New Caseload Policy Calls for Analysis of School Clinicians’ Total Workload As the new school year begins, the top concern of many school-based clinicians is no doubt the burgeoning caseloads that often impede their ability to provide quality services. According to data collected through the National Outcomes Measurement System (NOMS), as caseloads increase, opportunities for individual treatment decrease, the percentage of ... School Matters
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School Matters  |   September 01, 2002
New Caseload Policy Calls for Analysis of School Clinicians’ Total Workload
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School-Based Settings / Practice Management / Professional Issues & Training / School Matters
School Matters   |   September 01, 2002
New Caseload Policy Calls for Analysis of School Clinicians’ Total Workload
The ASHA Leader, September 2002, Vol. 7, 12. doi:10.1044/leader.SCM4.07162002.12
The ASHA Leader, September 2002, Vol. 7, 12. doi:10.1044/leader.SCM4.07162002.12
As the new school year begins, the top concern of many school-based clinicians is no doubt the burgeoning caseloads that often impede their ability to provide quality services. According to data collected through the National Outcomes Measurement System (NOMS), as caseloads increase, opportunities for individual treatment decrease, the percentage of children showing progress decreases, and classroom performance is affected. In addition, as demonstrated in the 2000 Schools Survey, the time speech-language pathologists spend on direct intervention has increased in recent years, leaving less time for their many other responsibilities.
To help clinicians advocate for more manageable caseloads and adequate, appropriate services for children, ASHA has adopted three new policy documents that provide “A Workload Analysis Approach for Establishing Speech-Language Caseload Standards in the Schools.” The technical report, approved in June by the Executive Board, and the position statement and guidelines, approved in July by the Legislative Council, were developed by the Ad Hoc Committee on Caseload Size as part of ASHA’s focused initiative on school-based programs and services.
The documents provide a template for state and local education agencies to use in establishing caseload standards. The new policy does not recommend a maximum number for caseloads, an approach that has not proven effective in the past.
In 1993, ASHA recommended a maximum caseload of 40 students, but today the average caseload is 53. Many states and districts interpret a recommended maximum as the minimum number of students a productive clinician should have on a caseload. In addition, a prescribed maximum does not encompass the full range of clinicians’ roles and responsibilities or reflect the intensity of services.
The new policy documents provide a conceptual framework for how total workload activities—direct services to students as well as related support and professional activities—can be taken into account when establishing caseload standards at the state and local level.
In developing new guidelines, the committee divided the school-based SLP’s workload into four activity clusters: direct services to students, indirect activities that support students in the least restrictive environment and general education curriculum, indirect services that support students’ educational programs, and activities that support compliance with federal, state, and local mandates. After brainstorming a list of activities and sorting them into the clusters, the committee saw a clear imbalance—clinicians spend most of their time on direct services, but this cluster actually had the shortest list of activities. The message must be communicated to decision-makers that enrollment of students into direct intervention increases the clinician’s workload in all activity clusters.
Schools 2002 Workshop
During a daylong workshop on “Caseload to Workload: Redefining Your Role in the Schools” at this summer’s Schools 2002 conference, members of the Ad Hoc Committee on Caseload Size introduced attendees to this new approach to caseload, challenging them to redefine their roles in terms of their broader workload.
While caseload remains at the heart of what school-based clinicians do, it is time for a paradigm shift, said committee co-chair Ann Bird. “This is different from what we’ve been thinking. We have to be open-minded and look at things differently,” she said. “It’s not just about direct services, but about providing appropriate services for each child to see that they are successful in the general education curriculum.”
Bird and her co-presenters—committee members Larry Biehl, Sally Disney, Ellen Estomin, and Judith Rudebusch—used data from NOMS and the 2000 Schools Survey to illustrate the effect of high caseloads on the quality and effectiveness of clinicians’ services. The presenters also used worksheets based on the new guidelines to help participants document their activities with examples from their caseloads.
While stressing that they are not suggesting that clinicians should plot out all their activities with every child on their caseload, the presenters explained that the process is a great way to collect data to present to administrators. Such documentation can also help parents understand how much time is actually devoted to their child, beyond direct therapy.
In addition to Bird, Biehl, Disney, Estomin, and Rudebusch, the members of the Ad Hoc Committee on Caseload Size are co-chair Frank Cirrin, Trici Schraeder, ex officio Kathleen Whitmire, and monitoring vice president Alex Johnson. The committee will present a session at the ASHA Convention on Thursday, Nov. 21, 2–4 p.m., in Ballroom 4 of the Georgia World Congress Center. The committee also is developing an implementation guide to accompany the policy documents, which will assist members in implementing this new approach at the state and local levels.
The new workload documents are available in Volume 3 of ASHA’s Online Desk Reference or by calling the Action Center at 800-498-2071. Worksheets to help clinicians analyze their workload are available in the ASHA Forums. For more information, contact Whitmire through the Action Center at 800-498-2071, ext. 4137, or by email at kwhitmire@asha.org.
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September 2002
Volume 7, Issue 16