School-Based Speech-Language Pathology Must Change

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.


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.

Written by: phuonglienpalafox

54 Comments on “School-Based Speech-Language Pathology Must Change”

  1. April 5, 2019 at 6:12 am #

    Excellent article! I wonder how the situation differs in states that have unions!

    • April 5, 2019 at 7:24 am #


      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.

      • October 9, 2022 at 2:28 pm #

        States with unions have 3 full time SLPs for 120 students. Plus, there is a district group of SLPs who do all the assessments, initials, testings, eligibilities, etc for the entire district allowing the in-school therapists to be creative about therapy. Also there is one to two RTI students receiving interventions before classes begin. (whereas non-union you could have 25 RTI interventions to write in less than one semester.) In addition, one northern unionized state paid therapists who worked on their own time for the hours spent at home doing documentation. We were able to do special projects with our students or work with classroom teachers to work on phonological skills in the classroom. We also saw neediest students 1 to 1.
        Sincerely, Retiree

      • October 10, 2022 at 8:42 am #

        Thank you for sharing this perspective. It wasn’t clear to me how widely our experiences were nationally until I started interacting with professionals from different states during presentations. This is a good example of how an influential body put some guardrails around work. In this case you had the Union which is awesome. There are some examples of non-unionized states being able to accomplish similar goals. I think what is shared in each situation is that everyone sees its in the best interests for the kids and retention to have limits.

  2. April 5, 2019 at 6:52 am #

    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.

    • April 5, 2019 at 7:34 am #

      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.

    • April 5, 2019 at 8:35 am #

      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.

      • April 5, 2019 at 9:15 am #


        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.

    • January 28, 2020 at 11:15 pm #

      Please tell me what your collaboration (in regular classroom) week looks like….what do you do that week?

      • January 30, 2020 at 10:04 am #

        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.

  3. April 5, 2019 at 7:34 am #

    Phenomenal article! Thank you for your advocacy and speaking our truth!!!

  4. April 5, 2019 at 8:18 am #

    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!

    • April 5, 2019 at 12:31 pm #


      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.

  5. April 5, 2019 at 8:35 am #

    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.

    • April 5, 2019 at 9:08 am #


      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.

  6. April 5, 2019 at 9:37 am #

    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.

    • April 5, 2019 at 12:20 pm #

      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,

  7. April 5, 2019 at 9:45 am #

    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!

    • April 5, 2019 at 12:11 pm #

      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.

  8. April 5, 2019 at 12:15 pm #

    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!

    • April 5, 2019 at 12:40 pm #

      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.

  9. April 5, 2019 at 4:04 pm #

    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.

    • April 8, 2019 at 7:53 am #

      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,

  10. April 5, 2019 at 4:19 pm #

    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!

    • April 8, 2019 at 7:49 am #

      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,

  11. April 9, 2019 at 3:41 pm #

    Thank you for saying everything you said.

    • April 10, 2019 at 3:10 pm #

      You are very welcome, Christina.

      • January 31, 2020 at 1:39 pm #

        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.

      • January 31, 2020 at 4:49 pm #


        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.

  12. May 2, 2019 at 6:35 am #

    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…..

    • May 9, 2019 at 4:56 pm #

      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.

      • May 13, 2019 at 12:08 pm #

        Thank you for information on what is being done in your school district.

    • May 13, 2019 at 12:39 pm #

      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.

      • June 15, 2021 at 1:16 pm #

        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?

      • June 16, 2021 at 6:18 pm #

        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

  13. September 5, 2019 at 8:23 pm #

    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.

    • September 6, 2019 at 7:26 am #

      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

  14. September 10, 2019 at 1:32 pm #

    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).

    • September 11, 2019 at 12:21 pm #

      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, 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

  15. January 31, 2020 at 7:43 pm #

    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.

    • February 3, 2020 at 10:38 am #

      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.

  16. February 8, 2020 at 11:18 pm #

    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

  17. February 8, 2020 at 11:21 pm #

    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

    • February 12, 2020 at 2:50 pm #


      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 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

  18. January 23, 2021 at 10:53 am #

    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.

    • January 26, 2021 at 12:58 pm #

      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

  19. October 28, 2021 at 11:39 am #

    SLP from California. Our school district has collective bargaining. It keeps the job manageable and confines your time to the actual 40 hour work week. We have an average weighted caseload limit of 55 students (roughly 11 students per day). If our caseload is larger, we are given SLPA support. We do not case manage/run IEPs for any students. We are also encouraged to follow the tiered requirements for service eligibility (is there a communication disorder, is it impacting them during oral language activities in the classroom, and can the SLP help or can other providers address this in the LRE?). I can actually devote a good deal of time to assess my students and write thorough eval reports.
    I previously worked at a school district in Texas (right to work) and it was a nightmare! Caseload of over 100, no SLPA support, scheduling/running IEP meetings, tracking down paperwork, everyone and their mother’s qualified for speech and remained until graduation, dismissing was looked down upon, additional school building duties. The list went on and our head SLP did not support us or advocate for us in the sped department.

    • October 29, 2021 at 7:43 am #

      Hi Sara, Thanks for sharing. After we work in one place for a while it is easy to just think it is the same everywhere. It is good to know what you are doing in California so that we know what is possible or even what to advocate for.

  20. November 22, 2021 at 6:08 pm #

    Thank you for this wonderful article. I love the way you framed it – it makes it so personal. I’d love to share your article with my state senator and assembly representative to try to get things changed here.

    • November 24, 2021 at 8:25 am #

      Your welcome! Share away! Sometimes I think that we think that what we are facing is unique to just our district or just our state. The truth is that many of us are in the same boat which means more voices to address a single issue.

  21. September 14, 2022 at 1:20 pm #

    I just started working as an SLP school-based after years in medically-based adult rehabilitation. The push for unethical billing in that area of practice by corrupt privatized healthcare providers pushed me out. I was offered a job as a contract SLP for students with disabilities via tele-therapy. I see mostly students on the spectrum or those with a host of medical and cognitive disabilities. My caseload is so much smaller, but it still seems unmanageable. I get paid 32.5 hours to see 27 students; most have 3-4 times per week visits, so the number of visits are a killer because they have to be delivered between 9-1 daily, but I don’t really have a four-hour window because I have to avoid their gym times, PT, OT, Psychology visits (30-50 minutes) and lunch time. That knocks the window down to about 2.75 hours for all 27 students to have 30 minutes each. Groups of four or five are really tough to manage online. I’m reliant on school staff who are stretched as it is (our students have behaviors or medical issues that sometimes mean they can’t help the student get online). Staff shortages are also partly due to states not wanting to add more staff (even if they have access to more help). Students with behavioral issues don’t always work well in a group setting. And then there’s the other obvious fact: I do far more than 32.5 hours per week (50 would be more accurate) writing notes, responding to a steady flood of emails, writing annual reports, Attending IEP meetings, lesson planning, writing letters of authorization for SGDs (“letter” is a misnomer–it’s a lengthy report). It’s a shame that all facets of SLP service delivery seem geared to beating the clinician to death with the workload or pushing for unethical billing (and then beating them to death with the workload). I know teachers and SLPs have had it and are quitting the field in record numbers since Covid. Covid isn’t making them leave…it was just the final straw.

  22. Richard Helvie February 12, 2023 at 11:27 pm #

    I’m quite frankly over working in this field simply because of the entire message said above. I’m already biting my fingernails with anxiety in general, and everyone around me in the school setting is communicating at a thousand messages per second. The intricacies of the IEP’s, special requests from those difficult parents, and the lack of respect in meetings makes me want to walk out and say “#!*& you people!” This problem is only going to get worse, the more liberal and more government-controlled the schools and this system becomes. People think that the internet adds time availability for therapists, lol. The rate of student’s receiving IEP’s, and the fact that any student family can request an assessment, will only get greater as the years go on. Lol and given Californian’s need for additional holidays (take tomorrow, 2/13/23 for example – a new holiday in need of those hungover from the Superbowl, taking a precious day away from us to do any functional, productive work such as providing minutes, holding IEP’s, completing IEP’s in SEIS). The whole system needs a change; I should have gone into Audiology, Linguistics, or became a DJ. I didn’t go to UC Berkeley and Purdue University for this crap.

    • February 15, 2023 at 7:26 am #

      You named at least 10 problems that are not under our control which in-part only adds to the frustration. Something that you highlighted here which I don’t think is talked about enough is the double-edged sword of technology. Programs are theoretically making things quicker but I am not sure that the design of them actually saves any time on our end. We are left with two pools of problems; those we can influence and those we can’t. The pool of things that we can influence might be getting smaller too. I also think that SLPs are diligently investing time into ways to become more efficient but the burden of caseload size, consent dates, and meeting numbers is quite a wall to face. Per your point, add to this the communications around all the events and your nail-biting is justified. You are not alone. And, many diagnosticians and teachers are feeling the same crush in their own respective ways.

      There was one point when I was working at a particular school that I went home deflated each day. It was like I was always choosing what WASN’T going to get done rather than what was. The immediate solutions like prioritizing services over email meant I was at real risk of missing something crucial and continual dread when I finally opened my inbox. Two things I did to maintain my own health: I went to my lead and explained that despite my experience, I must be missing something and must not have the skills to complete my work. I sat down with her for 30 minutes and presented my schedule, eval list, and thorough list of outstanding work. I asked her to show me how to accomplish what was expected. It became clear to her what I and others were up against. This then gave me some room to compartmentalize my days. I religiously had an eval day and a meeting day. I started working sequentially instead of simultaneously and just went home when it was time. When people said something was missing or late I said “Yes it is” and showed them where it was in my queue (e.g. I will be testing him after these other two) which gave me the ability to never say NO just WHEN.

      Your health is the priority. I think as a field we will get through this transition. But don’t look back on it as a lost time period for your life or health. Do good work. Turn your computer off. Go home. And in your case, yes become a DJ! It’s been years since I heard of someone getting reprimanded or fired. The climate doesn’t support it. Your choice to preserve yourself is a decision for showing up in a good way for your students. That’s our primary mission. The kids know when we are in a bad mood.

  23. lila May 16, 2023 at 7:16 am #

    Yes, I agree with everything. In addition, even with a cap of 46 contact hours, I find as the only SLP at a middle school, doing push-in and covering 32 classrooms, attending all the IEP meetings and eval meetings, etc, (lots of no-shows) – secondary is not understood by administrators who do the hiring and placing of the SLPs. Covering 7 self-contained rooms, where most of my attention should be (twice a week in each), there is no consideration as to where the guidance counselors place the resource students each year who receive speech/language services. A little consideration would make a difference of whether I pushed into 6 versus 12 classrooms. With one student here and 2 there, my schedule becomes mathematically impossible each fall as middle school runs on an ABAB schedule and each team of classes has a different schedule. Guidance is not aware of the fact that I cannot pull out due to rules such as: there is only one period a day which I am “allowed” to, which all other specialists are as well. I choose not to as SL needs tend to be addressed more successfully within the room. I end up each fall with no planning time, and cancelling sessions for meetings. There is no solutions as I seem to have no pull with my solutions.

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