What Is a Manageable Caseload Size? Depending on geographic region, SLPs in schools vary in perceptions of their caseload size. At a Glance
At a Glance  |   August 01, 2018
What Is a Manageable Caseload Size?
Author Notes
Article Information
School-Based Settings / Practice Management / At a Glance
At a Glance   |   August 01, 2018
What Is a Manageable Caseload Size?
The ASHA Leader, August 2018, Vol. 23, 30. doi:10.1044/leader.AAG.23082018.30
The ASHA Leader, August 2018, Vol. 23, 30. doi:10.1044/leader.AAG.23082018.30
Overall, school-based speech-language pathologists consider 40 students to be a manageable caseload size, with their actual caseload size at 45 students, according to the 2017 ASHA School Practice Mini-Survey.
The difference between what SLPs consider to be a manageable caseload and their actual caseload varies by geographic region, and is narrowest for SLPs in the Northeast and West (three students) and widest for SLPs in the South (nine students).
For additional survey data, visit on.asha.org/sch-pract-survey.
August 6, 2018
Tara Felkey
Caseload Size
This graph appearing in the ASHA Leader magazine makes me upset. I don't know who answered the questions in this survey, but it was clearly not anyone in Indiana. I had 120 students on my caseload last year (3 times the "manageable" amount). This is clearly much more than is actually manageable, but how is ASHA advocating for me and my students? What exactly is my $225 per year going towards? These ridiculous discrepancies in caseload numbers throughout the country should be the number one issue that is being addressed. It seems that my CCCs are doing nothing for me other than giving me more work because I can have an SLPA and bill for Medicaid.
August 9, 2018
Bridget Law
Response to Tara Felkey from ASHA Surveys and Analysis Team and School Services Team
Hi Tara,
The 2017 School Practice Mini-Survey was completed by more than 400 ASHA-certified school-based SLPs, including SLPs from the Midwest and Indiana specifically.
It’s important to keep in mind that the caseloads presented in the chart are medians––so half of the SLPs in a region had caseloads that were larger than the median caseload for that region, and half had caseloads that were smaller. Your caseload clearly falls into the former group.
ASHA additionally collects caseload data through the biennial Schools Survey. In 2018, this survey was completed by nearly 2,200 SLPs, enabling ASHA to present caseload data by state (not just by region). According to data from the 2018 Schools Survey (https://www.asha.org/uploadedFiles/Schools-2018-SLP-Caseload-and-Workload-Characteristics.pdf), SLPs in Indiana had a median monthly caseload size of 76, the largest of any state for which data could be reported (please see page 3 of the report).
You may want to refer to ASHA’s 2018 State-Issued Guidance for Caseload Chart (https://www.asha.org/uploadedFiles/ASHA/Practice_Portal/Professional_Issues/Caseload_and_Workload/State-Caseload-Chart.pdf) and contact your State Education Advocacy Leader (SEAL, https://www.asha.org/advocacy/state/seals/) and the Indiana Speech-Language-Hearing Association (ISHA, http://www.islha.org/page-276635), to learn more about how caseload is being addressed in Indiana.
ASHA’s Caseload and Workload Practice Portal (https://www.asha.org/PRPSpecificTopic.aspx?folderid=8589934681&section=Overview) contains information on key issues on caseload and workload, including why ASHA no longer recommends a specific caseload number and success stories of members who were able to negotiate manageable caseloads and workloads.
In July, ASHA held the annual ASHA Connect conference, which includes the Schools Conference, Health Care Conference, and Private Practice Conference, in Baltimore, MD. Considerations for addressing high caseloads were discussed in sessions and there were opportunities to network with members who have successfully achieved more manageable caseloads and workloads. Some of those sessions will be available for viewing on Connect On-Demand; you can learn more about Connect On-Demand here: https://www.asha.org/Events/Connect/Experience-Connect/#On-Demand.
ASHA recently convened the ASHA Schools Virtual Town Hall (August 7, 2018) which included panelists who were decision makers at the school level, district level, and state level as well as a union representative who addressed how school leaders, SLPs in schools, and ASHA can collectively engage in efforts to address longstanding issues like high caseloads. The event was recorded and will be accessible by the end of August on the ASHA School Services webpage (https://www.asha.org/slp/schools/) in the Trending Topics section.
ASHA School Services staff provide professional consultation to members; please contact them (schools@asha.org) to talk more about your caseload.
ASHA will continue to monitor caseload size through its surveys and to share this information with members. Our intent is to inform, not to upset. We’re sorry that the data presented in the Leader were upsetting to you.
--ASHA Surveys and Analysis Team and School Services Team
August 11, 2018
Tara Felkey
Caseload Size and Other Concerns
I appreciate the information you provided. ASHA does have a lot of information on the website. However, the webinars and other CEUs are very expensive. For example, the Schools Connect fee was $489 for on-site registration which doesn’t include the travel to Baltimore or a hotel. It seems like you have to be wealthy to take advantage of ASHA’s CEUs. The annual ASHA convention is $795 for on-site registration, again not including travel or hotel costs. I use speechpathology.com for unlimited CEUs for $99 per year. Why doesn’t ASHA have an option like that or a free option?

The ASHA Leader is delivered to my house monthly. It contains a lot of information about additional duties that are being added to my already overwhelming responsibilities with 120 students. The articles contain vague suggestions about how to implement what it describes, but overall they’re not very helpful. I would love an article on how to choose the correct ICD-10 code since there are so many exclusions and it can be very confusing and time consuming. It would be great if it could be included in my $225 dues instead of a $100 webinar for a 2 hour session.

ASHA membership seems to be helpful in creating more responsibilities for SLPs. I can bill for Medicaid since I have my CCCs, which is great for the school district, but much more work for me and I don’t see any of that money. I can also have an SLPA which sounds helpful, but just makes it so I can have up to 150-160 kids on my caseload. I know of people in Indiana who have had this many students. I was also asked to see this many myself, which I declined. Most of the time is spent on paperwork instead of seeing the kids and working with kids is why I became an SLP in the first place.

Having so much paperwork makes me feel like an administrator, but for some reason SLPs in the schools are paid on a teacher contract. Our colleague OTs and PTs are not treated this way, but for some reason SLPs are lumped in with teachers and thus paid much less than they should be.

The solution to the caseload problem in Indiana is to make speech a related service like PT and OT. That would cut the caseloads and workloads in half. Then we would approach something that is manageable. We could still see the students who need articulation or language help by using an RtI or MTSS model. This would also give us time to do all of the things the ASHA Leader makes us feel guilty about not being able to do – classroom lessons, push in, being on the school MTSS team, etc.

We would need a different funding model for this plan. In Indiana we only get money for students with a label - $500 for each student. We need to shift from that to cover the time we are seeing those RtI/MTSS students and are in the classroom.

I was so excited to be an SLP when I graduated from college. I still love the kids and what I do. However, in my 15th year I am so burnt out on all of the paperwork that goes with the job and the sheer number of students that I have to see. If the above items that I have discussed are not addressed, Indiana and America will see an even bigger SLP shortage. I would love to feel like ASHA is advocating for me and my students.

Please forward this information to the School Services Staff and the Indiana Speech-Language Hearing Association.

Thank you.
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August 2018
Volume 23, Issue 8