Category Archives: SLP Caseload

SLP caseloads.

How One SLP Manages Caseload and Eligibility

We are fortunate to consider the experiences of one school SLP dealing with the eligibility process and its impact on caseload size

“The load for case management mushroomed as the autism eligibility encompassed more children. Communication disability is often the next eligibility to come into play with children who are not making progress. Often children come with a diagnosis from early childhood and are already SPED eligible. I am finding RTI is keeping children from switching to LD or other eligibilities and they remain on my caseload for case management until I dismiss from the CD eligibility. I get pressure to keep them because they are often receiving other services under the umbrella of the CD eligibility. Parents sometimes play a role in this, because they would rather have the CD label than MR or ED. It creates a caseload of kids where the eligibility is not a good representation and the SLP is doing the case management of some very high needs kids. That is one reason why SLP case loads seem high for CD eligibility.

I find I’m doing a better job identifying or not identifying children from ELL backgrounds because of better tests and ELL support people. I don’t feel I am over identifying but I do feel some have the wrong eligibility because of the reasons I stated.

Administrators do not understand the difference between case management and caseload numbers. They keep counting the numbers and assume every child is your typical CD artic kid. This his been a continuing problem and is coming to a head as they have cut back on SLPs and put us into more buildings according to the numbers. I can not address the needs of the children with autism and train their assistants when I am not in the building

Kids stuff for school.

on a daily basis. They believe we can go back to the 70s and serve large numbers but forget the requirements of IDEA that have been added and also don’t realize the high needs kids.
Administrators also do not understand what SLPAs can do.”

CJ Monty

18. SLP Eligibility Management: Evaluation

To prevent over-identification, and disproportional representations, special education personnel must be sensitive to the processes which put children in special education, and be able to diagnose them instantaneously as the rush to place and comply happens around them.  Three questions must be asked:

1. Who makes the referrals?

2. Who evaluates?

3. Who urges placement?

As to the evaluators, it is interesting to note non-traditional specialties were put on the FAPE TEAM by the courts and congress in 1975, making them a legal part of education, under “related services.”  SLPs are on the evaluator list and are involved in misplacements.  It is also interesting that evaluators tend to take their cues from teachers, administrators, parents and IEP team members.  An evaluator who wishes to reduce the number of non-disabled minority children in special education faces pressures to place and retain.

In a prior post, we offered this about evaluators:

Related Services and Over-identification

We see there are too many children placed in special education, and often incorrectly. States allow great latitude for local school decision-making, with variable results. Who are the decision makers? What are their relative contributions to placing a child in special education? Is there much known about the process?

“Related services personnel (counselor, interpreter, medical personnel, occupational therapist, mobility specialist, physical therapist, rehabilitation counselor, school health personnel, transportation specialist, social worker) with exceptions do not make major decisions for child eligibility (IDEA 2004). They contribute evaluation data and opinion but defer to the determinations of the IEP team.

The related services having direct responsibilities for recommending special education eligibility include audiology, speech-language pathology, psychology and early intervention personnel:

Audiologist: “Identification of children with hearing loss.”

Speech-language pathologist: ” Identification of children with speech or language impairments.”

Early intervention: ” Early identification and assessment of disabilities in children means the implementation of a formal plan for identifying a disability as early as possible in a child’s life.”

Psychologists: “Administering psychological and educational tests, and other assessment procedures”

17. SLP Eligibility Management: On Guard!

8. SLP CASELOAD CUTS

Here’s an older post that packs a punch!  Your admission of the problem of over-identification gives you confidence to be watchful at every turn. You known it’s happening right under your nose, and now it’s time to bring it out for the fight.

“Let’s talk about practical techniques for reducing the SLP caseload by way of Strategic Eligibility Management – practical points.

OVER-IDENTIFICATION

First, assume you are placing too many children in special education.

National statistics and trends suggest SLPs are a part of the problem, especially with respect to phonology, language and learning disability where there is a lot of judgment involved.

Second, go over No Child Left Behind procedures in your school.

This is an old act going back to the civil rights era of the 1960s designed to help “struggling students.” Some schools will have some kind of child study program and pre-intervention planning. Plan to make use of it.

Third, push back on teacher referrals.

See if you can get the pre-intervention committee to meet and organize concrete suggestions for referring teachers. Participate and suggest techniques. Stress that pupils must be showing academic difficulties to be placed in special education. Try to prevent hasty referrals to special education, which require legal response within 60 days. Here is where the placement expectation gets set up because a referral is formal.

Fourth, promote a preschool intervention program to reduce referrals and placements.  Someone’s got to do it! It is hard to see that the 100,000 American schools are making rapid progress in this area. States cut out preschool programs. Check with your state requirements for preschool placement. Obviously functional articulation cases are suspect.

Fifth, flat out be on guard about admitting minority children, especially those with limited English.

Watch out for boys from minority groups. They have double jeopardy because they are boys. Watch out for the “hard to teach.” Watch out for emotional disturbed and hyperactive children. Most schools do not know what to do with “struggling students” and they tend to stick them in special education for remedial help.

Sixth, don’t misinterpret standardized test results for minority children. School psychologists have been doing this for a long time, to the point where IDEA 2004 knocked back reliance on standardized tests, and promoted wide arrays of evidence-based assessments.”

Seventh, watch out for shake and bake IEP meetings which are carried out in a hurry or carried out routinely, and which retain the child in special education.  Watch out for the quick 3 year re-evaluation meeting, perhaps having it waived.  This  is a leak!

Comment

Marsha in the office is a wonderful woman, a grandmother who brings in baked items every Thursday.  But she helps create the rush to compliance, calling out folks who are late with their paperwork or who don’t know the rules.  Sometimes she gets wrapped

Mr. Chang, swan-goose and friend, Lakeside, Arizona

up in herself, thinks she is the compliance officer for the director and the state.  In her rush to get paperwork done, critical eligibility decisions are washed out. And Mrs. Dykstra, the director, lets Marsha have her way.  She doesn’t want to cross Marsha. Marsha is the Zarina of Paper.

16. SLP Eligibility Management: Categories

In 1975 school speech-language pathology changed forever.  U. S. courts and  the U. S. Congress imposed on government education strict rules for the ways in which handicapped school children were to be placed and retained in special education. States had not been able to fix the problems of misplacement of minority children, and their systems of eligibility identification were in need of great improvement. Accordingly, a system of categories of children eligible for special education was originated and revised.  SLPs were obliged to use this system, with particular reference to the SLI category.

School speech pathology has evolved over 100 years and in this evolution it has developed a stellar record of assessment and intervention practices for service to at-risk children.  Where no other specialty is available, SLPs have refined methods of intervention adaptable to any disability implicating communication performance. Therefore, one sees SLPs assigned to all of the categories of disabled school children for “speech therapy” services.  SLPs apply behavioral, linguistic and cognitive training methods centering around speech, language and hearing interaction in the family and in the classroom.  The methods are of a cognitive and social nature so they support development in the general curriculum, which is what the IDEA law requires.

Yet, many SLPs are not well prepared to understand the nuances of the IDEA categories, weakening their positions to speak to issues of eligibility; indeed, abuses of eligibility. Uninformed SLPs fall into the patterns of sustaining disproportional representations of non-disabled minority children in special education.  Their outlook fits the cliche, “If you are not part of the solution, you are part of the problem.”  Their narrow focus on the speech and language impaired means they sit on IEP teams without contributing more broadly, in the spirit of FAPE as intended by Congress in 1975.

In our posts we describe each of the 14 disability categories for an initial overview. Full study is necessary for effective practice in schools.  See Categories.

 

15. SLP Eligibility Management: Prevention

Monitoring Misidentification for SLPs

In “helping professions” prevention is too often counter-productive.  If we prevented all health problems many would be unemployed.  In American schools, IDEA SAYS WE SHOULD PREVENT NON-DISABLED CHILDREN FROM BEING PLACED IN SPECIAL EDUCATION.  ASHA’s concept of prevention is generic. A school SLP has a specific job to do.

Window looking out.

SLPs want to manage special education eligibility correctly and in this way ethically keep caseload size and workload under control. IDEA 2004 regulations provides the legal basis to reduce overidentification and disproportionality in all private and public U. S. schools.

idea.ed.gov (Legacy 2007) provides a summary of what state and local school districts “must” do to monitor incorrect placements in special education. Here is the basic requirement:

“The State must have in effect, consistent with the purposes of 34 CFR Part 300 and with section 618(d) of the Act, policies and procedures designed to prevent the inappropriate overidentification or disproportionate representation by race and ethnicity of children as children with disabilities, including children with disabilities with a particular impairment described in 34 CFR 300.8 of the IDEA regulations.[34 CFR 300.173] [20 U.S.C. 1412(a)(24)]“

PREVENT is the operative word. When an SLP avoids an inappropriate placement, a measure of prevention is taken and caseload is reduced by one.

Moreover, the state must monitor local school districts to see they are doing their jobs to reduce overidentification and disproportionality:

“…in accordance with §300.646(a) of the IDEA regulations, the State or the Secretary of the Interior must…require the LEA to publicly report on the revision of policies, practices, and procedures described under §300.646(b)(1) of the IDEA regulations.”

These prevention measures assume background knowledge of the fact that too many American school children are placed in special education via misdiagnosis, and many of these children are from minority groups.

SLPs in their schools should feel free to explore this topic with administrators. They are in the same lifeboat.

14. SLP Eligibility Management: System Leaks

In a prior post, called SLP Caseload Eligibility, we had some important things to say about thoughtful pre-planing and investigation of what we call “leaks” in the system. This is highly original work indicative of our Famous Blog. First, one should try to work with other SLPs in the district to see how non-disabled children are being placed in special education.  You want to cut your caseload, no? This is the way to do it, find out where the leaks are in your system.  This is caseload management at its best. You’ll be surprised of the number of actors who are teaming up to pump the wrong children into special education.

“As a part of Strategic Eligibility Management (SEM), the alert SLP must start off whittling away at his or her individual caseload to reduce size and misidentifications in an ethical manner. Beyond this, the SLP is interdependent with other SLPs who might be creating placement “leaks” in the special education system. Caseloads are passed on from preschool to high school, and one can inherit the shaky eligibility judgments of others. Some SLPs also exit children rarely because of the difficulties of doing so. Sometimes SLPs do find themselves cleaning up a poorly managed caseload. Chances are new graduates do not know about the over-identification of at-risk children because it didn’t come up in their graduate programs and because of the stigma associated with it (cf. Why Over-identification). They are working strongly for compliance, getting along and keeping their jobs.

Placement “leaks” in the system must be diagnosed. Where and how are they occurring? Who is involved and how can they be gently influenced to make better professional judgments? How does peer pressure come into play? Where is judgment breaking down?

POINTS OF ENTRY

Child find. According to IDEA, schools must advertise in the community for referrals of at-risk children. They must arrange for screening sessions open to the public. Which SLPs are involved with this? Are they influenced by staff opinions?

Parents. Any parent can within a district (LEA) refer his or her child directly to the office of special education. The school by law must respond. Pressure is placed on the school for quick action, action that usually entails placement. “Rush to judgment” must be controlled.

Transfers. Children who bring active IEPs into the school district transfer their eligibility. The school may review the adequacy of the plan and how it will be carried out. It can review the disability judgment. Too often special education placement is automatically accepted. SLPs should flag questionable IEPs.

Home schooling. Parents who home school within the LEA are entitled to special education services. They must go through the standard eligibility procedures. One must watch for short-cuts in standard procedures.

LEA schools. Private and charter schools within the LEA can refer their pupils via parents to special education. The LEA must take the referral. Such referrals sometimes come in during the summer, when SLPs are on vacation.

0-3 years. Children who are made eligible for remedial support services must transfer into the LEA shortly before age 3 years. They bring an eligibility determination with them. The determination can be based on various disability criteria, and SLPs might believe they are obligated to accept the transfer information as is. Medical opinions must be translated into educational categories.

3-6 referrals. Kindergarten teachers and sometimes Headstart teachers can refer children to special education. Some at-risk children are identified through screening programs. Special education criteria change with regular school placement. How do developmental criteria translate into educational criteria?

6-21 referrals. At-risk children are often referred by elementary teachers as their academic learning patterns become evident. Referrals can be made throughout the school years, as, for example, in cases of traumatic head injury (TBI). Some teachers make questionable special education referrals. Pre-interventions must be considered, too.

Eligibility criteria vary with age, program and disability. Misidentifications can occur at any step. For example, migrant children sometimes bring out-of-date IEPs to their next school. Hurried acceptance can sustain misidentification.

13. SLP Eligibility Management: Adverse Effects

 If we use narrow SLP clinical criteria, we can overlook potential side effects of special education placement.  In a prior post, we went over this point.

One of our themes at SSP is that school speech-language pathologists along with other specialists do not consider among their special education placement criteria the potential of negative impact on long-term academic success.   It seems routine.   He or she has an “artic problem” so give the test and make the placement.   All seems innocent.   However, we have no data on whether being singled out as a special education child carries with it a stigma and impairs motivation to achieve. 

 

The National Center for Learning Disabilities (NCLD) is publishing now (February, 2011) a parent poll on LD child optimism for post-secondary achievement. 

 

“Is your child optimistic about college and a career?

 

Yes. She has confidence and drive. 36.6%

 

No. She thinks her LD limits her options. 26.8% Somewhat.

 

She’s waking up to the possibilities.   20.7%

 

I’m not sure. She doesn’t like to discuss it.   15.9%” 

 

SLI status overlaps with SLD status, and many SLI children have dual placements.   We guess that a survey for SLI children might look the same — overall, not much optimism.

 

In the case of non-disabled minority children, how would the survey look?

 

Special education children are singled out and over time administrators, teachers and pupils see them as different.   Expectations are lowered.   Special education children are more likely to drop out of school.  

 

Imminent renewal of No Child Left Behind suggests interest in improving graduation rates at American high schools.   Graduation should be a factor in early IEP planning.   Efforts should be made to exit children wrongly placed in special education.

 

SSP supports Response To Intervention as an alternative to speech and language placement in special education.  Better to work to improve Tier 3 and prevent needless placements.   SLPs have a professional responsibility to promote prevention of communication disorders.

 

 

Impact of School Speech Therapy on Pupil Achievement

 

12. SLP Eligibility Management: Data

Managing SLP Exits                                                                                       

Aggregate data are a must for caseload management.  

On the one hand, each and every eligibility determination must be made on an individual basis. That’s the right way. Data must be collected and the eligibility criteria considered.  The IEP paperwork should be checked for guarantees on ethnic and linguistic background.  For learning disability, each team member can vote no as recorded on the IEP forms. In all cases, the academic performance criterion should be weighed against disability criteria. 

 

On the other hand, you can’t see the forest from the trees unless you also have lots of data for your caseload and desirably from your school district. For example, if your caseload is chock full of Hispanic pupils with limited English, you must discipline yourself to see the issue in particular cases. You might have to say: “This is a child with limited English and communication skills but it is not a disabled child.” Administrators do not like to hear it because this statement implies the school is not providing adequate catch-up support of limited English children. A teacher might demand help because there is an apparent need. For a teacher it is only a practical matter.

A clown on mainstreet.

 

Here is an early post illustrating how one might study a caseload patterns on the exit side.

 

A school speech-language pathologist worked in a middle school on a one-year plan to exit children from special education.   During the year, 26 pupils were in the caseload. One child had a speech-only IEP.  Three children transferred in from other schools, and two of the three transferred out. 

 

Twelve of the 26 children were minority pupils (Hispanic or Native American), and 14 were Caucasian. Six of 26 were female students, and 20 were male. Eleven of the 12 minority students were classified specific learning disability (SLI), whereas four of 14 Caucasian students were classified SLI.   Ten Caucasian pupils were classified as autistic, hearing-impaired, retarded or speech-language impairment (SLI).   One female SLI pupil had a persistent /r/ problem.

 

Over the year, seven children were exited from speech and language services. Subtracting two who left the district, 17 children remained on the list to continue the following year. The exit rate was 27% for the year.

 

Of the 17 pupils on the continue list, 13 had been marked for dismissal but could not be dismissed for various reasons:

 

Parents insisted on continuation (3)

Parents were not phoned personally on time (3)

Parents could not be given timely office notice (3)

Summer IEP meetings were to be held (1)

Exit evaluations were not completed or were inconclusive (3)

Six of the seven exited SLI children were classified as specific learning disability (SLD). 

 

A list of 10 pupils projected to transfer to the middle school in the next school year included seven minority students with SLD classifications with SLI support.

 

COMMENT

 

The study is a microcosm of national issues of special education misidentification.   An emerging one is that females are under-represented in special education programs.   Another is that the learning disability category is over-used and this is where minority pupils are placed for remedial services.   SLP services are added to the SLD placements.

 

Even with an aggressive aim of reducing SLI and SLD placements in the middle years, many hindrances operate to keep the children in special education.   But without a systematic approach to caseload management, numbers grow and improvement declines. Seeking to exit minorities from the SLP caseload is both an ethical choice and a means of preventing SLP burnout.

 

The present report demonstrates the value of ethical total caseload management.”

 

Postscript

 

Here is an excellent original piece by Mary Steppling, Patricia Quattlebaum, Debbie E. Brady (2007). Toward a Discussion of Issues Associated With Speech—Language Pathologists’ Dismissal Practices in Public School Settings, Communication Disorders Quarterly. vol. 28 no. 3 179-187.

 

 

11. SLP Eligibility Management: Outlook

In an early post, SLP Caseload Management, key points were brought out.  Without aggregate data, there will be a large gap in your understanding of your caseload. Eligibility determination is process demanding good background, situational interpretation, and correct judgment. Dismissal is even more important to gaining intellectual control over caseload management.  You will see how neglect works against us all. Collaboration is an uncertain process because it means so many things to so many people.  The combination of factors properly attended to will increase your caseload management IQ.

“Seen through search records the topic of how SLPs handle their school caseloads continues to be a significant topic. If there is one issue that binds us together, it is the high demands placed on us to take care of all the pupils who come to us.

 

Aggregate Data

 

We continue to argue that one must manage the total caseload and not only individual children as described on IEPs.   We individualize, yes, but to see the “big picture” one must use aggregate data breaking down the caseload into types of children served.   This is important to see patterns of special education admission and dismissal.   It is evident non-disabled minority children make up a part of almost all caseloads and should be dismissed. 

 

Every case dismissed is one less to contribute to “burnout!” 

 

SLI Placement

 

We can APPLY our backgrounds in cultural variation and testing procedures to reduce the number of children we recommend for placement in special education.   This cuts down on our caseload size.   We are in control.

 

SLI Dismissal

 

We can APPLY our backgrounds in cultural variation and testing procedures to dismiss children from our caseloads who do not belong there.   This cuts down on our caseload size.   We are in control.

 

Collaboration

 

We can join and promote programs such as Response to Intervention to reduce the number of children placed in special education.   This cuts down on our caseload size.   We are in control.

 

End Result

 

We can review our caseloads and make sure only qualified children are in them.   We can keep our eye on the target:   Good case management leading to high school graduation and post-secondary success.  We are in control.   We don’t need to wait for the state to hire more speech pathologists for our school.”

10. SLP Eligibility Management: Plan

One powerful decision in planning your attack on caseload size and to reduce over-identification is simple:  Commit to a reduction of 10% in one school year.

All the other considerations are secondary.  A percentage reduction goal will inspire creativity and eliminate excuses.  The message is:  GET IT DONE!

With a concrete plan of action, good background knowledge, and the ability to communicate your intent to others, small solutions will appear, ones you would not foresee.  

Paying attention to the rules of least restrictive environment one can move some children out of direct service into consultation.  Asking, “Can I get the same results while making my interventions less restrictive?

And when someone asks about an IEP scale-down of direct treatment, it is a good opportunity to remind him or her gently of how LRE works.

Setting a 10% or 5% reduction goal takes the nonsense out of the thought process jerked around by habit.  If you are not doing it, you are not doing it.

Keep in mind guilt can jump up.  Dropping children from your caseload might make you feel you are lazy in the eyes of others, or you are trying to get out of work.  This is where certainty comes in.  You must realize that by not doing anything to take out non-disabled children from your caseload, you have a habit of mal-practice.  Guilt on that side can be constructive.

However, as you move toward your reduction goal, you might be surprised that a few others are lending support to you.  You can become a role model when that is not  your aim.  People can see that eligibility management gives one a sense of empowerment and new-found skill. You begin to see nuances and gain confidence decisions are sound and ethical.