Advocacy…Advocacy…who has the Advocacy…

Also known as 7 Habits of the Burnt-Out SLP

In preparation for a new series of posts on advocacy (SLPs and caseloads really), I have decided to repost the July 2012 post on Adventures in Advocacy.  There are two other Advocacy posts here and here. Please take a moment and check them out…They are relevant.

In the not too distant future (hopefully), I will be posting the results of a survey I conducted in April. To say the results were disturbing is an understatement. But…there’s always hope…right?   

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 reason 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