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Promoting the 3:1 Caseload Model Effectively

Promoting the 3:1 Caseload Model Effectively
Marva Mount, MA, CCC-SLP
July 11, 2017
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Introduction

I want to thank you for joining me for this topic. It is one of my favorite topics because I have used the 3:1 Model in a variety of situations and I find it to be very beneficial to me as a speech-language pathologist. The 3:1 Model has been around for quite some time and there has been much written about it. We are going to talk about a lot of those ideas that I have pulled from the experts, so hopefully you will find some information that will be beneficial to you as a clinician.

As for disclosures, I am being paid by SpeechPathology.com to present to this course. I do not have any non-financial disclosures regarding this presentation.

Let’s take a look at our agenda for today. First, we will talk about why the 3:1 Model is an effective scheduling tool. We are also going to look at what the non-direct service week might look like for you as a speech pathologist, and then the positive outcomes you can expect to see. 

We seem to be given more and more to do as SLPs working in the schools, and less and less materials and time to do it. We have to get really creative if we are going to make a difference in the lives of the children that we are responsible for, and also find a way to keep our sanity. The latter is very important because we have a lot of burnout in this profession.  I think the 3:1 Model has really assisted me in being able to prioritize my job responsibilities and my case management duties because in many of the schools I work in no one understands that except me.

I will give you some ideas for how to not only promote yourself and the work you do in your schools, but will also make you more accessible and visible so that others in the school understand how important you and your job are.

Overview of the 3:1 Model

What is the 3:1 Model?

Back in about 2001, some very savvy speech-language pathologists in the Portland, Oregon school district decided that they were drowning in paperwork and never had opportunities to do any of the case management duties that were assigned to them as a speech-language pathologist in addition to serving their children. They were concerned that their direct intervention with students was sometimes taking a back seat to more compliance-related paperwork issues.  I understand this -- sometimes I feel like that is 90% of my job and then indirect services are the other 10% of my job. So they came up with a “3:1 Model.” Basically, it is a flexible scheduling option that primarily uses the workload approach which looks at all of the case management activities that are required of you as an SLP, not just the direct services that you provide for your students. As you know, if you are the case manager, you have a lot to do besides just providing therapies to your students.

The 3:1 Model looked at that workload approach where direct speech and language services could be provided three weeks out of a month.  Bear in mind that you may not be functioning on an actual calendar month.  The three weeks on/one week off might not be all in the month of May.  It might fall in different months. During the three weeks designated for direct intervention, you provide all of those therapy minutes that are mandated by the federal and state government, that state the students must be seen for the number of minutes that are written into their IEPs.  Those three weeks give you the opportunity to do that direct instruction with your students, whereas one week is set aside for indirect services. The indirect week does not necessarily have to be that fourth and final week. I have been in school districts where we have tried to utilize it in a different way. Maybe we put it at the beginning of our 3:1. It seems to me that using that last week is the most logical option in most cases; but you could design it any way you need to based on your responsibilities as the SLP in the building.

Primary Objective of 3:1 Model

Some states are utilizing the Common Core State Standards and other states are not. But every state, even if not using Common Core State Standards, definitely has some sort of objectives for the student per grade level. The primary objective of the 3:1 Model is to help us align our goals for speech-language therapy with the curriculum.  I think far too often we designate our services to be apart and separate from the curriculum but really, if you read all the federal regulations and most state regulations, they talks a lot about the fact that you are there to support that child educationally. Our eligibility is about supporting them educationally. If students are having difficulty in the classroom settings, then that is typically why they qualify for services. They do have to be showing some sort of deficit educationally.  This model allows us to pull therapy ideas from the curriculum, because we are out there seeing it during our fourth, indirect week.

We are also able to work with our students in the classroom environment so that we understand what their challenges are. That really gives me a much better opportunity to look for carryover and generalization of skills in the educational setting. How many of you have students who come to speech and they do fabulously well with you and you can say they have mastered all their objectives, but then when you get to that IEP table and start discussing how wonderfully they are doing, the teacher is looking at you like, ”I think I entered the wrong room for the wrong meeting. I do not know this child that you are speaking of.” This model is a way to get away from that so that we are all on the same page, and the child is doing well not only for us in speech therapy, but also in the classroom. The primary objective of this model is to get us all out of our comfort zones, and give us a way to demonstrate our knowledge of the curriculum.  That is hard to do if you do not know what the curriculum is. Basically, the 3:1 Model is designed to do just that.

What Does the 3:1 Model Provide?

The 3:1 Model provides a lot of structure in order to formally discuss our students’ progress and strategies that they need on a regular basis in the classroom. We can talk about modifications all day long, but unless the teacher really understands what we are talking about when we recommend a certain modification, it is very difficult for him or her to follow through on that.  It is not necessarily because they are not listening to us or not wanting to do what is best for the student.  They just may not understand exactly what we are talking about because we do not always use the same vocabulary that teachers use. This model helps with that.

Why is the 3:1 Model Effective?

First and foremost, it ensures the successful implementation and sustainability of direct and indirect service minutes. You can do all types of service delivery models with the 3:1 model. It does not have to be all integrated or classroom-based, and it does not have to be all pull-out. It gives you a way to do your service delivery model in a way where you do not have to use the same service delivery model for every student. I think we all can get caught in that trap of, “I am going to give everybody 60 minutes a week and it is always going to be pull-out.” That was my mindset for so many years because that is what I knew and understood. But as I started to use the 3:1 Model, I realized, “Wow, there are a lot of different things that I could do with this student that would be much more beneficial to his learning process than just pulling him into my room and using specific manufactured speech materials.” In some settings, I do not have any materials. Luckily I am old, and have a lot of materials that I have collected.  Lack of materials is usually not a problem for me. But if you are a new clinician or if you are in a building where you do not have access to materials, this is a great way to utilize those curriculum materials more efficiently and effectively so you are not caught without something to use.

This model provides the school-based SLP with the opportunity to individualize service delivery based on student need. It's very difficult to individualize service delivery based on student need if we have 100 children on our caseload. That's very difficult - it is just pretty much impossible to do - but sometimes that is the expectation.  You have 70, 80, 90, or 100 students but you are still expected, and it is still mandated by law, that you individualize your services based on what your student’s needs are.  We know that every student is different. If you have met one student with a language problem then you have met one student with a language problem. The next student is not going to be like that student and her needs are going to be very different from, say, the third grade peer in that same classroom who is also having language difficulties. This model gives us an opportunity to look at all types of service delivery.

It gives us an opportunity to improve our Individuals with Disabilities Education Act (IDEA) compliance, which is always important, particularly if you are being audited or if you find yourself in some type of a due process situation with the family. You get to collaborate a lot more, and you also get to use your time and expertise much more in the 3:1 mode

ASHA Guidance

I looked at ASHA’s 1999 position paper on school-based therapy services. The best thing that I pulled from that document is that your service delivery is supposed to be dynamic. It is supposed to change as the needs of your students change, and no one service delivery model should be used exclusively during treatment. This is a pretty old position paper, but I think the first time I read through that and saw that no one service delivery model should be used exclusively, that really struck me because I did use the same model all the time. I tried to use the same dynamic with all children and I found that a lot of my children did not progress when I did that.

ASHA also addresses ensuring delivery of appropriate services, consistent with the intent of IDEA and best practices as speech language pathologists. They speak about the fact that the workload activities that are performed by the school-based SLP must be taken into account to assign appropriate caseload standards.  I do not know how that works in your school district, but typically, the people who are assigning caseload standards in my buildings do not know a lot about my workload activities. Some think I am just this woman who goes away and appears randomly in the hallway, and they are not sure what I do or where I do it. But this model allows us to open up that conversation with our administrators about the total workload activities that are required of us, and start educating others about how we have to function as speech-language pathologists in order to be of service to our students.

 “Workload” Analysis

Breakdown of our Workload

There are direct services to students, including instruction, intervention and evaluation. If I asked, “Is this what you became a speech- language pathologist to do?” you would all say, “Yes.” But as you got into the field and started working, you realized, “Oh wait a second; indirect services are a big part of what I do. Activities that support compliance with federal and state mandates are a lot of what I do, because I try to be compliant and I try to complete the paperwork in an effective manner.” But you realize that with each passing year, it seems like the amount of paperwork increases exponentially, and you never get any help with that. Your caseloads grow, and your compliance issues grow. How are you going to tackle all those things and be efficient and effective, and not feel like you are just spinning your wheels and not doing any good for anyone? That is why people leave the schools. That is why wonderful speech-language pathologists go and pursue other work setting. I think that students in the public school system are the ones that need us the most, because possibly, we are their only option in terms of improving their communication skills. They are not going to be able to get that anywhere else but with us. So it is very important that we have ways to effectively and efficiently assess their needs and then attend to those needs.

When we look at all the things we do and try to calculate our workload, we have to look at direct services, indirect services that are student-driven, indirect activities that are documentation-driven, as well as the amount of support that students need and that teachers need when dealing with our students. When you look at all of that, it adds up to the actual workload (see Figure 1).

This is much different than just counting little heads and saying, “These are the 50 kids that I have to help.” Primarily what we do and what administrators do is to look at the “direct” portion where the arrow is pointing. That is the only factor they are looking at because that is the primary focus. Everybody knows that if you do not do what you are supposed to do in that regard, there will be problems. You will suffer consequences. But when we only look at this one area, you can see why we all go crazy, because we are not looking at any of these other areas that we have to perform. When you try to spend all of your time in direct service, you leave yourself no time for those other activities that you must complete.  That is why we all have osteoporosis and one shoulder lower than the other shoulder, because we are packing that bag every night to bring it home. This is what we do from dinnertime to bedtime in many households -- maybe not every day that you are at work, but certainly a large portion of the day.

So how are we going to fix it so we can stop that? How are we going to be able to function in all of these activities and still make a difference and not lose our minds?

Unlimited CEU Access - Join Now   to get the whole article and handouts.

marva mount

Marva Mount, MA, CCC-SLP

Marva Mount, MA, CCC-SLP has worked in a variety of settings in her 30+ year career, with school-based services being her favorite work setting due to the amazing treatment programs that may be delivered there. Marva has presented at the state and national level on a variety of school-based issues.  Marva is a chapter author/contributor to the Fourth Edition of Professional Issues in Speech-Language Pathology and Audiology as well as a contributing author to ASHA Special Interest Group 16 (School-based Issues) Perspectives.  



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