High Speech Therapy Caseloads and Workloads are Forcing SLPs to Leave the Field
Categories: Increase Your Effectiveness - Tips for SLPs
I received an email from one of our SLP Impact members about speech therapy caseloads and a heavy workload in the school setting, and decided to put together a post to answer her question. I know her concern is shared by many SLPs in our profession. She wrote:
I am looking for tips, if you have any, for SLPs who are directed to help cover vacancies in their districts in addition to serving full caseloads. This has happened, to some degree or another, in most of the districts I have worked in over my 17 years as an SLP. It has typically been to cover for colleagues out on leave but it is happening in my current district with unfilled vacancies. I want to be ready with a good response to district leadership next year as I am fearing the worst. At the moment, we have one unfilled vacancy but I expect an additional 2-3 vacancies by the end of summer (we are a tiny district so 3 or 4 vacancies is a big deal). Do you have any guidance on how to respond to directives to provide services to students who need them but who are not accounted for in my workload or caseload? Or any idea who I could ask about this at ASHA? I am exhausted and not sure I can continue to “make it work” as some administrators have suggested.
Sadly, this is not a new problem. High speech caseloads are a problem that speech-language pathologists have been facing for decades. In 1991 ASHA recommended that speech caseloads be capped at 40. Yet, despite that recommendation, speech caseloads continue to be far greater than that. Before we go any further, let’s discuss caseload vs. workload.
Speech Therapy Caseloads Vs. Workloads
A speech therapy caseload is simply the number of students a speech-language pathologist serves for speech therapy. In the schools, it is the number of your students who have Individualized Education Plans that include speech therapy. Workload is often used to account for the many other things that SLPs do as part of their jobs, such as IEP meetings, IEP development, progress notes, consultation, and so forth. For more on Workload versus Caseload, visit ASHA Caseload and Workload Sizes. Whichever term we choose to use, the numbers are too big, SLP job satisfaction is low, and people are leaving the field in flocks.
What can we do? Well, I always like to start with the research. I found two studies that I think we should share with school administrators.
One study found that caseload size is the strongest predictor of job satisfaction for SLPs in schools. Another study found that other things that contributed to job satisfaction were: smaller speech therapy caseloads and serving a smaller number of students served per day. Other important characteristics were having friendly coworkers and supervisors and having time to get work done.
In a survey of more than 2000 school-based SLPs across the United States, Katz and colleagues (2010) sought to identify the threshold at which a caseload feels unmanageable for SLPs. They found that as caseload size increased, the percentage of SLPs who felt their caseload was unmanageable also increased.
As speech therapy caseloads crossed the threshold of 45 students and into the 46-50 range, approximately 40% of SLPs felt their caseload was unmanageable. 45% of SLPs considered caseloads of 51-55 students unmanageable. 60%-70% of those with caseloads of 56-90 students, and 100% of those with caseloads over 90 students considered their caseload unmanageable. This information is summarized in the table below.
| Speech Therapy Caseload Size | % of SLPs who considered caseload unmanageable |
|---|---|
| 46-60 students | 40% considered unmanageable |
| 51-55 students | 45% considered unmanageable |
| 56-90 | 60-70% considered unmanageable |
| 91+ | 100% considered caseload unmanageable |
Now, here’s the thing that should motivate school administrators—the higher the caseload, the more likely SLPs plan to leave their school-based speech-language pathology job as soon as possible. This is based on a study in which more than 8,000 interviews of service providers were conducted. Here are the details in a nice little table for you to share.
| SLPs with a median caseload of: | Here’s what they said. |
|---|---|
| 46.2 students | said they planned to stay in the profession as long as possible or until retirement. |
| 49.2 student | said they felt undecided about their careers |
| 59.7 students | said they planned to leave their school-based speech-language pathology job as soon as possible. |
A number of states have created speech therapy caseload and workload limits for speech-language pathologists. This 2019 document from the Oregon legislature summarizes guidance for caseload limits by state. As you will see, many states do not have any limits. For those that do not, talk to your state representatives and your state association to introduce legislation in your next legislative session.
Our message to those asking us to “make it work” is,
“Spreading SLPs thin exacerbates the problem!”
For more strategies, download Advocacy Strategies for School-Based SLPs
I found this information so helpful and agree that school-based SLPs need support around advocating for manageable caseloads and workloads! Thank you for this post!
So glad you found it helpful. Hopefully everyone will share with team leads to influence needed changes in the field!
Good information on link about caseload limits per state. May be a great starting point for advocating for limits in Texas. Thank you!!
You’re welcome, Martha! Thanks for your kind note.
Thank you for addressing a pressing issue head on. It would help with some actionable tips on how to address employers. Perhaps a script on what to say would be useful.
I’d keep it simple and get your whole team on board. Call a meeting with your leadership to talk about expectations for the coming year. Share how you felt after last school year. Let them know you can’t do another one like that. Share the research I shared with you. Put in writing your group’s ideas about what you think is reasonable. In addition, brainstorm ways you can work more efficiently as a team by sharing forms and resources so you are tackling the issue from more than one side.
I have been in my district for 45 years. I am working part-time after retirement. I have 34 students to see in two days. Sixteen of those students are in the Significant Support Needs class. There is no cap in Colorado.
My District is getting a full-time employee for part-time pay. This is despicable practice.
This is great information to have. I am feeling very overwhelmed. I have a great school and staff to work with. My caseload of 90 plus students makes my job feel completely unmanageable. I even have a Speech Pathologist Assistant who helps with the the caseload at the elementary. However, I also have to share her with a middle school campus. She is also feeling exhausted with back to back therapy and traveling between schools. I feel as though more advocacy is needed for School Speech Language Pathologists. It is really overwhelming and a difficult job to stay with for an extended period of time.
I agree. I think we work with some of the best people on the planet, both the kids and peers. I wouldn’t trade that for the world. As we gain experience and years in the field, it becomes doubly difficult when we have new SLPs and SLPAs looking to us to understand how to navigate everything and we are overwhelmed. I will say that this is an issue for diagnosticians, special education teachers, and now general education teachers. Advocacy seems to be working in specific states or districts but not on a national level yet. Those that have had success formed solutions within their SLP teams and grew the solutions outward. Doesn’t look like it is coming top-down any time soon.
I have worked in too many schools where it all comes down to money and if there aren’t any hard rules around workload and caseload size, we are handed a huge workload due to ‘financial constraints’ and told to use our discretion to deal with it. I am so disappointed with ASHA’s guidelines for caseload and workload. It’s basically a cop-out using wishy washy language to conclude that we are left to our own devices. It didn’t matter how chummy I became with any administrator, it always came down to what was asserted in writing from our professional organizations. I am looking for a way out of this profession myself as I am tired of fighting to convince men and women in suits of my worth.
I think your sentiment is shared by many. Interestingly enough, I am heading out to do a keynote and this was a priority around what I was asked to address. So hopefully things are making their way into the forefront.
It is a sentiment shared by many – especially in Canada, where our school-age caseloads top 200 students easily. I will be speaking with the workers compensation board (WCB here) and an employment lawyer this summer to see what we can do to pressure our regulatory bodies to set concrete parameters for our work. How are we supposed to follow their many guidelines required of us when our caseloads are quadruple the size of what was once ‘recommended’? I like working in the school setting but I am so burned out and I fear for the new grads entering the schools here – many are quietly quitting. I hope your keynote presentation goes well.
Well it’s official then. SLPs everywhere are facing a new paradigm. 200 students! Unbelievable. And you have to shovel snow too! Really not fair. (I moved south from Wisconsin so I feel for you on both fronts :)). I will work this summer to publish the course so everyone can see it. The message is being well received and I am presenting again next month. I will post back here when we get it up online.