Saturday, May 10, 2014

Soapbox Saturday: What if we have the wrong answer to our problem?

Years ago when I started as a speech language pathologist, there was a big push for us to service children with reading disorders.  Around that same time, it seemed that our scope of practice was getting so big as to be impossible to reach every child.  For awhile, it seemed like we were expected to treat everyone-and there were a lot of discussions about what we should and should not do.

A quick disclaimer:  I live in a state that has one of the strictest criteria for initially qualifying children for speech and language services.  Students need to be 2 standard deviations below the mean on 2 separate language measures in order to receive services within the school.  Once students have qualified initially though, we can continue to service them by demonstrating continued need.  I actually didn't realize that we were so strict until I joined some of the SLP Facebook groups.  I was a little shocked.  I find that a lot of therapists in my state don't realize that a lot of these students would qualify in other states for speech and language services.  The schools here can't service them-but does that mean that they wouldn't make progress or shouldn't receive services within a medical model?  

Many districts have adopted a primary service provider model within birth to three programs.  In most cases, an early intervention teacher is going out to the house but can access information from the Speech Language Pathologist at any time.  I've seen a few nonverbal clients coming in at around 3 years of age who qualify for 15 minutes per month with the speech language pathologist.  I get the idea of having one main person who is in contact with the family.  But are we saying that we don't have anything special to offer these children at an age when it benefits them the most?  Is the early childhood teacher trained to prompt and change cue levels in the same way as a Speech language pathologist is?  

Some students on the Autism Spectrum are being serviced by the Autism Specialist and do not receive speech and language services.  Communication as well as social interaction is one of the MAIN areas of concern for individuals on the Autism Spectrum.  I'm pretty sure communication is part of our scope of practice.  Don't we have specialized knowledge of typical communication development that is not taught in applied behavioral analysis programs?  

There are rumors that some districts are moving towards servicing language only students through special educators rather than Speech Language Pathologists.  Do we provide distinctly different services to address vocabulary and comprehension?  Do we have specialized training on development and do we approach vocabulary and comprehension in a different way than teachers.

Some of these changes are being made in part due to a shortage of speech language pathologists.  Some of them are being offered as solutions for high caseload sizes.  Part of it is based on the law.  School therapists can only treat students who demonstrate educational need.  School therapists cannot spend their time treating students who are not motivated to change or refuse to attend therapy.  

But I feel like the answer to high caseloads that I keep hearing is: "We need to see less students."  When I think the answer should be: "We need to hire more Speech Language Pathologists."  

Unfortunately, our current graduate programs cannot train the number of Speech language pathologists to fill the need.  And current pay structures don't provide many incentives for therapists to go back and complete their doctorate.  Even if there was a plethora of speech pathologists for hire, schools continue to be underfunded by the government making hiring additional speech language pathologists difficult if not impossible.  

Could we narrow our scope down to a point where we no longer have a job?  What options (if any)  should we provide for students who no longer qualify for services within the school district.

I don't know that there is an easy answer, but I do think we need to start thinking about how we can help our students and families access all available resources within the community.  And that's going to require a pretty big policy shift from administration.  I hope you come back next week to hear why I think collaboration and referrals could be one of the keys to reducing caseload sizes which continuing to provide services to individuals who benefit from speech and language interventions.

I'm curious-what is your caseload size?  Do you find that is manageable or not manageable?  Leave a comment below.  


Allison said...

I work in Utah at a charter school for students with high-functioning autism. Between myself and a SLT, we have 135 students on the caseload. We have tried to convince administration the benefits of hiring an additional SLP, however, due to budget constraints our requests have been turned down.

Allison said...

Thanks for your post! I love your insights! I work in Utah at a charter school for students with high-functioning autism. I have 135 students on my caseload and a full-time SLT who helps me tremendously. We have approached administration with the benefits of hiring an additional SLP, however, due to budget constraints our requests have not been granted.

Speech2U said...

Allison-Yikes. That is a really high caseload! It's so hard and I know that schools are struggling with funds too.

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