25 years ago) because I had 3 schools and a caseload of 70. I felt like I was putting a bandaid on an artery wound. As a female dominated profession we are waaaay too accommodating. If you look at male dominated professions they would not put in all those extra hours without compensation. We need to speak up, union up, and or leave the work setting when it is intolerable. I have a son with special needs and understand that we feel like we are abandoning our students but we are doing them no favors by providing less than adequate services because we are overloaded. I am now back in the schools because it suites my family life, but I have caseload limits that keep me busy but not much more than when I was running my own practice. I encourage everyone with a colossal caseload to team up with the SLPs, OTs, PTs in your district and present to the powers that be as a group. The schools need us as much as we need the work. We can’t forget this. GO TEAM SLP!
Kathleen! YES! YES! Your words resonate deeply with me. When something happens, I usually let it go. When something happens repeatedly, I know that I am a part of the problem. Without diving too deeply (which I CAN!) into the gender differences in job roles, responsibilities and compensation, we are accommodating this big problem when we put in the extra time and hours. I recall talking to one of my former SLPs in a large district. She was crying because she was going home each night after 7pm, and she was exhausted. As her lead SLP, I had no idea this was happening. When we make accommodations within our day and outside the boundaries of our self-preservation, we are letting others know that we are okay and getting it done. We all know it’s NOT OKAY.
And, you’re so right, Kathleen. Gather your teams, SLPs. Garner your frustrations and speak up and speak out. As communication experts, I know we can do this. At this point, there is not another option.
I really want to respond to this with a more thoughtful note. However, after 29 years in a school and school district I have loved, for the first time the word “retirement” has entered my thoughts over and over this school year. I simply can’t sustain the workload nor reconcile it with my ethical standards. You know me, Bilinguistic peeps, and you know that I am passionate about my work so this is a tough realization. In our district, we do use a workload approach, have complete autonomy and flexibility in how we deliver our services and have the most supportive and proactive boss but even those things can’t fix the problem. Then, the state senators (SB3) decided we weren’t worthy of being included in the big pay raise they want to give teachers. At least all but one of house representatives (HB3) felt we were worthy and passed a bill to include us in the raises. That gave me the strength to continue another day. Another year? Probably will do that too.
Oh, Gina. You said it, “I simply can’t sustain the workload nor reconcile it with my ethical standards.” There are so many layers to your words, and you are right on all accounts. I’m with you–I work alongside a supportive team within a profession that I love so very much, AND something is not right. This crescendo of mishap has been building for the last 7-8 years, and we need help. Thank you for being honest. And, I will keep saying it loudly, “Our SLPs are so worthy of so much more.”
SLP in solidarity,
Phuong
This was a terrific read, thank you. I am a school SLP in Canada, and this is my first year on the job. We don’t have caseload caps here, and I currently have 100+ kids on my caseload at three different schools in a small, remote city.
I have described the job in a similar way to a commenter above, as putting a bandaid on a bleeding wound. I’ve felt like I was failing my kids because I don’t have time to provide adequate therapy, much less collaborate with educational assistants, teachers, other therapies OR prepare materials. I try to share with teachers and admin about the workload, and I’m happy to say most have been supportive and understand we are not superhuman (even though we try to be).
This article was a great read, and provided some real info on the profession. Thank you so much!
Hi Gabby,
Most states in the US do not have caseload caps either. From experience, I know that serving students across different schools adds a whole other layer of complexities. Thank you for being a part of this profession–I know it’s so hard. The part that makes my heart ache the most is you saying “I was failing my kids.” This is the part that is not okay. SLP are doing their best, including you, and this is what I continually see. It’s not YOU. It’s a system that needs to change. Thinking of you as we continue to speak our truth and potentially make some meaningful change.
Take care,
Phuong
Thank you for saying everything you said.
You are very welcome, Christina.
Perhaps we have expanded our scope of practice too much. Direct service with children with artic and phonological difficulties is the best use of our time. Our services become way too diluted when we try to remediate receptive language with kids with cognitive impairments instead of with a specific language disability.
Gina,
I agree that it’s difficult to address all parts of our roles and responsibilities. I feel that this challenge, however, is due to our overall workload (e.g., compliance tasks, IEP meetings, evaluations, report writing) and not necessarily the arenas of communication (speech, language, social-pragmatic needs, fluency). And you’re right–supporting the comprehensive needs of our students is challenging. I will say that I have observed our SLP peers supporting these needs well despite all of the challenges. Here’s to potential change within the systems for us to support our students valuable communication needs. Thank you for your perspective, Gina.
I am a Speech Language pathologist currently working in schools in Australia. This made for very interesting reading as I think all school based staff have unmanageable caseloads in Australia as well. We are following a RTI model and a lot of our time is taken up with promoting tier 1 and 2 interventions and attending meetings. Would you be able to explain one of the responders comments…” with the new response regarding Dr Zirkel’s letter[ January 29th 2019] from the US Dept of Ed, our responsibilities can no longer include RTI or MTSS…..
It said that RtI cannot be used in place of intervention. The way its interpreted in my district is that SLP’s only see students that qualify for services. We can provide consultation with teachers to implement tiers 1 & 2 in general but we don’t provide direct or indirect services to a single student. The interventions do not require a ‘specialist’ any teacher can implement them. In other words, if an individual student needs services from an SLP then they should be on an IEP. Teachers should receive education regarding tiers and administer the interventions in the classroom from their district. That said I will occasionally take an articulation student on as a “visitor” for a few sessions-if I think they can get something quickly, like a frontal lisp but I’m not involvend with any students without an IEP.
Thank you for information on what is being done in your school district.
Hi Cathy,
I’ve been thinking a great deal about how to best respond to your comment, and I think the considerations have many layers. First, I think this boils down to the sentiments of this blog post–SLPs do not have enough time to fulfill our role and responsibilities as determined by IEPs. Now, in terms of what is part of our responsibility, my feelings are mixed. How much do we participate in the RTI/MTSS process? As a former lead for a group of approximately 50 SLPs using a workload model, I will say that most of the SLPs had, on average, a caseload of 45 students. This was in 2007. With a time study I did with the SLPs, the time required to adequately support RTI for a child with receptive/expressive language needs required as much time as students receiving direct services through an IEP. When I say “adequately support” what I mean is: teachers understanding what daily documented intervention looks like and checking in with teachers. Now, due to guidance that has been provided for over a decade on RTI/MTSS and funding restrictions (special education funded salaries versus general education and special education funding), SLPs are minimally involved. From my perspective supporting various districts, I see a hard line being drawn. Teachers will ask SLPs for communication help, and SLPs are responding by saying that they are unable to help at the general education level. Then, I see teachers getting frustrated, and I can honestly see why. Teachers are overloaded, they are unsure of what to do and they are given significant paperwork to complete for a referral. I understand why these parameters have been put in place. Notwithstanding, I will say that I have been to many campuses where teachers stop referring students for speech because “it’s so hard.” This is not okay. Now, I am going to say that workload has surely increased for school-based SLPs in the last decade. So, on top of how to best help our teachers and students, we are now inundated with more work, bigger caseloads, less time, more IEP meetings and more documentation needs. This is also not okay. These two topics to me, our involvement in RTI and our increasing workload, are two separate topics. Cathy, I am not sure of how to fix this. I will say that finding areas in which to “cut” will not fix the problem. Our efforts in RTI/MTSS is only one part of the dilemma. For me, I find solace in school districts moving toward a workload model, school districts looking at a continuum of service delivery options and service delivery models and school districts with leadership who whole-heartedly understand the full role and responsibilities of an SLP. And, finally, I want SLPs to speak up truthfully. Our thought leaders are not yet fully aware of our day-to-day work duties and the exhausting efforts needed to maintain compliance(ish). This doesn’t even include the needed training and support to effectively provide efficacious intervention. Cathy, I am not sure I answered your question; however, you’ve asked a great one. Thank you and keep in touch.
I love this discussion and have read through most of the responses. I am curious how you organize your workload model. Would you be willing to share the details?
Hi Tamara,
I would be happy to share. If you are asking about the 3:! model, basically it is serving students directly for 3 weeks and then serving them indirectly for 1 week where you check in with teachers, observe, plan sessions, and sometimes pull students to do progress and data gathering. We have two courses about it if your area hasn’t implemented it yet:
Making Life Better in the Schools : A How-to Course on Service Delivery Models
Breaking Into the Classroom : Speech Service Delivery in the Schools
As far as organization of my workload, SLPs are definitely under stress related to the workload expectations but there are some things that can be done to ease the pressure. I will share a few but hopefully people chime in with their own.
1. When I get my caseload in the fall, I immediately question who I am going to dismiss. I always find kids with old eval dates or great progress. There is so much less work to do in the fall compared to the spring so that is a better time to do an evaluation to dismiss if no one is concerned or they look like a solid dismissal.
2. I move easy students to individual therapy. Most SLPs hold their individual spots for the toughies – behavior, Autism, etc. Keep doing that but also get any potential dismissals (single sound 3-5th graders) into individual therapy, hammer out those goals, and dismiss them. It is the fastest way to create holes in your schedule. After you dismiss one, move the “next most likely to be dismissed” into that individual slot.
3. Starting in the late fall, move ALL your IEP meetings and evals forward 30 days. I make it a game to see if I can clear out the May calendar completely. I have never done it though! But here’s the thing: May is packed with meetings, the Principal is less available, the kids have tons of parties, events, and fieldtrips. May is tough for a number of reasons and easier without the added pressure. Another great advantage to this is you no longer fight with the Diags/PTs/OTs/SPED for meeting slots, testing rooms, IEP calendar dates, anything! Be very vocal about it. Say to the principal “This year I am going to work to free up your schedule in May but I am going to have to ask you to attend my stuff in Feb-Apr. They are always receptive to that idea.
4. Lastly, mix your groups more with lit-based therapy. If you get good at literacy-based intervention, you can have a group of, say 2nd grades, with a crazy mix of goals. You don’t need strict artic/lang groups or even by grade level. Check out our literacy-based course or book if that is of interest to you.
Hope this helps. Scott
Thank you for writing this article and acknowledging the woes of SLPs. I currently have a caseload of 70 students and growing. I am ordered to complete all IEP and MDT meetings outside of duty hours because they cannot staff rooms to complete them during the day. I am not paid for coming in or staying late an hour or more for IEP/MDT meetings. I have spoken to multiple supervisors and all I get is a shoulder shrug. I have no time to adequately address my goals or complete paperwork. I feel as if I am not providing therapy, but just pushing children through an assembly line. They expect for me to complete paper work after school or on my weekends. I am paid as a teacher with a Master’s degree, yet they ask for me to bill for Medicaid money. I question my abilities as an SLP everyday because I am spread so thin and do not feel effective. I question even if I am cut out to be an SLP. I am upset multiple times a week, and I am too exhausted to live my life on the weekends. I used to work as a hospice SLP, and it was not even close to how stressful my life at the school is. I changed settings so I could have more time off with my family, but I have less time off now. Thank you for writing this post! It has inspired me to speak to the superintendent of the district. She will probably do nothing, but it is a try.
Christy, I am so very sorry to read all of this. You bring up so many layers to your daily SLP woes–from professional to personal. None of this is okay, and you are exhausted. Yet, I hear you still showing up and doing your work despite everything. I am going to reach out to you via email. I want to continue our dialogue. Talk soon. – Phuong
Hello,
I am currently an SLPA at a charter school in Texas and the above article looks a lot like my situation. I have been an SLPA since 2004 and have always had a caseload of 40-60 students (sometimes between multiple campuses). I ended the last school year with approx. 75 students between two campuses I began this year with a caseload of 84 and am already getting requests from teachers to have my supervisor visit with the students. The problem is, I have no supervisor at the moment (They’ve hired a new one, just hasn’t started yet). I really enjoy the people I work with and I couldn’t ask for a better special education coordinator. If things go like last year (18 initial evaluations), I will be over 100 students by April or May. I’m starting to get very stressed due to missed visits (3 weeks worth) and teachers and building administrators wondering when I will start seeing students. I know my hands are sort of tied because I’m an SLPA and I can’t really do anything but I can’t help but feel guilty.
I’m sorry for such a long first post, I guess I just needed to rant. I am open to suggestions (wife suggested asking for a raise).
Thanks.
Steve
Steve, this sounds really hard. While I do not have a easy, quick solution, I would love to problem-solve with you. Please email me at [email protected], and let’s talk. In my work with fellow SLPs and SLP-As, we have found avenues to support your stress load and health. Additionally, there are ways to advocate for more support. In saying this, I acknowledge it’s been getting harder for us and our SLP peers. Talk soon. – Phuong
In seeing this article and responses I am on the same boat. As slps we need to adovocate and stand up to legislature to help up build up a cap. I have a total of 3 elementarys and 3 headstarts where I’m responsible for evaluations, ieps, ards and it causes a big stress on me on top of supervision which I don’t mind but workload is heavy. Total kids is 164 but I don’t do therapy at the moment. It’s tough and we need to come together to stop the overload as today media posted in Austin about slps quitting and 32 have left since August.
Eliza, it does sound like your SLP-plate is full. Even without the therapy, I acknowledge that being repsonsible for 164(!) students, supervision of SLP-Assistants and maintaining your own well-being and health is too much. We have been following AISD closely, and we support their efforts 100%. I ackowledge their bravery, and their actions have propelled SLPs to begin their own advocacy work. I also acknowledge how HARD is it for the special education department in AISD right now. It is not easy to make the choice to quit a profession you love. It is also not easy to not have the ability to quit, as well. I feel sad that this is the current tone of the field; however, I’m hopeful. We need to unveil these truths to move toward changing the field. While there are many complicated layers when it comes to the amount we work, I feel that we need to examine our workload (versus caseload) and place parameters on the amount of work to best serve our students well. At the heart of all of this is our students, and they need our (best) support on their communication journeys. Thank you for your sentiments, Eliza.
I am late reading this evolving conversation, and wish I would have found it sooner. I too have similar stories of extreme caseloads, no administration support Or understanding of what our job encompasses. I have been riding the school based SLP bus for twelve years, and honestly I feel I am at my breaking point.
We just want to be acknowledged and respected by those other than our speech kiddos! All I hear is advocate advocate advocate for your self. But that will only work when someone is actually listening to you….not just hearing you!
So my journey, and all the other SLP journies I have heard and shared over the years has led me to my current place.
I am writing a dissertation for my doctoral degree in educational leadership. The topic dear to my heart…and many other SLPs….I have embarked upon. It is “Adminstrator perceptions on the role of speech language pathologist in the school setting”.
I begin my research this year and am exciting to see what their true perceptions are of SLPs, then aim to take this knowledge and use it to show how educating administrators on our role in the school system could help retain SLPs, by making changes that benefit SLPs and the students we care for.
Reading this post gives the extra boost when I am exhausted from working all day and being a wife and mother of four, to stay up a little longer writing and reading and preparing.
Thank you for reiterating to me just how important this subject is!!
❤️My SLP peeps
reading this evolving conversation, and wish I would have found it sooner. I too have similar stories of extreme caseloads, no administration support Or understanding of what our job encompasses. I have been riding the school based SLP bus for twelve years, and honestly I feel I am at my breaking point.
We just want to be acknowledged and respected by those other than our speech kiddos! All I hear is advocate advocate advocate for your self. But that will only work when someone is actually listening to you….not just hearing you!
So my journey, and all the other SLP journies I have heard and shared over the years has led me to my current place.
I am writing a dissertation for my doctoral degree in educational leadership. The topic dear to my heart…and many other SLPs….I have embarked upon. It is “Adminstrator perceptions on the role of speech language pathologist in the school setting”.
I begin my research this year and am exciting to see what their true perceptions are of SLPs, then aim to take this knowledge and use it to show how educating administrators on our role in the school system could help retain SLPs, by making changes that benefit SLPs and the students we care for.
Reading this post gives the extra boost when I am exhausted from working all day and being a wife and mother of four, to stay up a little longer writing and reading and preparing.
Thank you for reiterating to me just how important this subject is!!
❤️My SLP peeps
Dawn,
Thank you SO much for sharing your sentiments. First, I am sorry that it’s been so very hard. It’s not okay, and I hope that by unveiling our woes, change can finally be made. I LOVE,LOVE, LOVE your dissertation topic. If you feel comfortable, I am very interested in the outcomes of your research. You can reach out to me at [email protected]. I am in the preliminary stages of working alongside Dr. Tobias Kroll on research related to the current state of SLP stress in the schools at this time. Know that an SLP in Austin, TX is loudly cheering you on. I honor the energy and heart you put into your students, I hold space for the valuable research you are bringing into the arena of speech-language pathology and I am grateful for you, you, you. – Phuong
I’ve read through many of the responses to this article and I greatly appreciate the honesty, and even the ugly things people have shared. This article lets me know I’m not alone in feeling overwhelmed, and ineffective in working in the school environment. I am just a CF, and I feel like I do not have the skill(s) needed to effectively address many of the deficits on my caseload in my school. I’d love to pour more time into learning how to be more effective, and to take as much continuing education as I can, but I am simply TOO EXHAUSTED. When I get home, I have no energy to delve into research or force myself to watch hours of recordings to take a quiz and hope I’ve learned a skill that will actually help me. I thought some of the nuts and bolts of how to do some aspects of therapy would be learned in grad school, but have realized that a lot of treatment knowledge lies within spending more money to get specialized AFTER grad school. I learned a lot about “what” to do, but not necessarily a lot about “how” to do it all. Now I have to set aside more money to learn skills to do my job better, even after the debt of grad school has piled up, and I think we all know that a school SLP salary does not help when I know like many others, we purchase our own materials because we have high standards for those we serve, and sometimes we don’t know how to work on some goals, so we purchase products from TPT and hope for the best. I never guessed that grad school would spit me out into the real world still having to buy things from an online store that any parent could buy and probably implement themselves, or at least as well as any CF. I apologize for that comment, but I need to just let this out in a space where hopefully someone understands. I am not proud to say that much of my therapy consists of TPT products, but I hope to hear that I am not alone in this struggle, so there is my embarrassing secret for anyone else who feels the same. I only hope I’m not alone in this, and hope other people have gone through similar times at some point in their career. I want to reach the higher standard I have in my mind of how good my therapy should be, and I feel far from my goal, but too exhausted to start the next journey to get there. It is so frustrating to feel this way.
A parent I called this week about an upcoming ARD was upset about the lack of progress her child has made in speech the past two years. She said I am the fourth “speech teacher” she’s had to talk to about her child, and she asked me whether or not I would be at the same school in the fall, because she wanted to know whether or not she could trust me and whether or not it was worth it to bother talking further with me.
Hearing this did two things to me simultaneously:
1. My heart immediately sank. I felt her frustration and understood exactly why she had every reason not to take the time to discuss things with me. Of course, she rightly thinks, “Why bother? You’re just going to leave.”
2. I guess this is my second exposed secret… But I immediately thought to myself, “Am I going to lie to her?” Because the truth is, I DON’T know if I can stay here and continue to do this work. It’s more administrative work on nights and weekends, more PREPARING for meetings, more HOLDING of endless meetings that keep me from learning how to do my job better, or preparing some actual lesson plans, or simply keeping me from living life and doing things with my own family! I DON’T know if it’s better for me to find a workplace that won’t take my nights and weekends away from my own family, because I’m doing so much of my report writing/meeting prep work/billing/progress reports from home.
This is a very stressful push and pull of not knowing what to do, or how to maneuver the system that seems to keep growing larger and larger and gives me (not just me – EVERYONE who works in a school) more work to do, which keeps me from providing better therapy. It’s a terrible cycle that I can’t decide whether or not I want to “fight” against, and just keep trying (but feeling like I’m failing?), or get out, let it destroy itself with its own paperwork and high employee turnover until the system learns on its own that it needs to change. And then there are the parents saying, “Well, there goes another speech teacher.”
What on earth is going on here?? I guess this question is how I even ended up on this website, finding this article and finding some solace in it. If nothing else, thank you to anyone who identifies with my experience. Especially other CFs out there with me in this new world of covid regulations, having to deal with wearing masks, and dealing with all the shutdown backlogs that make everything even worse. Thank you for trying like I am trying, thank you for listening (or, reading, rather?), thank you for (hopefully) forgiving my CF/less experienced trials and errors, and thank you for trying to move forward. When I read about others pushing forward and finding happiness in their SLP careers, it gives me hope.
Hi Crystal,
I’m sorry to hear that things are so tough for you right now. The CF year is a hard one. Working in the schools can be tough. Throw a pandemic on top of it, and it’s certainly pushing us all to the edge.
Thank you for sharing how you feel and what you are experiencing. Every one of us has had these kinds of experiences and it helps us to know we are not the only ones.
I know if takes a little time but I encourage you to dive into our Free Resources library. We have a lot of things there that have been designed to support SLPs by reducing therapy planning time and facilitating the evaluation process and reducing report writing time. Things will get better!!!
Best, Ellen