Adventures in Advocacy

Advocacy…Advocacy…who has the Advocacy…

Also known as 7 Habits of the Burnt-Out SLP

Alternately known as 10 Ways to Dump an SLP …

paperwork  Affectionately known as Who has a Life? I have Reports to Write…

As a member of the #SLPeeps (on twitter) who has been around since before the hashtag was created, I can verify that one topic that continually raises an ugly head is the subject of caseloads and workload management. For the record, the conversation comes up on Facebook as well. There are as many thoughts on the subject as there are members of the #SLPeeps (and there are 100s if not 1000s of #SLPeeps on twitter). Now, for the majority of this post, I will not use names – not because I think those SLPs don’t deserve credit for what they’ve said – but because I don’t want this post to cause difficulties (however remotely) for anyone.

Typically, the way the conversation arises is someone innocently mentions their numbers, or is asked how many kids they see… and then smoke starts…followed quickly by flames. Don’t get me wrong – those in the discussion aren’t flaming each other, rather the bureau-babble that has created the situation. To date, I haven’t found any #SLPeeps that aren’t supportive of each other in this discussion which means a lot (because frankly there’s not a lot we agree on just start a discussion on Oral Motor or PROMPT or ABA or Facilitated Communication and you’ll see what I mean!).

For some reason, the caseload discussion never creates the same dissension the other subjects do. I think we all know that there’s a fine line between a balanced budget and caseload…just as we know there’s a fine line between effective group sessions and babysitting (did I just say that outloud?). Don’t get me wrong – I think group sessions can be effective – I use them myself and I actually LIKE group sessions. But, I also know that sometimes we are forced by sheer numbers to have group sessions that are so big the effectiveness of the session is dramatically lessened. When you couple the sheer number of kids that have to be seen with the paperwork each student generates the workload of the SLP (and other specialists) is mind-boggling.

There’s no surprise that so many SLPs have reached a stage of burnout before their student loans have been paid. ASHA suggested way back before 2002 (because I’m reading an Ad Hoc report dated 2002 that discussed previous documents written a decade ago) a caseload of 40  maximum. More accurately, “ASHA recommended that school SLP caseloads not exceed 40 under any circumstances, with special populations and circumstances dictating a maximum caseload of 25 or less.”  The Ad-Hoc Committee on Caseload (2002) went on to say that the previous statement of 40 students caseload cap was outdated because it didn’t take into consideration all the added responsibilities of the SLP. Which is absolutely true. Response to Intervention (RTI), more complex students/diagnoses, and added paperwork have increased the workload of the SLP (and other SPED personnel).

This tidbit is also from that AD-Hoc paper…I’m going to quote it here simply because it’s powerful and something every administrator needs to be told (because let’s face it – most of them are clueless as to the work required per student):

“Each student added to the caseload increases the time needed not only for evaluation, diagnosis, and direct and indirect services, but also for mandated paperwork, multidisciplinary team conferences, parent and teacher contacts, and many other responsibilities. Multiplying the number of students on the speech-language caseload by the number of forms that must be completed per student and the number of meetings that must be attended gives a rough indication of the time implications of this factor (ASHA, 1993). Table 1 presents an example from a Midwestern urban school district of the required forms and meetings added to SLPs’ workloads when just one student is added to the caseload.”

I know many SLPs who do the majority of their paperwork at home or on the weekends. Lesson plans are written at home (or not written), and their bosses continue to expect more from them. But, what’s an SLP to do? This one is tough…but one thing I’ve learned from some of my Canadian friends is not to take paperwork home.

Now, before you get defensive – please know, I do take some paperwork home…But it’s typically because I’ve mismanaged my time OR I forgot a certain time frame that is suddenly looming (Oh, you mean progress reports are due on Friday and today’s Tuesday? Oops.).  But, for the most part, I don’t take paperwork home. The reason for that is not because I’m better than anyone else…it’s because I firmly believe that for me to continue to LOVE what I do (and I do love it – I even wrote a post about it!)  and continue to make a difference in the lives of my students and their family, I have to have a happy medium. So, I schedule my day accordingly.

Now, I don’t go home at 3:30 when the kids are done with school (of course not! I have IEPs silly!)…most nights I stay until 4:30 – 5:00 because that’s what I’d work if I were in a corporate job (been there – done that!). That time is devoted to paperwork and/or collaboration with SPED personnel and regular ed teachers (or calling parents).

A wise SLP (hi Tanya!) taught me that doing the extra – staying way late, coming in on weekends, taking paperwork home isn’t going to help the situation. The employer will never understand the toll and will always expect that if SLP Susie can manage a caseload of 100 kids so can every other SLP. The behavior becomes expected and help never arrives.

However, if the employer can see the expectations are unreasonable – there may be hope.That’s worth repeating…

If we as SLPs continue to enable our employers to spread us so thin we cannot provide effective therapy, complete paperwork on time, or continue our professional development, the behavior will become expected… We have enabled the behavior to continue – there is no reason for it to end.

I understand budget constraints, etc. but not hiring appropriate personnel goes beyond budget constraints. Not hiring enough personnel is more about devaluing the role of the SLP. Again… If we as SLPs continue to enable our employers to spread us so thin we cannot provide effective therapy, complete paperwork on time, or continue our professional development, the behavior will become expected… We have enabled the behavior to continue – there is no reason for it to end.

Now, I don’t want anyone to get fired for not doing their work…that’s not the point of the post. But, I do believe we need to no longer quietly accept the punishment for being excellent at what we do…we need to squeak just a bit. We need to ask employers to help prioritize WORKLOAD to ensure that things are more equitable. I would like to believe that in some cases, it’s simply that most managers/employers don’t have a clue…maybe printing out the previous link and this link will help?

Now, things that I’ve done to help my caseload (and yes, I know not everyone can do these)…

1) Schedule time during the day for assessments and paperwork (if no assessments scheduled – use it for paperwork…goodness knows there is no lack of paperwork).

2) Set aside 10 minutes a day for collaboration with teachers. Typically before school starts unless there is an IEP meeting.

3) Say No. (This one is hard!) I don’t get involved with RTI right off the bat. I help guide teachers to great interventions and give feedback…but I don’t actually see the student until later on unless I can see them as a “speech buddy” and work them into a group session.

4) Say NO (again)…when my supervisor asks me if something is doable – if it is, I agree… if it’s unreasonable I say no or I ask her to help me prioritize. While at first, this made me feel like a bit of a loser – it wasn’t approached or received that way. I simply told her that I wanted to do the most “good” I could – where did she see the most need? I laid out my WORKload (not caseload) and we prioritized. This had a three-fold effect. A) she was able to see exactly what I do (because like most – she was clueless) and B) I was able to get a better feel for the needs of the school – not just my individual kids and C) I was seen as a team-player willing to go above and beyond – not just someone stuck in a room.

Now, I realize that I have a great situation here and I am very very lucky. My caseload is under 50, my workload is manageable, I’m fairly autonomous, and I have awesome administration (my superintendent is great, my elementary principal totally rocks, and I’m very very lucky to work with them). But I also know that like every school they are faced with budget cuts and trying to figure out where expenses can be lessened. Sometimes, like all administrators, they need to be reminded that it’s not a job – it’s a child. Thankfully, they are open to these reminders (at least, they haven’t replaced me so far).

One of the things I was taught in grad school is that it’s my job to advocate for my students. Again…It’s my job to make sure the needs of the student are being met. Part of that advocacy is making sure I’m able to meet their needs by having a manageable workload – if I’m spread too thin or groups are too big, I can’t provide effective therapy.

I also firmly believe that if there is a problem – and you are not an active part of the solution – then you are by default part of the problem (and yes, I realize I probably made some of you mad with that statement – but I sincerely hope not). I’d love to hear your thoughts about how you can advocate for your clients and yourself at the same time. What time-management techniques do you use to avoid burn-out? If you could initiate one change in your workday – what would that change be?

Until then…Adventure on!

Mary

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13 thoughts on “Adventures in Advocacy

  1. Very sensible, personally I can’t see anything particularly contentious here Mary. I know of cases in the UK where therapists have fallen foul of our regulator, the Health Professions Council. Bad practice has occurred and people have tried to use caseload pressure as a defence. The upshot is that if we as autonomous professionals don’t raise the problem up to management we are responsible for slip ups. Personally I would feel troubled hearing about paperwork regularly going home. It would raise questions regarding client confidentiality and would be a red flag to me that someone isn’t coping with their caseload. I’ve recently introduced a new capacity measurement system for my team that shows how far demand outstrips what can reasonably be achieved. This has proven to be quite handy when discussing caseloads with my management. I’d recommend similar to others.

  2. I’m just starting in the field and I straight up told the women who hired me that I do NOT take work home. I said, “Listen, I might be here late some nights and that’s how life goes. But once I’m home I AM HOME. That is how I do it.” And they seemed bizarrely okay with it. And I think the workload model just makes so much more sense than the caseload model. It’s a way for us to advocate for ourselves, and we need to be going to our state associations and pushing for help at the legislative level to get workload into our facilities.

    • I agree – and I’m glad you were able to advocate for yourself and your students that way. I think we, as a profession, want to help so much – we forget that in order to help the most, we need to help ourselves.

  3. It might be worth having a quick explanation of “workload” vs “caseload” (according to ASHA) just in case there is someone reading who doesn’t know the distinction. “Workload refers to all activities required and performed by school-based SLPs. SLP workloads include considerable time for face-to-face direct services to students. Workloads also include many other activities necessary to support students’ education programs, implement best practices for school speech-language services, and ensure compliance with IDEA and other mandates. ”

    “Caseload typically refers to the number of students with Individualized Education Programs (IEPs) or Individualized Family Service Plans (IFSPs) that school SLPs serve through direct and/or indirect service delivery options.”
    From ASHA: http://www.asha.org/docs/html/TR2002-00160.html

  4. Love the post. 🙂 I also think workload/caseload is a big reason many #slp2b people are shying away from the school (at least in my experience).

    • I agree – I think it is part of why SLPs are reluctant to enter the school setting. I think it’s a case of we are our own worst enemies… 😦

      I think we, as a profession, want to help so much – we forget that in order to help the most, we need to help ourselves. Administration and those in charge will allow us to continue doing what we’ve been doing until we complain and say no. I think it’s the “law of inertia” or some such…

    • I am a new CF and I hope I’m not depressing anyone with this, but ladyecho is right. Several of my classmates were very dedicated to working in the schools from the beginning and are there now, but many who were on the fence were scared away from it by their student experiences. In addition to seeing that the rumors are generally true about huge caseloads, heartless administration, and spending more time with paperwork than with kids, some were even told by their supervisors that getting into the schools isn’t worth it!

  5. I can SO relate to this – I had *only* 27 students on my caseload, but 4 days to see them all (all but one had twice a week sessions), and in two schools (one school had 10 students, the other 17, so I was flat out at one and had blocks of time “off” in the other), and did 17 evaluations, 4 quarterly progress reports for each student (and I write more than one line), billed Medicaid electronically, entered (because the last SLP wasn’t computer-savvy) IEPS into Infinite Campus and then maintained them, was case manager to 12 of my students, and had lunch and/or playground duty every day – that’s another time-eater that wasn’t mentioned that direct-hire SLPs have to contend with. That, and school staff meetings whose content almost never had anything to do with me (discussions on math curriculum, etc.) served to cut into my planning, meeting, and report-writing time quite considerably. I was resigned to writing eval reports at home and/or staying late (usually 5 p.m. every day) because there just wasn’t enough time in the day. I LOVE working with children and they love me, but I am already getting burned out by this and my loans are not yet paid off. At my last position, I had 25 students and a 5-day workweek – it was heaven – I rarely took work home, and when I did it was like Mary said, sometimes my fault for not prioritizing my workload. I then moved to another state, and that also caused additional work for me – they consider SLPs teachers so I had to take a graduate course to meet the state requirements for teacher certification – “Teaching Exceptional Children in a Regular Classroom” – I had to laugh – ALL my students are “exceptional” and my “classroom” is anything but “regular”! I was fortunate that they had just removed the requirement that the SLP had to go through a year-long mentoring program with supervision, etc., EXACTLY like our CFY – what a waste of manpower, time, and money that would have been! Someone must have advocated for that change and I’m thinking we need to for that course, as well. It puts a financial burden on the districts (they paid for it – $700) as well as the SLPs, who pay for the textbook and have to put the time in (which was considerable) to complete it. And we wonder why there’s such a turnover and a need for SLPs in the schools – especially the urban settings.

  6. What a great post, Mary! You are correct about us staying together on this issue. We are true “sisters & brothers” in the caseload/workload discussion. Illinois has a state mandated limit of 60 students per caseload for SLPs. 60 is a nightmare and I have been in that nightmare many times. I have been a school SLP for about 30 years now and I have plenty of scary stories to tell. However, just like everyone else, I love my job and I am glad I persevered. I have rarely taken work home. I would rather stay at work until 6 or 6:30 in the evening than bring it home with me. When my own kids were little that was often not an option. I look back on those days and often wonder how I got through! To this day, I do not eat in the faculty lounge. Unless I go out for lunch with my SPED colleagues, I am working though lunch or checking on my PLN. I’m not saying that’s how everyone should do it. Just saying that’s how it has worked for me. I also make sure to have a diagnostic slot in my schedule. I, too, will use this for paperwork if not needed for testing.
    My husband is always amazed that I have been at this for all of these years and often he will make it home before I do! You’d think I’d have my act together by now. Well, as soon as I get that perfect plan together to be prepared for students, simplify the paperwork, handle all of the necessary communications and control meeting times… I will write the book and make my millions!!!
    ~@SLPDeb or @debtruskey

    • Amen! As each school year starts, I lay out that “perfect” plan to meet all the obligations of the job in an effective, timely manner. It lasts about one week before reality sets in. Still, I look for a way to manage everything easily. Somehow unable to give up those pipe dreams!

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