Larry now livesin Arizona, home of the magnificant saguaro cactus.
The caseload crunch
Managing a high number of communication disorder caseloads in the schools—with all its required responsibilities—has left many speech-language pathologists feeling utterly overwhelmed and burned out, according to Larry Biehl, CCC-SLP. Some have left the field, while others do their best cutting corners. Yet, the real losers are the students who need and deserve high quality services.
Addressing the problem
This problem is not going unnoticed. Larry Biehl works with seven others on an ad hoc committee sponsored by ASHA (American Speech-Language-Hearing Association) to address this problem of caseload size.
In the past Larry has held other leadership positions in the field of speech-language pathology. He has been a member of several executive boards including the Council of State Association Presidents (CSAP). He has also served as President of the Iowa Speech-Language-Hearing Association. Now Larry is traveling across the country giving presentations titled, “A Workload Analysis Approach for Establishing Speech-Language Caseload Standards in the Schools.”
Larry has been advocating this approach for five to six years in his own practice. However, in 2002 he was invited by ASHA to join the new caseload committee. “ASHA was receiving a lot of feedback that caseload size was becoming a real issue with speech-language pathologists. Some states allow up to 100-125 kids on a caseload.” He notes caseload standards vary greatly from state to state.
“In the early 90s,” Larry continues, “ASHA wrote a caseload position statement saying that 40 was the recommended maximum number of students a speech-language pathologist should be responsible for. At that time the organization figured there was a magic number for the ideal caseload.”
Larry working on his presentation.
The need for a new approach
From his own experience, Larry realized that a number approach was inherently flawed. “What if you have a caseload of 25 really severe, involved kids that take all your time?” he asks. “A number system doesn’t take into consideration where the child is. A number is just a number.”
Larry and his committee worked on developing a different way of looking at caseloads—one that was not tied to quantity of students. He calls it the workload analysis approach. “The theory behind this approach is that it’s not how many students you have, it’s what you do with the students.”
According to Larry, in the last ten to fifteen years the caseload number has not changed, but job responsibilities have significantly increased due to IDEA (Individuals with Disabilities Education Act) and other federal mandates. For example, an average of ten meetings and 52 forms are now required for each child. He notes that the following list represents some of the changes that have increased the workload of speech-language pathologists:
- Zero reject policies: every child that qualifies receives services
- Nondiscriminatory evaluations: any student with a disability must receive a full evaluation before being placed
- Free and appropriate public education: speech-language pathologists have to make sure they are providing services in the least restrictive environment
- Due process
- Parent participation
- Early intervention activities
- Addition of a very large preschool population
- Expansion of transition services which includes preschool to kindergarten transition, kindergarten to elementary transition, environment to environment transition, et cetera
- Prescribing and identifying assistive technologies appropriate to student needs
- State and district assessment requirements
- Multidisciplinary teaming: speech-language pathologists need to know what’s in the curriculum, what is required of students, and how it relates to their communication needs
Larry elaborates, “When you think of all the things you do on behalf of a student, it adds up to a lot of time. We’re really trying to change the concept that the only time you’re working is when you’re sitting across the therapy table. All of these other pieces are part of the workload that moves a child to a designated level of performance that you and other professionals have determined is appropriate.”
Unfortunately, today speech-language pathologists in the schools spend a lot of time and energy trying to make what is available look like what’s appropriate. “The law says we must provide appropriate services. All too often we are limited to providing available services, which is far away from benefiting students,” Larry explains.
In essence, if schools want to be in compliance with the law, they need to take a look at the full spectrum of the speech-language pathologist’s workload.
Increasing professionalism
Larry’s workload analysis approach can help speech-language pathologists make their case with school administrators and other officials. The approach developed by the ASHA committee includes a position statement, guidelines, a technical report, and a just-released implementation guide. “The approach provides a format or structure that allows you to outline all the work that will be done on behalf of a child.”
During his presentations, Larry explains how the approach increases professionalism and helps achieve real results. “Instead of saying to an administrator, ‘I have too much to do,’ which sounds like whining, you say, ‘these are the specific things I have to do with this student. And you need to be aware that this is the time commitment we are making on behalf of this student.’ Once you do that, you can start working within the parameters of compliance. When you come to the table with information, you become part of the solution.”
Larry finds Arizona's mountains the perfect place for reflection.
Establishing partnerships
Another dilemma occurs when the speech-language pathologist tries to do it all. “Sometimes we get caught up in the ‘statue of liberty syndrome.’ Just send me anybody, all of your poor and communications impaired, or any other problem, and I will take care of it.”
According to Larry, you need to identify other players and spread the solution across the environments of the children served. For example, important partnerships can be formed with parents, teachers, social workers, and other individuals to help make the workload more manageable. “Speech-language pathologists, who I have had the opportunity to work with, are some of the most generous and creative people in the world.”
Educating others
The next step, says Larry, is to continue spreading the word about the workload analysis approach. “I think it’s a very straightforward and structured approach to the problem. It’s also the most fair way of providing services to children. They are the big benefactors here. I truly believe that this is what we have to do; we have to make some changes.”
If you are interested in learning more about the workload analysis approach, contact Larry Biehl at spkezy@cox.net.
If you happened to stop by the AGS Publishing booth at the ASHA conference in Philadelphia, you might have met Clarice Karam-Polston, M.S., CCC-SLP. She was the vivacious speech-language pathologist who spent an hour each day in the booth encouraging visitors to fill out drawing forms for the travel case on wheels.
