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.
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.
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.