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Cover Story

Doing More with Less

School-Based Clinicians Address Current Issues

By Mark Palacio

SPEECH-LANGUAGE PATHOLOGISTS WORKING in the school setting are facing growing caseloads and less time to treat children. The school environment stretches clinicians in many directions as they strive to provide the best service to their young clients while working within the confines of school budgets and time constraints.

State Education Advocacy Leaders (SEALs) of the American Speech-Language-Hearing Association (ASHA) offer practical tips for clinicians faced with such issues as burgeoning caseloads, administrator demands and professional ethics.

"The biggest concern is that people have too high a caseload," said Sue Ann Goldman, MA, CCC-SLP, a speech-language specialist in the Edison Township Public Schools in Edison, NJ. "That's probably the case throughout the country."

Clinicians are concerned about how they can ensure all their students are served effectively and efficiently, added Jane Ball Willard, MSP, CCC-SLP, with the Cabot (AR) Public Schools.

Clinicians should direct complaints about caseloads to their local teacher's union, the state department of education, and finally the state speech-language-hearing association, stated Sharyn Mann, CCC-SLP, on staff with the Hallowell-Farmingdale Maine Schools.

This grievance process also is appropriate for concerns about wages, hours and working conditions.

"Several speech-language pathologists in Wisconsin have brought in their union representative to talk about these issues as they relate to each school district's master contract," reported Trici Schraeder, MS, CCC-SLP, on faculty in the Department of Communicative Disorders at the University of Wisconsin-Madison. "Often times things are settled that way."

"Speech-language pathologists should know all the aspects of the Individuals with Disabilities Education Act [IDEA]," Goldman and Schraeder agreed.

If speaking with an administrator fails, clinicians should take steps to ensure their recommendation for best practice is documented at an individual education plan (IEP) meeting.

"No administrator has the right to interfere with an IEP," observed Goldman. "An IEP should include specifically what a child needs. If a child needs to be seen two times a week and one of those times needs to be a pull-out session in a small group, put the exact number of the group in the IEP."

While New Jersey has implemented a limit of five students per group, administrators have been known to demand all groups have a maximum enrollment.

Since an IEP is a legal document, detailing the course of treatment can safeguard clinicians. If a conflict persists between the administrator's mandate and the clinician's obligation to best practice, clinicians should put their concerns in writing to the school administration. The letter should read, "The only thing I can do is violate IEPs, and these are the following IEPS that will be violated."

However, this action puts the clinician in an adversarial role. Having the teacher's union mediate the issue is the safest option.

A clinician who fails to comply with an administrative directive could be considered insubordinate. Speech-language pathologists who feel they are being asked to do something illegal should familiarize themselves with state whistle-blower laws that protect individuals reporting unethical or illegal working environments from retribution by the offending party.

All interactions should be documented, Goldman said, if only in a short letter that reads, "You have directed me to do this. I will do this because I do not want to be insubordinate, but please be advised that this is not what I feel is best for the child."

Parents can be invaluable resources in advocating for their child's therapy needs.

"Cultivate the support of parents. IDEA mandates that parents be made aware of their legal right to appeal any decision," Schrader said. "Parents are now equal partners in the IEP process. If they are not satisfied with the level of service their child is getting, their views must be heard in the IEP process."

Speech-language pathologists sometimes can avoid potential problems with administrators if they present themselves as authorities. Clinicians should be able to cite the literature to back up their requests or explain disorders.

"If you can offer a second opinion, cite professional journals, or provide evidence of research regarding what you have done to serve a child, an administrator will respect that," said Willard. "Take the time to establish yourself as an authority and become a team member within the school."

Many afternoons, she said, "I go in front of the school building and assist with dismissal if there's a need, even when I don't have duty. I serve on building-level committees and help with school events. If you make yourself available part of the time, you've conquered half of the problems you will ever have in that building."

After-school or lunchroom duty can provide clinicians with ample time to observe, converse, direct play, and see how their students are doing outside the therapy setting, she noted. "Look at extra duty from a proactive point of view because it is something that you are not going to change. Working in a public school setting requires interaction with children in every setting. This includes supervision of students and interaction with other staff members."

Clinicians also can generate professional respect through the collaborative effort of team meetings with regular education teachers. A referral should be made only after all the regular education instructional options for a child are exhausted, Schrader told ADVANCE.

By following this approach, "administrators will know that a child is referred for special education only because every other possible regular education option has been tried," she said. "Therefore, referrals are considered very seriously."

Demonstrating excellence in this way gains the respect of administrators by letting them know that recommendations are made only after all the angles have been considered, said Mann. "You are not asking for frills; you are asking for what is absolutely necessary."

Administrators want to make the most positive decisions concerning a child that they can, Willard explained. "If you approach administrators from a student-based point of view, you are going to get their ear. It will work for you 95 percent of the time."

Clinicians in time-constrained situations should propose the hiring of additional support staff or ask for parent volunteers to handle some of the clerical responsibilities. A school district often can help by hiring someone to assist with conference and appointment scheduling.

A final component of ensuring professional respect is for speech-language pathologists to take advantage of every inservice opportunity available to educate their peers.

"I present to the school board every May during Better Hearing & Speech Month," Willard said. "If you are in a public school setting, you have to both embrace and reflect your desire to see children become educated. If you don't recognize Better Hearing & Speech Month and make use of the materials available through ASHA, you have really slighted your clients, your peers and your leaders because those are the things that tell everyone you work with the services of which you are capable."

"We need to talk to our administrators about what our job entails," Goldman said. "It is important to sit down with your supervisor and discuss this. Even if they are unwilling to listen at first, some of them begin to understand better over a period of time."

For More Information

Sue Ann Goldman, e-mail: Sgoldslp@aol.com

Sharyn Mann, e-mail: Shanmann@gwi.net

Trici Schraeder, e-mail: pbschrae@facsaff.wisc.edu

Jane Ball Willard, Cabot Public Schools, Cabot, AR 72023; e-mail: speacherjw@aol.com

Mark Palacio is an editorial assistant at ADVANCE.