Monthly Archives: December 2009

10. Caseloads SLP

SLPs prepare an evaluation report for the purposes of placing a child in special education. This report is typically a generic clinical presentation surveying such parameters as voice, fluency, articulation, speech mechanism, language, hearing and pragmatics along with a summary of background information and recommendations. It is generic because it can be used in any clinical setting to identify communication problems.

Generic assessment overlaps with clinical educational assessment. Using anecdotal material, Steppling et al. (Dismissal) have authored a good study on the topic: “IDEA guidelines differ in many respects from the guidelines set forth by ASHA. There is no research that clarifies how these differing guidelines are reconciled when SLPs begin working in the schools…”

Observations in the school setting might include reading assessments, classroom interaction, following directions and lesson attention. As a part of the eligibility team, SLPs must consider a variety of observations spelled out by IDEA 2004 regulations (cf. 17 Reducing LD), for example:

“Whether the child does not achieve adequately for the child’s age or to meet State-approved grade-level standards consistent with 34 CFR 300.309(a)(1); and the child does not make sufficient progress to meet age or State-approved grade-level standards consistent with 34 CFR 300.309(a)(2)(i); or the child exhibits a pattern of strengths and weaknesses in performance, achievement, or both, relative to age, State-approved grade level standards or intellectual development consistent with 34 CFR 300.309(a)(2)(i); or the child exhibits a pattern of strengths and weaknesses in performance, achievement, or both, relative to age, State-approved grade-level standards or intellectual development consistent with 34 CFR 300.309(a)(2)(ii);”

An essential criterion overriding SLP criteria is progress in the general curriculum. A child can have a medical disability and still be a high achieving student. There are autism spectrum children who are enrolled in exceptional education programs. There are seizure children who achieve on grade level. The same can be said about children with minor voice and /r/ problems. In such cases these children can receive private therapy off-campus. Special education is not a remedial service.

Misidentification results from the faulty application of criteria.

REPORTING

SLPs should emphasize in the eligibility report the observations and factors leading to recommendations to place or deny eligibility. The framework should combine the use of clinical and state criteria. The report outline should be a tool a for preventing needless placements. Testing should rule out non-disabled children, and make it clear why they are not eligibility. SLPs should make a clear case AGAINST placement to the eligibility group including teachers and parents. The standard to place is lower!

SLPs who 100% of the time recommend eligibility are probably engaging in misidentification of at-risk children. They are also missing an opportunity to control caseload size. “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” (Speech and Language).

SLPs must be the keepers of the light: “Don’t needlessly place children in special education!”

9. SLP Caseloads

Window looking out.

When there is no extra help for school speech therapists (SLPs) they cope the best they can. So “…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” (Speech and Language).

One busy SLP said everyday she has to do triage to cover all of her duties.

R. Greenwald of the University of Minnesota reports most SLPs like their jobs in many ways, but once their caseloads pass 45 pupils approaching 60, frustration sets in. Based on her survey data, “Speech-language pathologists are satisfied with their job even if they have a large caseload…[but]…the larger the caseload size, the lower the job satisfaction.”

One SLP sought advice on “language therapy for a large caseload” (Speech Pathology.Com): “I am having a hard time feeling like the therapy I provide for my language disordered students is effective. My caseload is large (60 + students), and the teachers have been difficult to work with as far as letting me group my children in the way I feel is appropriate…Can you help me?! I’m approaching burnout!”

ELIGIBILITY CONTROLS

Reducing one’s caseload through eligibility management shifts the locus of control to the SLP as defined by his or her job description. If caseload standards are set by the state and more SLPs are hired within the district, all the better. But the overloaded practitioner does not have to wait for external solutions. One can work within the framework of IDEA 2004 and be a local leader in the reduction of misidentification of at-risk children. There is more support for this school agenda than hiring more SLPs.

Eligibility management is contagious. Other specialists catch on fast when they see a concrete examples and hear articulate justifications. Special education teachers also have children who make for extra work and do not seem to belong in the resource room.

Administrators know about “disproportionality” and can identify with efforts to exit children who are no longer eligible. Reducing overidentification enhances professionalism.

John M. Panagos

8. SLP Caseloads

Trying to manage a caseload through “external solutions” such as efforts to have administrators and government agencies set lower caseload limits and hire more SLPs takes great energy with mixed results (cf. About Us). School administrators can eliminate caseload caps, reassign, or reclassify SLP services:   

 “The elimination of speech language pathology is driven in part because of concerns about the overidentification of students into the special education category. Overidentification prevention would best be done by a focus on literacy in the early grades and the creation of early intervention programs as Catherine Ciarlo did in Cranston.         By making speech services a related service not part of special education, districts will provide less speech language services to children who need such services…..Despite the good will of school administrators, budget issues will drive decisions to the detriment of education quality” (Providence Teachers).

Administrators, too, have to manage caseloads, but from an entirely different vantage point. Not only is money involved, but the push for general education programs such as early intervention and RTI is intense. SLPs are thought to be highly qualified and creative employees who are more valuable in collaborative prevention programs than in self-contained speech programs. IDEA 2004 legally justifies much programmatic change, and reduction of overidentification cannot be ignored (cf. 1. SLP Caseloads).

7. SLP Caseloads

“Strategic Eligibility Management (SEM) is an approach to school SLP caseload management which has at its foundation the laws and regulations of IDEA 2004 requiring the reduction of overidentification of at-risk children” (cf. 4 SLP Caseloads). It provides a framework for improving the quality of service delivery through reducing caseload size, workload and special education overidentification.

One “strategic” mechanism is participation in pre-referral programs like response to intervention. Speech Pathology Group shows how the goals of reducing overidentification and caseload size can be managed together (SPG):

“The purpose of implementing a response to intervention (RTI) program is to not only reduce the number of special education referrals and evaluations, but to also prevent inappropriate placement of students in special education. RTI yields major cost savings to the education system by preventing over-identification of speech and language impairments, reducing long-term costs of educating struggling learners and allowing special education resources to be allocated on the basis of highest need.”

SLPs can contribute by making sure such programs do in fact reduce overidentification and the number of speech and language children placed in special education. Workload could be affected by being an RTI team member but the work may well reduce the number of children served.

6. SLP Caseloads

SLPs under-appreciate the gravity of the initial placement decision.

Children placed in special education, even if they do have an initial disability, are at risk for all kinds of “side effects.” When the placement decision is learning disability, a pupil’s whole life is at stake, and there is no hyperbole here. The list of negative effects is long! This is what is called stigmatization, and it is well documented.

It’s a judgment call. Parents in some cases would be better off getting private reading lessons than to allow placement in a learning disability program. It is better socially to say, “No, Hanna is not in special education and never has been. She likes to read.”

Worse yet, once a child is placed it is difficult to exit him or her from special education. We can call it the 4:1 rule. It is four times more difficulty to exit a child than to put him or her into special education. For example:

1. There is exit paperwork to complete.

2. Goals have to be reached.

3. Parents and teachers have to be convinced.

4. An exit meeting must be held.

The national picture is that a good many LD children stay in special education until they drop out of school, become involved in criminal behavior and are sent to prison, or die in a few cases.

“As many as 70% of the youth involved in the juvenile justice system have disabilities. (National average from The National Center on Education, Disability and Juvenile Justice. http://www.edjj.org)

Learning disabled youth are 200% more likely to be arrested than non-disabled youth for comparable activity, are more likely to be adjudicated, and spend longer periods of time locked or on probation” (Rural Education).

Harshly, one can argue it is better existentially in some cases to have an untreated disability than it is to be an institutional outcast, where all the kids in high school know you are in special education and that sets the tone of all your experiences.

SLPS must be the keepers of the light: “Don’t needlessly place children in special education!”

5. SLP Caseloads

In that last post on Strategic Eligibility Management we said the capacity to say no is a powerful tool for cutting down on the number of children placed in speech and language. It appears to fly in the face of the “collaborative approach” but SLPs are responsible for an objective recommendation. The team can always override an evaluator’s recommendation.

Larry Biehl offered his insights about managing SLP caseloads, and remarked: “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” (Speech and Language).

Saying no to eligibility within the context of the eligibility group, however, is not an arbitrary technique. A good science-based judgment must be rendered.

For example, a boy who speaks White Mountain Apache may seem to be lisping to the ear of the referring teacher. A science approach is to point out that his native language contains a lateral stop fricative that sounds exactly like a lisp. Therefore, there is no diagnosis of disability. The boy simply has an accent carried over from his first language.

SLPs have to overcome what Biehl called “Zero reject policies” — “every child that qualifies receives services.”

In our rush to please and be compliant we forget sometimes about the stigma of special education placement. Our colleagues do, too.

4. SLP Caseloads

Strategic Eligibility Management (SEM) is an approach to school SLP caseload management which has at its foundation the laws and regulations of IDEA 2004 requiring the reduction of over-identification of at-risk children (cf. About Us).

It depends on individual action rather than group policies, and can be repeated thousands of times daily by individual American school speech-language pathologists. It requires no federal or state funding or legal justification.

It is self-empowering, educational and rewarding. An immediate reward is a smaller caseload. The larger reward is the feeling of positive action that helps children.

The approach taken to SEM is three fold:

1. Reduce the number of children enrolled in special education.

2. Support least restrictive environment.

3. Dismiss children who no longer belong in special education.

SEM requires almost no preparation. It is more of a state of mind and a personal goal honored every day on the job. It does require social grace and ability to explain a good idea to others.

The chief qualification for SEM application is the ability to say no. Most of us are afraid of saying no, especially when the peer expectation is yes.

It can start with something as simple as this: As you sit at the computer writing up an evaluation, ask yourself, “Does this child really belong in special education?

Or asking yourself, “Are there pupils on the caseload who should be dismissed?”

Of course this is a formula for all special educators and related services personnel. They can take individual action, too. But that is their personal choice.

3. SLP Caseloads

The American Speech-Language Association has published an in-depth analysis of SLP workload issues (ASHA Caseloads). One comment is striking:

“Each student added to the caseload increases the time needed not only for direct and indirect services and evaluations, but also for mandated paperwork, multidisciplinary team conferences, parent and teacher contacts, and related responsibilities.”

Here is the starting point for Strategic Eligibility Management in the school setting. Practicing school SLPs know that one extra pupil can make a big difference, and one less pupil can make a big difference too. Therefore, reducing the over-identification of special education pupils is an immediate way of reducing workload, even one pupil at a time. Exiting one child who should not be in special education makes a difference in workload and in the quality of service offered to other pupils.

It is also the right thing to do: ” We have a legal and ethical duty to ensure that students are not misidentified for special education and to ensure that all students have equitable opportunities to succeed” (Sullivan et al, 2009; cf. Misidentification Psychology).

17. Reducing LD

There is a degree of magical thinking inherent in the 2006 regulations to identify learning disabled children. The idea that the underlying arguments evolved by Congress over the last 35 years to reduce overidentification will be grasped clearly and enthusiastically by local eligibility groups. Somehow they will see the light and the opportunity to do the right thing.

No, the issue should come through loud and clear, that the reason for a carefully constructed set of revised regulations for the identification of learning disability is to produce a direct result. It remains to be seen whether subsequent high-level national reports will document the reduction of learning disability placements. Right now, the issue is muted by indirection, and we ask eligibility groups to do too much when they are faced with so many observations for making quick decisions (IDEA 2004 regulations, Education Legacy):

“5. Specify documentation required for the eligibility determination.

For a child suspected of having a specific learning disability, the documentation of the determination of eligibility, as required in 34 CFR 300.306(a)(2), must contain a statement of:

Whether the child has a specific learning disability;

The basis for making the determination, including an assurance that the determination has been made in accordance with 34 CFR 300.306(c)(1);

The relevant behavior, if any, noted during the observation of the child and the relationship of that behavior to the child’s academic functioning;

The educationally relevant medical findings, if any;

Whether the child does not achieve adequately for the child’s age or to meet State-approved grade-level standards consistent with 34 CFR 300.309(a)(1); and the child does not make sufficient progress to meet age or State-approved grade-level standards consistent with 34 CFR 300.309(a)(2)(i); or the child exhibits a pattern of strengths and weaknesses in performance, achievement, or both, relative to age, State-approved grade level standards or intellectual development consistent with 34 CFR 300.309(a)(2)(i); or the child exhibits a pattern of strengths and weaknesses in performance, achievement, or both, relative to age, State-approved grade-level standards or intellectual development consistent with 34 CFR 300.309(a)(2)(ii);

The determination of the group concerning the effects of a visual, hearing, or motor disability; mental retardation; emotional disturbance; cultural factors; environmental or economic disadvantage; or limited English proficiency on the child’s achievement level; and

If the child has participated in a process that assesses the child’s response to scientific, research-based intervention:

The instructional strategies used and the student-centered data collected; and

The documentation that the child’s parents were notified about:

(1) the State’s policies regarding the amount and nature of student performance data that would be collected and the general education services that would be provided;

(2) strategies for increasing the child’s rate of learning; and

(3) the parents’ right to request an evaluation.”

16. Reducing LD

One factor in overidentification of LD children is the rush to place dictated partly by the 60 day time line to process referrals (cf. 3 Reducing LD). It creates a false sense of urgency without regard for the long-term consequences of misplacement. When a team takes time to investigate the child’s learning experiences in the classroom, the teacher’s referral is put in context. Native American children process formal learning differently from other groups of children.

Therefore, it makes sense to gather classroom data “observed in the learning environment.” Such data ethnographically can be useful to exclude minority children from learning disability placement. Consider the regulations (IDEA 2004 regulations, Education Legacy):

“The public agency must ensure that the child is observed in the child’s learning environment (including the regular classroom setting) to document the child’s academic performance and behavior in the areas of difficulty.

The group described in 34 CFR 300.306(a)(1), in determining whether a child has a specific learning disability, must decide to:

Use information from an observation in routine classroom instruction and monitoring of the child’s performance that was done before the child was referred for an evaluation; or

Have at least one member of the group described in 34 CFR 300.306(a)(1) conduct an observation of the child’s academic performance in the regular classroom after the child has been referred for an evaluation and parental consent, consistent with 34 CFR 300.300(a), is obtained.”

There is too much reliance on child performance data taken completely out of context.