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